The Wide World of Grief
The Center for Loss and Life Transition sits on a picturesque ridge on the outskirts of Fort Collins. The dirt road leading to it would be tough to negotiate for anyone not driving a tank; there are no less than four sharp switchbacks, and potholes large enough to lose a microwave oven in. But those fortunate enough to make it to the top are rewarded for their efforts by a spectacular view of Horsetooth Reservoir and the city beyond, observable from a series of structures that quietly echo the natural beauty of the surroundings.
The founder of this development, Alan Wolfelt, lives on the ridge, too, residing in a palatial home near a pair of charming, hexagonal gazebos, one of which is fronted by a small, painted figurine of Little Bo Peep crying over her lost sheep. These accoutrements are linked by a wooden walkway lined with what initially appear to be lecterns; in actuality, they're "information stations" containing glass-covered pages that impart facts about the flora, fauna, climate and geology of the site. But all paths eventually lead to the center itself, a multilevel, hexagon-shaped monument to the nurturing of the human spirit.
Welcome to the complex that grief built.
According to Wolfelt, a brisk, remarkably intense man of 46 with a taut, compact frame, a penetrating gaze and the sweeping hairstyle of a TV newscaster, the building was originally the swinging bachelor pad of an English playboy slumming in the States. But the reconfiguring and redesigning overseen by Wolfelt, who bought the property in the mid-'80s, eradicated every last bit of hedonism from its walls, transforming the edifice into a mini-campus that practically oozes benevolence. "People feel better just being here," Wolfelt says, and after a trip to the "eagle's nest," a glass-enclosed room capping the center, few would argue with him.
On this day, Wolfelt is hosting a conference called "Music, Meditation and Memories," a retreat for bereavement caregivers described in the center's catalogue of educational seminars as providing "natural medicine for soul-starvation" via "healing memory rituals" and regular "periods of solitude and reflection." The course is available only to people who've completed preliminary programs that are offered at the center roughly once a month for a week at a time; learners receive continuing-education units through Colorado State University's Department of Educational Outreach for attending the classes, with five sessions earning them a certificate in "death and grief studies." Thirteen professionals from across the U.S. are taking advantage of this opportunity to join Wolfelt for happenings such as the next morning's scheduled sunrise observance, which will ritually greet the coming dawn. Wolfelt says, "My philosophy is, when words are inadequate, have ceremony." Tuition for the seminar is $695, but breakfasts, lunches and materials are thrown in.
Students are also taking part in lectures and discussions on the center's second floor, where each participant has his own desk distinguished by a name tag, a jar of M&Ms and, conveniently, a personal box of tissues. Their chairs face a fireplace over which is mounted an illustration titled "Wolfelt's Grief Gardening Model." It depicts a route through agony that takes sufferers past dangerous areas -- one is marked "weed patch," another "nature of death" -- with stops that encourage them to "acknowledge reality" and "develop new self-identity." Elsewhere in the room, a poster delineates "My Grief Rights," which include:
I have the right to have my own unique feelings about the death...
I have the right to need other people to help me with my grief...
I have the right to try to figure out why the person I love died...
This graphic and others on similar themes are found in a series of placards that Wolfelt has produced to get the attention of mourners who may be reluctant to acknowledge their struggles; they can be found in funeral homes from sea to shining sea. In addition, Wolfelt has written more than twenty books published by his own company, Companion Press, including The Journey Through Grief: Reflections on Healing, Healing the Bereaved Child and How I Feel: A Coloring Book for Grieving Children, as well as a staggering number of pamphlets on seemingly every conceivable aspect of anguish, ranging from Helping Yourself Live When You Are Seriously Ill to Helping Yourself Live When You Are Dying. And as befits someone who's a nationally acknowledged expert in his field, he travels all over North America (he has a branch office in Toronto) giving grief seminars. He's on tour as frequently as a rock star with a new album: Next week Pennsylvania, Kentucky the week after, then Maryland, Rhode Island -- and the road goes on.
