“Sometimes it is necessary to reteach a thing its loveliness” – Galway Kinnell

After years and tears spent treating girls with eating disorders, I found myself pregnant — in my 40s — with a daughter.

Penelope is now 10, and suddenly, everything I’d preached and chiseled and chipped and interpreted in my office is getting put to the test. How was I going to try to prevent my own child from having an eating disorder?  How would I prevail against a culture of young girls in short shorts, strappy tops and frankly lewd fashion, where my 4th grader must choose between “boyfriend jeans” and “skinny jeans”?  As I had told my patients:  “Many girls entertain diets — not everyone gets an eating disorder.”

Still, I reviewed the early dangers for developing such a disorder — flipping through my own brain for knowledge.

1. Genetics
We had some family history of mood disorders but nothing that seemed so severe it couldn’t be tempered by attentive parenting.

2. Home obsession with foods

I made absolutely sure that nothing in my house was low-fat, low-calorie and insisted that dessert was part of the meal if you ate your ‘growing foods” a useful phrase I learned from her pre-school teacher.

3. Range of affect (or, enough feelings)

Yup, no problem there. My house was never one where feelings were suppressed. In fact, I might have spent too much time inquiring what my child thought or felt. I was politely interrupted. “Mom,” she said, “I’m watching the cars outside” or “Making a friendship bracelet” or “Telling myself a story.”

4. Too much affect

Yes, I wanted to tone this down. She neded to learn resilience — that horrible feelings, the dementors of loneliness, sadness and intense anger can be survived. She needed to endure them and learn to soothe herself. I reminded myself of this as I clenched my nails into my hand while she hurled about in her crib.

5. Too much talk about appearance
I failed on this. I could not even try to stop my outpouring of sheer joy at her natural beauty. I was, as C.S. Lewis said, “surprised by joy” in this department. I craved her attention like a jilted suitor. But it amuses both of us — and possibly helped her — that I would joke about my “separation issues.” I believe I gave her the freedom to express those same feelings and a good many more.

6. A sense of purpose  

We are currently working on this. The most effective cure for the most recalcitrant eating disorders is — surprisingly — community service.  Like people in a nursing home who thrive when they care for a plant, children do better when they feel their effect on the world is real. I ramped up on chores, folding laundry, carrying grocery bags. A child who danced for hours could use her legs to help me.

7. Perfectionism

When my daughter was three, I saw a child in her nursery school crumple up a drawing, burst into tears and throw it away. I vowed I would do my best to melt perfectionist thinking. We practiced making mess-ups into other shapes. We practiced turning pages over and writing on the backs of things. I told her often, purposefully, about my own mess-ups, what caused them and how I still was growing. I learned to ask her if she felt proud of something — not to tell her that I was instead.

8. Culture

This huge piece of influence is almost indescribable. Culture is written across the bottom of shorts, the straps of shirts, the piercings and tattoos called body art. Wherever you stand on particular trends, it’s hard to deny that a new, frankly lewd look is popular. Somehow feminism has been replaced by exhibitionism.  Reality TV and instagram make looks all that matters. Sexting seems a natural outcome from this atmosphere.

All I could do on this front is to hold my ship fast at home. I batten down the hatches. I encourage critical commentary about dolls that are too thin, pictures of girls who were too thin. Movies which demean fatties. I censure TV and books about mean girls.

What I cannot plan for is my daughter; her own self. She dances (at a studio she feels is like a second home). All I did was steer her toward the one that has the most diverse group of girls’ strong bodies I’ve seen.

But she is at a liminal age and it terrifies me.  She is a perfectionist at times and it drives me nuts. I never want her to look at herself with loathing, to pinch a part of her skin with disgust and wish it gone. I detest the bonding that begins — very soon — when girls turn to each other and say: “I’m fat.” And the response — rather than saying “Don’t be ridiculous” or “How boring,” the only scripted response is: “Are you kidding, I’m fat. You’re thin.”

A few days ago we went to buy jeans — she’d grown again. I was sick to see that our choices were reduced to two categories: “Skinny jeans” or “Boyfriend jeans.’ Those are her choices.

Is she skinny or does she have a boyfriend whose clothes she borrows? She’s 10. Why can’t the pants simply be called straight or baggy?

