Our Challenge: Helping Patients Focus on What Remains

I have a lot of experience helping people deal with loss. In my prison clinic, many of my patients have experienced unimaginable losses. They’ve witnessed the murder of friends, the suicide of family members, been burned in house fires, or witnessed horrible crimes. They’ve lost homes, jobs, and spouses in addition to freedom.

I know what to say to them; it’s somewhat practiced by now, but it seems to help. I remind them what they haven’t lost: that last friend, the supportive ex-girlfriend, the young child in foster care. I advise them to stay in the present instead of dwelling on the worst conceivable future. I encourage them to take pride in their past accomplishments, even if those accomplishments seem small or insignificant to others. I tell them they will find a new purpose for their lives and a reason why events happened as they did.

Disaster and loss, trauma and recovery, are always easier to manage when it happens to someone else. When it hits closer to home, it can be a challenge to take your own advice.

I found myself thinking about this in late October as I attended the American Academy of Psychiatry and Law conference. This conference is notorious for bad weather stories; survivors of the infamous Denver conference remember the 3-foot snowstorm that shut down the airport and kept us stranded until the hotel ran out of food.

This year’s conference was no exception, and I stayed glued to weather forecasts as Hurricane Sandy crept up the East Coast. I was relieved that, contrary to my usual luck, my presentation was not the last session of the last conference day. I had a reasonable chance of leaving early if it was necessary.

I was impressed by the size of the storm, by the predictions of doom and disaster. I tracked the NOAA coastal flood advisories and fiddled with the online flood model of New York to see how bad things could get. I attended luncheon talks with my colleagues from New York, all the while thinking that the storm probably wouldn’t be as bad as the news was saying.

I was so wrong. Watching news stories about the evacuation of NYU Langone Medical Center and Bellevue Hospital, I thought about the people I knew there and the patients they were moving. I saw the devastation on Staten Island and heard stories of lives lost there. Suddenly, my prison advice seemed cliché and trite.

There is no easy way to salvage the remains of a past life. One can pick through the wreckage, create a monument to lost memories, or let go of the remnants determined to rebuild in new and better ways. There is no right way to deal with it, no better way, only ways that are less painful than others. The only certainty is that life will not be the same. As psychiatrists, the best we can do is instill faith in recovery.

I think the poet Elizabeth Bishop said it best in her poem, One Art:

The art of losing isn’t hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster.

Lose something every day. Accept the fluster
of lost door keys, the hour badly spent.
The art of losing isn’t hard to master.

Then practice losing farther, losing faster:
places, and names, and where it was you meant
to travel. None of these will bring disaster.

I lost my mother’s watch. And look! my last, or
next-to-last, of three loved houses went.
The art of losing isn’t hard to master.

I lost two cities, lovely ones. And, vaster,
some realms I owned, two rivers, a continent.
I miss them, but it wasn’t a disaster.

—Even losing you (the joking voice, a gesture
I love) I shan’t have lied. It’s evident
the art of losing’s not too hard to master
though it may look like (Write it!) like disaster.

DR. ANNETTE HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychi­atrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, in­cluding the Maryland Department of Health and Mental Hygiene or the Mary­land Division of Correction.

I have a lot of experience helping people deal with loss. In my prison clinic, many of my patients have experienced unimaginable losses. They’ve witnessed the murder of friends, the suicide of family members, been burned in house fires, or witnessed horrible crimes. They’ve lost homes, jobs, and spouses in addition to freedom.

I know what to say to them; it’s somewhat practiced by now, but it seems to help. I remind them what they haven’t lost: that last friend, the supportive ex-girlfriend, the young child in foster care. I advise them to stay in the present instead of dwelling on the worst conceivable future. I encourage them to take pride in their past accomplishments, even if those accomplishments seem small or insignificant to others. I tell them they will find a new purpose for their lives and a reason why events happened as they did.

Disaster and loss, trauma and recovery, are always easier to manage when it happens to someone else. When it hits closer to home, it can be a challenge to take your own advice.

I found myself thinking about this in late October as I attended the American Academy of Psychiatry and Law conference. This conference is notorious for bad weather stories; survivors of the infamous Denver conference remember the 3-foot snowstorm that shut down the airport and kept us stranded until the hotel ran out of food.

This year’s conference was no exception, and I stayed glued to weather forecasts as Hurricane Sandy crept up the East Coast. I was relieved that, contrary to my usual luck, my presentation was not the last session of the last conference day. I had a reasonable chance of leaving early if it was necessary.

I was impressed by the size of the storm, by the predictions of doom and disaster. I tracked the NOAA coastal flood advisories and fiddled with the online flood model of New York to see how bad things could get. I attended luncheon talks with my colleagues from New York, all the while thinking that the storm probably wouldn’t be as bad as the news was saying.