To his credit, Wolfelt doesn't pretend that his organization is a nonprofit: He's entrepreneurial enough to have ordered up a nice variety of Center for Loss clothing; logo-imprinted T-shirts go for $20 apiece, and sweatshirts and polo shirts are available for $30. Yet he gives not the slightest indication that he's anything other than completely sincere in his desire to assist folks whose sadness, he believes, is capable of absolutely obliterating their lives. Sitting in the center's office, which contains a calendar showing his schedule for the next year-plus, a vast collection of toys highlighted by a bike-riding E.T., and a frowning-clown painting by the late comedian Red Skelton, he says, "We impact thousands each year, and I couldn't be prouder."
At the same time, he's got to deal with frustrations of his own -- particularly those that have arisen since the 1999 shootings at Columbine High School, when so-called grief counselors were thrust into the limelight as never before. Since the assault, some detractors have implied that grief counselors are the equivalent of ambulance-chasing attorneys, waiting for a calamity so they can pounce on already overwhelmed victims for their own gain.
Wolfelt is still upset about being sucked into just such a critique -- a May 17, 1999, Time article headlined "The Grief Brigade: When tragedy strikes, the counselors rush in. They offer succor, but their methods are up for debate." Amid comments from numerous observers who expressed reservations about the worth of the approach, Wolfelt was quoted defending the concepts he's spent his career preaching: "Our culture is full of buck-up therapists who want to move people away from grief. But you have to feel it to heal it. You have to go through the wilderness."
Immediately thereafter, the piece's author, reporter Nadya Labi, dismissed his observations with the line, "That kind of sound bite appeals to a generation raised on Oprah, but some psychologists are skeptical." The zinger hit Wolfelt where he lives: After all, he's been on Oprah, not to mention Today, where he chatted with Katie Couric, and Larry King's old radio show. Articles like this one prompted Wolfelt to pen a de facto manifesto taking the media to task for what he called its "flawed analysis" and standing up for himself and his calling: "Yes, some people may question the need for what you and I do to help people in grief. But I suggest we stand tall and stand proud. Because it is through having places to 'story' that people have the opportunity to try to make sense of the senseless, to embrace what needs to be embraced, and to reveal that the human spirit prevails."
Over a year later, he still thinks various elements of the press are misrepresenting grief counseling, thereby convincing impressionable people that there's something either dubious or sinister about his chosen profession. "When they go on about it being an 'industry' -- that, to me, is tragic and sad," he concedes. "What's the alternative? Shouldn't we acknowledge the special needs of people who've experienced loss?
"I've worked so hard for so many years, and then we have a tragedy and people start to question everything I've ever done. It strikes at the root of my whole mission. But if someone goes through a trauma, that's an injury just as much as if there was a physical injury -- and no one questions that. If somebody is in a car crash, we don't say, 'Should we take them to the hospital?'"
As Wolfelt emphasizes, grief counseling is nothing new: He's been at it for more than fifteen years, and others have similarly lengthy track records of helping loved ones mourn after the deaths of children, siblings, parents, even pets (see sidebar, page 28). But the term entered the public vocabulary with a vengeance after the April 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, the scope of which (168 slain, many more injured) shook not just family members and emergency personnel, but the rest of the nation to its core.
The timing of the explosion coincided with the rise of all-news cable television channels desperately in need of compelling programming. Experts on grief filled their needs perfectly, providing dramatic testimony about the ordeals confronting the living that could be juxtaposed with explicit imagery of the dead. Never mind that a lot of what was (and continues to be) identified as grief counseling really wasn't; most therapists label their work with affected parties in the minutes or hours after a serious misfortune either "trauma counseling" or, in the case of emergency workers and the like, "debriefing." It sounded good, and in the end, that's all that mattered.