I don’t know how we can hold back this enormous wave surging toward our girls. But we must keep trying. I hope I will not be reteaching Penelope her loveliness as I do, here, in my office, every day at work.

Katy Aisenberg is a psychologist in private practice in Cambridge

So what happens when we feel bad? Well, many of us feel guilty about it.

But, according to research by psychologist Jonathan Adler, negative emotions should be celebrated — or at least not be discounted — because they serve a critical function.

Adler, of the Franklin W. Olin College of Engineering in Needham, Mass., spoke to Scientific American recently about the work:

…anger and sadness are an important part of life, and new research shows that experiencing and accepting such emotions are vital to our mental health. Attempting to suppress thoughts can backfire and even diminish our sense of contentment. “Acknowledging the complexity of life may be an especially fruitful path to psychological well-being,” says Adler…

Unpleasant feelings are just as crucial as the enjoyable ones in helping you make sense of life’s ups and downs. “Remember, one of the primary reasons we have emotions in the first place is to help us evaluate our experiences,” Adler says.

Here’s a bit more on the mechanics of the study:

Adler and Hal E. Hershfield, a professor of marketing at New York University, investigated the link between mixed emotional experience and psychological welfare in a group of people undergoing 12 sessions of psychotherapy.

Before each session, participants completed a questionnaire that assessed their psychological well-being. They also wrote narratives describing their life events and their time in therapy, which were coded for emotional content. As Adler and Hershfield reported in 2012, feeling cheerful and dejected at the same time—for example, “I feel sad at times because of everything I’ve been through, but I’m also happy and hopeful because I’m working through my issues”—preceded improvements in well-being over the next week or two for subjects, even if the mixed feelings were unpleasant at the time. “Taking the good and the bad together may detoxify the bad experiences, allowing you to make meaning out of them in a way that supports psychological well-being,” the researchers found.

Readers, are you oppressed by overwhelming pressure to be bubbly and positive all the time? Does this notion of embracing complexity — both the good and the bad — ring true? Let us know.

By Orit Avni-Barron, M.D. and Greg Barron, Ph.D.
Guest contributors

Our text exchange from Monday afternoon:

Greg: “Everyone ok?”
Orit: “Sure, why?”
Greg: “Bomb”
Orit: “*#$@”
Greg “ (( I thought we left this behind in Israel.”

We’re used to this. Greg’s 20 years and Orit’s 33 years of exposure to terrorist attacks in Israel. Greg, a former assistant professor at Harvard Business School, has published papers on the psychology behind our responses to risk. Orit, a psychiatrist, has treated patients for post-traumatic stress disorder, anxiety and depression.

All that would appear to make us “experts.” But we still weren’t prepared for the Boston marathon tragedy on Patriots Day.

Still, as we struggle, together with an entire city, to make sense of what happened and to deal with uncertainty and overwhelming sadness, anger and fear, we’re confident: As hard as it has been, we shall overcome. In fact, as both the Israeli experience and academic research show, we are psychologically hard-wired to overcome.

True, the obstacles to surmount are significant. One of our city’s symbols has come under attack, naturally evoking fear, anger and hopelessness, and prompting us to question our safety.

How can we reassure ourselves in the face of this trauma? How do we go downtown again? How do we regain a sense of normalcy? How do Israelis, who repeatedly deal with this sort of thing, do it?

The impact of terrorist acts far exceeds the physical injuries it inflicts on innocent victims. It evokes fear in millions of others. The closer we are in time and place, and the more we identify with the victim, the greater our fear: if not a marathon runner, a family member or a friend of one, if not a spectator of this wonderful event yourself, you could be. Maybe in another big city or another big event. Our minds go wild with what seems like an infinite number of scary similar scenarios.

We feel that we will never be safe again. This is normal. Most people respond to perceived or actual threat to their physical or emotional well-being with feelings of shock, disbelief, difficulty processing and panic. Witnessing or even just hearing about such events may be enough to provoke these symptoms. Depression, sadness, difficulty sleeping, even flashbacks and other symptoms of distress may ensue in the following days. Luckily, this response is self-limiting and the intense symptoms dissipate within a short period of time — typically days, in the majority of cases.