I was so wrong. Watching news stories about the evacuation of NYU Langone Medical Center and Bellevue Hospital, I thought about the people I knew there and the patients they were moving. I saw the devastation on Staten Island and heard stories of lives lost there. Suddenly, my prison advice seemed cliché and trite.

There is no easy way to salvage the remains of a past life. One can pick through the wreckage, create a monument to lost memories, or let go of the remnants determined to rebuild in new and better ways. There is no right way to deal with it, no better way, only ways that are less painful than others. The only certainty is that life will not be the same. As psychiatrists, the best we can do is instill faith in recovery.

I think the poet Elizabeth Bishop said it best in her poem, One Art:

The art of losing isn’t hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster.

Lose something every day. Accept the fluster
of lost door keys, the hour badly spent.
The art of losing isn’t hard to master.

Then practice losing farther, losing faster:
places, and names, and where it was you meant
to travel. None of these will bring disaster.

I lost my mother’s watch. And look! my last, or
next-to-last, of three loved houses went.
The art of losing isn’t hard to master.

I lost two cities, lovely ones. And, vaster,
some realms I owned, two rivers, a continent.
I miss them, but it wasn’t a disaster.

—Even losing you (the joking voice, a gesture
I love) I shan’t have lied. It’s evident
the art of losing’s not too hard to master
though it may look like (Write it!) like disaster.

DR. ANNETTE HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychi­atrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, in­cluding the Maryland Department of Health and Mental Hygiene or the Mary­land Division of Correction.

I have a lot of experience helping people deal with loss. In my prison clinic, many of my patients have experienced unimaginable losses. They’ve witnessed the murder of friends, the suicide of family members, been burned in house fires, or witnessed horrible crimes. They’ve lost homes, jobs, and spouses in addition to freedom.

I know what to say to them; it’s somewhat practiced by now, but it seems to help. I remind them what they haven’t lost: that last friend, the supportive ex-girlfriend, the young child in foster care. I advise them to stay in the present instead of dwelling on the worst conceivable future. I encourage them to take pride in their past accomplishments, even if those accomplishments seem small or insignificant to others. I tell them they will find a new purpose for their lives and a reason why events happened as they did.

Disaster and loss, trauma and recovery, are always easier to manage when it happens to someone else. When it hits closer to home, it can be a challenge to take your own advice.

I found myself thinking about this in late October as I attended the American Academy of Psychiatry and Law conference. This conference is notorious for bad weather stories; survivors of the infamous Denver conference remember the 3-foot snowstorm that shut down the airport and kept us stranded until the hotel ran out of food.

This year’s conference was no exception, and I stayed glued to weather forecasts as Hurricane Sandy crept up the East Coast. I was relieved that, contrary to my usual luck, my presentation was not the last session of the last conference day. I had a reasonable chance of leaving early if it was necessary.

I was impressed by the size of the storm, by the predictions of doom and disaster. I tracked the NOAA coastal flood advisories and fiddled with the online flood model of New York to see how bad things could get. I attended luncheon talks with my colleagues from New York, all the while thinking that the storm probably wouldn’t be as bad as the news was saying.

I was so wrong. Watching news stories about the evacuation of NYU Langone Medical Center and Bellevue Hospital, I thought about the people I knew there and the patients they were moving. I saw the devastation on Staten Island and heard stories of lives lost there. Suddenly, my prison advice seemed cliché and trite.

There is no easy way to salvage the remains of a past life. One can pick through the wreckage, create a monument to lost memories, or let go of the remnants determined to rebuild in new and better ways. There is no right way to deal with it, no better way, only ways that are less painful than others. The only certainty is that life will not be the same. As psychiatrists, the best we can do is instill faith in recovery.

I think the poet Elizabeth Bishop said it best in her poem, One Art:

The art of losing isn’t hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster.

Lose something every day. Accept the fluster
of lost door keys, the hour badly spent.
The art of losing isn’t hard to master.

Then practice losing farther, losing faster:
places, and names, and where it was you meant
to travel. None of these will bring disaster.

I lost my mother’s watch. And look! my last, or
next-to-last, of three loved houses went.
The art of losing isn’t hard to master.

I lost two cities, lovely ones. And, vaster,
some realms I owned, two rivers, a continent.
I miss them, but it wasn’t a disaster.

—Even losing you (the joking voice, a gesture
I love) I shan’t have lied. It’s evident
the art of losing’s not too hard to master
though it may look like (Write it!) like disaster.

DR. ANNETTE HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychi­atrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, in­cluding the Maryland Department of Health and Mental Hygiene or the Mary­land Division of Correction.