The coverage of the Columbine killings further codified the grief angle in most reporters' minds, especially locally. Now there's hardly a report about a distressing incident that doesn't include something about counselors. For example, a June 17 Denver Post account about the Hi Meadow and Bobcat fires underlined the availability of counselors in its subhead and throughout the article that followed, and an August 17 Rocky Mountain News story about the drowning death of Denver firefighter Bob Crump made a point of noting that his peers would have assistance to deal with their feelings. Likewise, the Post's Bill Briggs, the author of a late-August series about the high rate of suicide in the West, capped a sidebar about a thirteen-year old who'd killed himself by noting that the boy's family had undergone grief counseling and was finding it easier to "smile" again.
Taken cumulatively, these messages and many others imply that grievers have little hope of moving forward unless they seek professional assistance, even though much of the evidence supporting such theories is anecdotal; it's largely based on comments from mourners who describe counseling in positive terms. Yet they also demonstrate that editors have grown to understand that describing the grief attendant to tragic events is a way of keeping a story going when it might otherwise drop out of sight. Again, Columbine proves the rule, with headlines being generated by any semi-prominent figure who's admitted to feeling post-traumatic stress. Last October, when rumors surfaced that he was about to be given his walking papers, Channel 4 anchor Bill Stuart came forward to announce that he was in treatment for clinical depression fueled in part by Columbine (the sympathy this concession spawned probably saved his job), and the August resignation of the Reverend Donald Marxhausen, a Lutheran minister who said stress connected to Columbine influenced his decision, was covered here and in numerous locations across the country.
In reporting stories like these, the local media has received copious assistance from grief-counseling boosters at institutional levels. It's hardly a coincidence that the U.S. Department of Education chose to stage "Picking Up the Pieces: Responding to School Crises," a three-day conference on school safety that begins on Thursday, September 21, in Denver. Nor should it startle anyone that one of the key sessions on Friday, September 22 -- "Responding to the Psychological Aftermath of a Crisis: Columbine Shootings" -- deals with grief. Expect the press to notice.
Publicity like this cuts both ways. The leader of the panel noted above will be Betsy Thompson, the coordinator of Jefferson County Safe and Drug Free Schools, and the Jefferson County School District is listed as a "partnering sponsor" of the conference as a whole. Yet Jo Anne Doherty, vice president for clinical services with the Jefferson Center for Mental Health, and one of the primary liaisons between the mental-health community and Jefferson County Public Schools, says that the post-Columbine grief-milking has had many negative consequences. "Some of the stories carried in the media have exacerbated people's grief -- stories that have graphic detail played again and again, stories that have a component of blame in them," she says. "Just the continued coverage of the Columbine shootings is a continual reminder. It's hard to get back to a renewed sense of normalcy when they open the paper in the morning and see yet another story."
Donna Reutzel of the Grief Clinic in Lakewood, a private practice that specializes in treating those seeking to deal with heartache, reiterates these observations using even more fiery language. "The media is willing to knock grief counseling, but they don't knock the biggest culprits of all -- themselves. They did and still do profit from this kind of thing. In the beginning of Columbine, we needed to be informed, and there was a lot of consideration for the victims. But when it goes on and on, it doesn't allow them to have rest periods from their grief, because it's in their face all the time. And it causes extra pain for everyday people who didn't get such notoriety. I've had many clients tell me, 'Those people are getting so much attention, but what about the loved one I lost? What about my pain?'"
These days, there is no shortage of counselors willing to listen to such inquiries. Reutzel, whose background is as a psychiatric nurse, became involved in the domain of grief early last decade via the Grief Institute, a Denver volunteer group and counselor training center that was founded in the mid-'70s, a period when far fewer services of this type existed. When the Grief Institute folded four years ago, it did so because, Reutzel says, "it had fulfilled its mission." And true enough, assistance for grievers is now offered by countless hospitals, hospices, churches, even mortuaries. Some of these are overseen by qualified professional therapists, others by those whose expertise comes from bitter experience.