On a cognitive level, the bombing has changed our perception of risk, and for the worse. Research provides both good and bad news for Bostonians. The bad: We tend to overweight (emphasize) rare events, either good or bad, when their outcome is described to us. For example, hearing about the jackpot makes us more likely to buy a lottery ticket, and we would be more likely to buy insurance after a hurricane.

The good news, in this case: We tend to underweight (ignore) the same rare events over time as we focus on more recent and, more often than not, safe experiences. Take the risks related to motor vehicles, for example. An average week in Massachusetts results in over 7,000 serious injuries and over seven fatalities. Yet, you won’t think twice about this before getting behind the wheel on your way to work.

When it comes to risk we are a bit like an infant lacking object permanence — “out of sight out of mind.” When we see an interesting object — the equivalent here is seeing news about frightening bombs — this is all we think about. But once it’s gone — the news has moved on — our attention returns to our immediate day-to-day experience, and we feel safe again.

That’s the secret of any country plagued by repeated devastating acts of terror. It’s not just about resilience or national identity, although those are important, its also our hardwired and adaptive ability to ignore things that usually don’t happen, to the extent possible. We may not perceive our city as safe at the moment, but that will change as we accumulate increasing uneventful days. It’s how we ‘work’. In the meantime, ease off the news.

And then there’s heart. Much like the 1936 marathon runner Tarzan Brown, who lost his lead on that notorious last climb before the descent to Boston Marathons finish line — named that day as “Heartbreak Hill” — we fear we have lost, and may never feel safe again in our city. But, also like Brown, Bostonians will persevere, overcome Heartbreak Hill and return to participate in next years marathon.

We will definitely be there.

Orit Avni-Barron, MD, is a psychiatrist and the founding director of the womens mental health service at The Fish Center for Womens Health of the Brigham and Womens Hospital, Boston. Greg Barron, PhD, is a director at Lax Sebenius LLC, The 3D Negotiation Group.

By Marie Colantoni Pechet
Guest Contributor

Recently I was sitting in heavy traffic, and no matter what lane I chose, it seemed like the other lane moved faster. Eventually, I decided to commit to staying in the right lane and trying to relax about it all. Taking a deep breath, I watched a white Jeep pass me in the left lane and I noticed its license plate. Sure enough, about 20 minutes and a mile later, I found myself sitting behind that exact white Jeep.

Realizing that hurrying doesn’t always get me there sooner doesn’t stop me from racing to get ahead in other aspects of life. For example, my to-do list seems to be never-ending, leaving me feeling like I am always behind and that there isn’t enough time.

I suppose that feeling is normal. Then add chemotherapy to the mix. Every other week, I am basically out of commission. So I try to cram two weeks’ worth of living into one week.

As I’m sure you know, you can be efficient and even rush around, but some things can’t be rushed. I can’t rush traffic or how fast the train runs. I can’t rush conversations with the kids, reading a book to them, doing a project, watching a movie together, or being available as they do their homework. I can’t rush time connecting with family and friends.

When I was initially diagnosed with cancer, I became conscious of time and specifically, I held a sense of having a finite amount of time. I thought a lot about how I was spending it.

For example, I could justify seeing my oncologist as investment that could pay off in having more time. But waiting to see my oncologist? That felt like wasted time and I raged internally as minutes turned to hours.

Away from the cancer center, I resented standing in any kind of line, wanting to scream out, “I have stage IV cancer and I don’t have time for this!” From there, my little fantasy progressed in one of two ways:

1. Someone else waiting patiently in line reveals that they have a worse prediction of their future or
2. Everyone feels sorry for me and lets me go first.

Neither is an attractive scenario, so I usually waited quietly (albeit fuming and fidgeting).

When I wasn’t waiting, I struggled with how to use my time. Did I really want to be washing dishes, picking up after my sons, and doing the many mundane tasks that can make up my day? Should I instead check items off my bucket list (starting with making a bucket list) and do “big things,” whatever they were?

Whenever I am stuck in indecision, I end up doing…nothing. All that empty time, doing nothing, only added to my stress, frustration and feeling of going in circles.

Eventually, some confluence of circumstances forced me to focus on each individual moment. I’m sure those circumstances included feeling like I couldn’t count on tomorrow or even this afternoon. I’m also sure those circumstances involved some degree of grace that swept in like a gentle breeze or maybe like a hurricane, forcefully knocking me from my stuck place. Whatever brought me to the present moment, it gave me peace and sanity.

Though I stopped feeling as pressured, I continued to think about time, the norms around how we spend it and specifically how I spend mine. I dropped commitments that didn’t fuel my passion. I prioritized doing fun things over chores. I spent time with people who give me energy and lift me up.

Still, I feel like I can’t fit everything in.

One weekday morning, I put the dog in the car with an intention to take him for a walk. Instead, I ended up at church and wandered into the Mass. Yes, with the dog, who sat quietly under the pew.

While I was there, I realized that I think of Lent as this time when Jesus went into the desert, using this time to connect more deeply with God and to pray for strength as He approached His crucifixion.

But during that Mass, it occurred to me that he walked into the desert despite the gazillion people who still needed and wanted to be healed, the many people to help and the many who wanted to hear His teachings. He walked away from all the demands and all the contributions that He could make in order to do the single thing he needed to do.

If there was time enough for Him to walk into the desert, and if he was able to put aside His very important work, maybe I need to reconsider my own little list of things to do. Maybe I can remind myself that doing even one thing can constitute time well spent as I try to keep from racing to wherever it is I am going and trust that I am wherever I am supposed to be.

To everything there is a season and a time to every purpose under heaven.

Marie Colantoni Pechet lives in Cambridge with her husband and two sons. Read her previous posts here and here and listen to her speak frankly about her life with cancer here.

“Look at these wrinkles.”

“I would do anything to look younger.”

“Do you want to come to a Botox party?”

You don’t have to read scientific journals to know that bad body image plagues women of all ages. There’s no getting away from the fact that, even before girls develop curves, self-perceived “figure flaws” are a deep source of distress for the vast majority.

Of course, there’s no shortage of scientific evidence confirming this sad fact of modern life. Just this month, a new study in the Journal of Eating Disorders confirmed what has become painfully obvious: bad body image knows no age limit.

If you missed that study, here’s the research recap: Trinity University psychologist Carolyn Black Becker and colleagues asked more than 900 American, British and Australian women between the ages of 18 and 76 about “fat talk” and “old talk” — complaints about feeling fat and old. All ages complained of feeling fat, but, surprisingly, even the youngest women worried about looking old.

To make sense of this surprising finding, I tracked down Becker and asked her why so many young women engage in “old talk.” Here’s what the San Antonio eating disorders expert told me:

“We live in a culture that constantly tells us that we should strive for an appearance that is not just perpetually young, but perpetually and abnormally line free. We are bombarded with these messages, and many are designed to increase appearance anxiety so that we will buy products companies are hoping to sell us. Given this environment, it is not surprising that old talk is trickling down to younger women.”

If commiserating with your girlfriends about sagging breasts and spreading hips strikes you as harmless, think again. While “old talk” and “fat talk” may make you feel better in the moment, if you keep talking the talk over time, you’re more likely to struggle with anxiety, depression and disordered eating, among other mental and physical health problems.

Rather than commiserating, consider doing as the “old talk” researcher says: “Imagine a world where we focused our energy and money on simply making sure we’re taking care of our bodies and minds from a functional perspective. Think about how differently people would feel about their bodies if we gave up the belief we should all look as young as possible for as long as possible. It would make it a lot easier to be comfortable in one’s own skin.”

You might also consider the increasingly popular solution of swearing off body bashing. Easier said than done, especially all by your lonesome. Which is why women’s groups are doing what Tri Delta sorority started doing five years ago — declaring “fat talk free” weeks.

Short of that, take a moment of body kindness. Simple suggestions for giving your body, your whole self, a break are available on my blog here.

Jean Fain is a Harvard Medical School-affiliated psychotherapist specializing in eating issues, and the author of “The Self-Compassion Diet.” Her website is www.jeanfain.com.

Don’t miss this important heads-up on Healthcare Savvy: An anxious month for social workers, psychologists and psychiatrists. WBUR’s Martha Bebinger writes:

If you visit your therapist this month or next and he or she seems stressed out, it could be about money. Here’s why.

Therapists who accept health insurance submit a bill that includes a code for your visit. 90862 was, for example, a very common code for a medication adjustment visit to a psychiatrist. As of this month, almost all the mental health codes are changing and this is causing a lot of anxiety.