"Many of them are simply people who've had losses such as their infant child dying -- so they'll start a newborn group," Reutzel points out. "Suicide groups, homicide groups...you name it, they're out there." These organizations bring with them an infinite variety of philosophies, precepts and quirks, but a vast majority of them preach that grievers must share what they're going through with others in order to get a grip on their feelings. Likewise, such people need to be reassured that their reactions are normal and to learn how to handle those times when thoughts of a death or traumatic episode resurface, as they inevitably will.
For Reutzel, this last truism proved to be one of the biggest stumbling blocks she's overcome personally: In her book Original Loss, she writes that her inability to process the death of her husband in a car accident haunted her for 25 years. The tome was completed in 1996; she's working on a followup.
News reports about traumatic events -- big and small -- often make it seem as if there's a local Grief Headquarters, where therapists prompted by screaming alarms race off at a moment's notice, shoulders ready for leaning -- and although that's not literally the case, it's figuratively closer to reality than many might expect.
"We have an entire team of people qualified and trained to provide immediate, on-the-spot counseling in the case of a traumatic event," says Dan Mosley, the chair of the "disaster committee" for the Mile High chapter of the Red Cross. "There's always someone on call and ready to respond."
Here's how it works: The Denver branch of the Red Cross has a core cluster of trauma authorities on call; right now there are nineteen of them, up from just five when Mosley got started, and he predicts the total will keep growing. Like Mosley, a licensed psychologist, each is a professional in the therapy realm who's undergone special Red Cross training sessions to further prepare him for the specific trials he's apt to undergo. (Training takes place at least twice a year, supplying a pool of people to call in case things get downright biblical. Mosley says the current list contains well over a hundred contacts.)
The counselors, all volunteers, are placed in an on-call rotation, and if there's what Mosley calls "a triggering event" -- an incident in which "there's been death or serious injury or people displaced" -- the point person will be paged by a representative of agencies at the scene (police or fire departments, most likely). The pro in charge will then direct a counselor or counselors to the scene or go there himself, ready to offer an open ear to anyone who might conceivably benefit from one. That's often followed the next day by debriefings, in which mental-health presentations are made before entire groups.
On most occasions, the occurrences that precipitate a call to the Red Cross take place on a relatively small scale: a single house burns down, someone dies in an automobile accident. But in his time, Mosley has also made debriefing appearances before residents forced out by a fire at an apartment complex, a community upset by the shooting of a child, and those caught in the Buffalo Creek blaze and subsequent flooding, among other occasions. And when he was acting as the coordinator of the Red Cross reaction to Columbine, he temporarily found himself on the other side of the therapist: His squad was debriefed by representatives of the Mayflower Critical Incident Stress Management Team, a volunteer group that offers its services to emergency responders and hospital personnel. "We really needed it," he says.
(When the Denver Mayflower team was founded in 1985, it was the first in Colorado -- there are now ten -- and just the third in the entire United States. According to founder Patricia Tritt, who's the program coordinator in Denver and the state as a whole, the primary difference between Mayflower's approach and that of the Red Cross involves the makeup of the counselors. Approximately one-third of the volunteers are mental-health professionals, while the other two-thirds are specially trained individuals culled from the ranks of the very departments whose members the team counsels. "In order to have credibility with certain work groups or populations, you need to have peers as part of the team," she says. "Sometimes it's difficult to go into a fire agency or hospital as just a mental-health person. But when you're with their peers, you can.")
For Mosley, making sure that debriefers and counselors know their stuff is key: "After the Oklahoma City bombing, you had all these well-intentioned people showing up wanting to help counsel people -- but unfortunately, some of them didn't have the training they should have had to be doing it." To that end, he not only encourages his fellows in the Colorado Psychological Association to volunteer with the Red Cross, but he takes every opportunity to make sure he and his current staffers are on top of their game -- hence his role as the chair of the Disaster Mental Health Services Committee for a September 6 drill at Denver International Airport. The exercise called for emergency crews to test their readiness in the case of a massive crash at DIA, and in recognition that the Red Cross is designated by Congress as the primary agency to provide family support in the event of an aviation tragedy, a therapy team was on hand to mock-debrief mock victims of mock trauma. "It's good that we get a chance to practice our preparedness, too," he says.