Therapists aren’t sure which code to use, and they aren’t sure how much they’ll be paid. Insurers say the new codes, which are reviewed and set by the American Medical Association, will likely mean lower reimbursement rates for therapists who don’t prescribe drugs. Insurers say they won’t cover some of the codes at all. Many therapists are angry and discouraged.

“The Governor and the President are asking for more emphasis on mental health, but then the coding requirements increase and the reimbursements go down,” says Jonas Goldenberg with the Massachusetts chapter of the National Association of Social Workers.

Sigh. Read the full post here.

Both of these behaviors are not only impolite, they can lead to overeating. But according to new research out of the Netherlands, simply taking prescribed smaller bites (or sips of soup in this case) can counteract the negative impact of distracted eating. The study was published in PLOS One; here’s more from the news release:

Previous studies have shown that taking smaller bites helps people eat less. Other research has also shown that people tend to eat larger meals if eating while distracted.

In this new study, the authors assessed whether taking smaller bites or sips of food affected meal size if eaters were distracted during their meal. Participants in the study were given a meal of soup as they watched a 15 minute animation film. Two groups ate in pre-measured volumes of either ‘small’ or ‘large’ sips, and the rest were allowed to take sips of whatever size they liked. All participants could eat as much as they wanted, and were later asked to estimate how much they had eaten.

The authors found that people who ate pre-specified ‘small’ bites of food consumed about 30% less soup for their meal than those in the other two groups. The latter two groups also under-estimated how much they had eaten. Across all three groups, distractions during the meal led to a general increase in food intake, but even when distracted, people who ate pre-specified small sips of soup consumed less food than the others. According to the researchers, their results suggest that reducing sip or bite sizes during a meal may help those trying to lower their food intake, even if they are eating while distracted.

The other option would be to simply eliminate the distraction. (Note that all of the groups ate more when distracted, despite bite size.)

Readers, tell the truth, do you read, check your phone or otherwise disengage when eating? Can you share any tricks for eating more mindfully?

We, as widows and widowers, remain connected to the spouse who has died. History is not pre-empted by time. This is difficult to explain in a society that worships “closure” and “getting through.” How does one account for “extended mourning” to those who have not experienced this loss? In our culture, it is believed that mourning is a linear, sequential process that ends up “freeing” the bereaved. Mourning is not linear. It is circular and changes its rhythm daily…often from moment to moment. We own the memories and the connection forever. If we were ever attached, we remain attached.

There is loss of physical presence — loss of daily physical and conversational connection. “Hi. I’m home,” has vanished. The bed is empty. Flashbacks of spouse’s suffering repeat. Panic occurs in solitude. No understanding of death can soften the fact that it happened to your spouse. The intellect and emotions do not coalesce.

In our culture, we are discouraged from speaking of this amputation. That inability to speak the emotional truth adds a second burden — one of emotional isolation. This emotional loneliness is underlined when people (often in couples) are impatient with what they see as a lack of “moving on.” Widows and widowers are often accused of “wallowing.” Or, we are offered phrases like “he/she is in a better place.” “You should enjoy your own life.” Are these cliched placebos for the bereaved, or for the comfort of the speaker?

I have seen many widows and widowers “self-pathologize” when they feel they are “doing poorly” and cannot “get over” their loss. This self-incrimination leads to depression beyond loss.

Therapists have often used a “model” of mourning, setting a goal of “healing” at about 2 years. At that time, without major “improvement” the patient could be deemed clinically depressed. Has it occurred to clinicians that the fact that widows/widowers have been blocked/prevented from telling the truth has contributed to the so called “pathology?” Are they aware that a linear/scientific/mathematical model should not be imposed upon emotions?

For widows and widowers who have not found this elusive “closure,” it is imperative to link with others who know and understand the truth. The energy used to repress emotional authenticity would not be needed. A support group led by those who know the loss (not theoretically) would enable a process of “Un-feigning” and would encourage truth without correction. A genuine trust of not being judged would allow and even encourage non-socialized responses to “How are you doing?” One could relax in the safety of shared honesty.

Readers, your responses?

Psychiatry calls this ‘complicated grief.’ ‘Complicated’ meaning not complex but that the healing process that normally occurs, after even a sudden and terrible loss, goes somehow awry. It develops a complication, like an infection in a wound. Complicated grief is under consideration to become a new official diagnosis, and psychiatrists have developed specific therapy to help patients who become “stuck” for years in their grief. Carey Goldberg, of WBUR’s CommonHealth blog, explains:

One beautiful July evening, as 62 year-old Gerrit Schuurman was cooking dinner, he told his wife, Cynthia, that he was having some trouble swallowing. Two days later he was dead, killed by an aneurysm his surgeons said was like a ticking time bomb in his brain.

Numb, disbelieving and alone after 37 years of marriage, Cynthia soldiered on. She left Germany, where she and Gerrit had been living, and returned to her native Boston. She found work as a teacher trainer for a non-profit, spent time with her new granddaughter.

On the outside, Cynthia was doing all right. But not inside. Every pleasure was soured by sadness; she obsessed about Gerrit’s death — “Why did this happen? Could I have done something?” — and the parallels with her father’s sudden death when she was just 13. The grief just wasn’t letting up, and it threatened to break her.

“I thought, well, I’m going to feel better in a year. People always say the first year is very difficult,” she recalled. “Other people told me the second year is even worse in the grief process,” she said. “And the second year came and it was worse. So I thought okay, maybe by the third year I’m going to feel better. But I was going through the motions. I was functioning but inside I was a mess. I was very, very upset and crying when nobody was around…About the third year, I was in a class, I was teaching my students and I broke down in the middle of a sentence.”

“The day I had that ‘mini-meltdown,’ I sent up a silent prayer to God and the universe saying, ‘I need help, please help me.’ So on the way home on the train there was a big sign, a big poster, an advertisement poster for ‘complicated grief.’ It said, ‘Are you crying all the time? Are you depressed? Are you stuck in grief?’ And I said, ‘Well, that’s me, it has my name on it.’”

Dr. Naomi Simon, head of the complicated grief program at Massachusetts General Hospital — the program Cynthia noticed in the subway ad — says people can ‘get stuck’ in grief for a wide variety of reasons.

“It could be a sudden or traumatic loss that is the main reason that one person gets stuck.,” she said. “It could be a prior history of mood or anxiety, or a trauma, or early life loss is another example of what could get someone stuck. It could be how somebody is able to deal with emotions, so someone who’s very, very avoidant of allowing themselves to feel those emotions can get stuck.

“So there are many reasons and we’re still really understanding it as to who would be at risk, to really need some kind of help in order to move to some more integrated form of grief. We really do think about it as that we are targeting where they got stuck with our interventions.”

Researchers estimate that about 7 percent of bereaved people develop complicated grief. And it is being considered as a formal diagnosis in next year’s DSM-5, the so-called bible of psychiatric diagnoses, though some details — including its official name — remain to be worked out.

But should there be a diagnosis? Is there really a “normal” way to recover from a terrible loss? And isn’t there a danger of pathologizing the very personal process of grieving?

“We expect acute grief after someone dies, absolutely, we expect that,” responded Dr. M. Katherine Shear, the director of the Center for Complicated Grief at Columbia University. “But we also expect a healing process, and that healing process can get derailed. So we’re not talking about normal grief. 93% of the population has normal grief. We’re not trying to diagnose the normal process.”

Dr. Shear led the development of a targeted therapeutic treatment for complicated grief. While the factors behind it may vary, she says, complicated grief looks remarkably similar across people. The complications “are virtually always one of a small number of typical thoughts — counter-factual thoughts of ‘if only’ something different had happened the person would not have died; excessive avoidance behaviors; or extreme difficulty regulating emotions.”

The treatment, she says, focuses on two main goals: Resolving the complications, and reactivating the normal healing process. As part of the treatment, she said, “We ask them to go back and revisit the time of the death.”

For Cynthia, that meant that soon after she enrolled in grief therapy at Mass. General with Dr. Naomi Simon’s team, she recorded her memories of her husband’s final hours and replayed them repeatedly.

“I had to keep playing it and playing it until what I call the emotional ambush stopped and I could really listen to what I was going through,” she said. “At one point, I thought, ‘Oh you poor thing, what you’ve had to go through!’ I felt really sorry for myself. So I think I was turning a corner.”

Cynthia’s treatment encouraged her to take better care of herself, do more pleasurable things and try to think of her husband’s death in the context of their long life together.

She also took an antidepressant, and the medicine combined with the talk therapy helped her feel better with surprising speed.

“I started to feel lighter,” she said. “I explained to Dr. Simon that I’d been feeling like I’d been carrying an overcoat of sadness and depression on my shoulders, just weighing me down, and within two weeks it felt like the coat had come off somehow. I knew I was still in the beginning stages, but I was starting to feel the way I normally felt in the past.”

The research into medication for complicated grief is ongoing, Dr. Simon says.

“We think medication is probably not necessary for everyone,” she said, “but it can help in the way it helps in Post-Traumatic Stress Disorder, to help regulate emotions and to decrease the intensity of the depression so that people can re-engage with their life and the loss can be processed.”

As her treatment progressed, Cynthia tapered off the antidepressant. Toward the end of her treatment, her therapist, Dr. Cindy Moore, asked her to have an imaginary conversation with her late husband.

“So I was able to say to him the things I needed to say to him, to tell him that I loved him, I missed him and how am I ever going to get through without you?”

It did help, she said. “I do believe there’s a thin veil between us and them, wherever they are, and I think he heard that. I felt a relief.”

Columbia University’s Dr. M. Katherine Shear says that this sort of “imaginal conversation” helps reassure patients with complicated grief that they can remain connected with their loved one even as they heal.

Also, “it gives them another opportunity, if there’s something that’s been really troubling them about the death, another opportunity to work through that…and that can also be very reassuring.”

Early research suggests that this type of therapy may be roughly twice as effective as conventional psychotherapy for complicated grief patients.

“We did a prospective randomized controlled trial of this treatment using a very stringent test,” Dr. Shear reports. “Of all the people who started treatment, 51% of the ones who got Complicated Grief Treatment (CGT) got much better compared to 28% of the ones who got a more usual psychotherapy. Among the ones that finished all 16 sessions, 66% of the CGT group and 32% of the other psychotherapy were much improved.”

More research is under way, including at Columbia, the University of California at San Diego, the University of Pittsburgh and Mass. General, where Cynthia was part of an ongoing study comparing different treatments.

Cynthia says her complicated grief therapy unquestionably helped her heal and go on with her life. So is she cured?

(Admittedly, an unfair question: Dr. Shear says that unlike depression or anxiety, “We do not try to cure grief. We try to resolve or cure the complications but the natural healing process — grief itself — is a lifelong process.”)

“I would say that this is going to be a lifelong journey at different stages,” Cynthia said. “Now we have the holidays and I’m busy with my family…I think it’s better than it was last year, and I hope next year will be even better, and I think we just have to keep going on, and it’s a journey of mourning and grief. But the intensity is less. As far as being cured, I don’t know if any of us in this lifetime get cured of anything – but we learn how to manage it. It’s my new normal. And though this program, I do believe I’ve learned how to manage this grief.”

Further resources:

Complicated grief research at Massachusetts General Hospital

Center For Complicated Grief at Columbia University

A poem about Complicated Grief and the process of “revisiting” — visualizing yourself at the time you learned of a loved one’s death — with the aim of making peace with the finality of the death.

By Mary Kelly

The train stop
>>>>>> Where clouds of despair
>>>>>> suffering sorrow
>>>>>> No longer hover
>>>>>> Once off the train.
>>>>>> In the space between
>>>>>> The closed and opened steel doors
>>>>>> Hope kindled-
>>>>>> In the space between letters
>>>>>> That make a word
>>>>>> Meaning discovered-
>>>>>> In the space between the words shared and sacred silence
>>>>>> Spirit found-
>>>>>> Entrusted only in the truth of trust
>>>>>> Emptiness died ~ Creating anew
>>>>>> Separating to join~Enfolding to know
>>>>>> The bridge unites
>>>>>> Parallel train tracks
>>>>>> New destinations
>>>>>> The bridge offers
>>>>>> Life renewed
>>>>>> for
>>>>>> All directions
>>>>>> On the train
>>>>>> Revisiting
>>>>>> Tender times to cherish.
>>>>>>
>>>>>> (c)marykelly.dec2012.newyork.10463.
>>>>>>

December 21st will be the day to end all days. A galactic alignment 26,000 years in the making will realign the Earth’s equator with the sun; at the same moment our planet will be directly centered on the Milky Way’s galactic plane.

It will also be a historic “year zero” according to arcane Mesoamerican texts, signaling, some think, a “great end” to the world as we know it.

This will also be the day that a rogue planet hurtling through space is scheduled to smash into Earth. Massive solar flares will burst off our sun, scorching our planet’s surface, sparking gargantuan earthquakes, monstrous tsunamis, and the end of humanity.

Well, that’s the theory.

This “2012 phenomenon” may be more creatively developed than most apocalypses, but the death-wish zeitgeist has been part of the human experience for centuries – 23 to be exact. Biblical scholar Dr. Lorenzo DiTommaso says this Doomsday worldview has been present in all cultures and in all eras, though it first appeared in the Book of Daniel, a Judaic text from the 2nd century B.C.

There are many droll examples of prediction and subsequent back-pedaling (remember the May 2011 rapture and then the quick recalibration of the Last Day?). But the real question is not when, it is why. In the exasperated words of Boston University archaeology Professor William Saturno: “Why do we keep trying to kill ourselves off?!”

Perhaps because popularizing Armageddon is a safe way for us to express an underlying anxiety about our own mortality and the state of the world. “There’s always something – the nuclear bomb, Communism, and now terrorism,” says social psychologist Jeff Greenberg. “We need these things to heroically battle against to get past our anxiety and helplessness.”

This “Terror Management Theory” sprouts from psychologist Ernest Becker’s Pulitzer-winning “The Denial of Death,” which posits that civilization is humanity’s answer to the threat of impending mortality.

Greenberg, one of the theory’s founders, whose birthday happens to fall on December 21st, explains that humans, like other animals, have a basic survival mechanism wired into us; yet unlike other animals, we are aware of our eventual death. To cope, we devise elaborate cultural traditions and worldviews that lend us a sense of symbolic permanence. From this vantage point, apocalypticism might be equivalent to scratching a nagging itch caused by our looming mortality.

Armageddons tend to attract certain people – usually those who feel marginalized – as an expression of discontent and hope for a better future, says Greenberg. To religious Doomsdayers, an apocalypse would bring a paradise to Earth or their soul forever to heaven. To secular Doomsdayers, preparing for the worst is a way to distract from the anxiety and vulnerability of daily life. After all if you’re doing something, at least you’re not helpless.

The 2012 hubbub can be traced back to several archaeologists in the ‘50s and ‘60s who interpreted a traditional calendric system of the astronomy-savvy ancient Maya of Mesoamerica as ending on 13.0.0.0.0, or in the Gregorian calendar we use, 12/21/2012.

This date was not actually a Doomsday to the Maya but rather the end of one cycle (a period of time called a b’ak’tun) in their Long Count Calendar, Saturno said, though some archaeologists popularized the idea that this date meant the Big End.

Saturno believes the misconception of the end of b’ak’tun signaling an apocalypse is due to Western arrogance (mangling a cyclical concept of time to fit our linear version) and a general anxiety about groups of zeros occurring simultaneously (one word: Y2K).

Since then, the date has snowballed to accumulate all sorts of end-of-the-world happenings, not only astrophysical catastrophes.

And that’s what makes this Day of Reckoning not your average everyday Apocalypse: Instead of one main dire vision declared by a messianic leader, this Doomsday encompasses dozens of calamities bubbling up from thousands of different people on the Internet.

DiTommaso calls this process “super-flat” to reflect the nature of Internet-age information exchange – unanchored, widespread, and devoid of a deeper meaning or roots in tradition.

The “super-flatness” of 2012 explains the vast number of cataclysms that are to befall humanity on December 21st. It can seem as if everyone got to tack on their ruination of choice. Galactic plane alignment, pole shifts, tsunamis, rogue planets, even the day the Twinkies finally go bad – everyone gets to contribute.

“Technology is changing the way we think,” DiTommaso says, adding “this is the world’s first public Apocalypse.”

Perhaps the apocalypses of the future will be regarded as entertainment; perhaps there will even be a national holiday dedicated to our impending doom – it would at least relieve some pent-up universal angst. Then again, maybe it won’t matter after December.

Further reading: On Point with Tom Ashbrook: The Real Mayan Cosmology.

Sara Knight is a writer currently studying at Boston University in the science journalism graduate program.