Not that Mosley is rusty: As a participant in Disaster Services Human Resources (DSHR), the Red Cross's national system for disaster response, he traveled to Puerto Rico after Hurricane Georges struck the island in 1998 and pulled similar duty last fall in North Carolina in the wake of Hurricane Floyd. "I commit myself to a block of time every year," he notes, "because when there's something of that scope, the needs are tremendous."
The Red Cross isn't the only group with a squad of counselors ready to jet off to far-flung locales at a moment's notice. In the event of a major outbreak of on-campus violence (of which Columbine is, for the moment, at least, the most extreme American example), the Bethesda, Maryland-based National Association of School Psychologists is prepared to respond via the National Emergency Assistance Team, or NEAT.
Dr. Theodore Feinberg, the assistant executive director of the association, says that the Oklahoma City bombing established the need for NEAT. "There were so many children involved in that terrible tragedy," he says, "and two school psychologists from Oklahoma called our office in Bethesda asking for help. Then, after sending one of our members out to do what he could, we developed a group of individuals who had prior experience with major crises in the country to be available for communities in these kinds of situations." Feinberg was a natural choice, having volunteered for the Red Cross during flooding in the Midwest back in 1993, and his cohorts sported similar backgrounds: Two had counseled victims of hurricanes in Florida, and a third was a veteran of the Los Angeles Unified School District, where he'd had to deal with multiple shootings, suicides and no shortage of other unpleasantness.
A couple of years later, the rash of school shootings began in earnest -- so many of them that they began to be referred to by their settings: West Paducah, Kentucky (a fourteen-year-old student killed three classmates and wounded five); Jonesboro, Arkansas (two boys, ages thirteen and eleven, killed four students and a teacher, leaving ten wounded); Springfield, Oregon (a seventeen-year-old killed his parents and two students, and wounded more than twenty innocent bystanders). NEAT representatives -- at present, there are seven of them -- raced to all these scenes as well as numerous others where the carnage wasn't quite so voluminous: Flint, Michigan, where a seven-year old murdered a six -year-old student in February, and Lakeworth, Florida, which made news in May because a thirteen-year-old took the life of a teacher who'd chastised him for tossing a water balloon earlier that day. And Feinberg himself traveled to Littleton after the April 1999 assault on Columbine, when the media's fervor reached a new high.
An example? The first thing Feinberg was asked to do upon arriving in town was hold a press conference. "There must have been journalists from thirty different broadcast and print organizations there," he recalls. "And they had been there for quite a while."
Whether the coverage fed the citizenry's distress Feinberg can't say, but when he oversaw a community meeting the second day after his arrival, "we were very surprised by the turnout. We expected a reasonable number of people; sometimes we've had as few as 25 people, 50 people, and the most we'd had was in Jonesboro, where we had 600. But in Columbine, we had 3,000. It was a very moving experience." He particularly remembers a conversation with a husband and wife whose son had been present in the school when the gunfire started but who had to that point refused to open up about his feelings -- "and as he was telling me about it, suddenly the father broke into uncontrollable tears."
Of course, Feinberg realized he would only be in the Littleton area for a short time and would be unable to counsel the family himself. But he was confident that there were others who could provide what they needed. "I told him that there was an extensive network of resources available to him right there in his area. Extensive."
That's not the case in some other parts of the U.S., especially rural ones, and many other countries are similarly grief-counselor-challenged -- which is why NEAT is in the preliminary stages of developing a crew prepared to cross borders. One NEAT participant has already gone global, flying to Turkey in 1999 to help survivors of a devastating earthquake, and the organization recently presented a workshop to the International School Psychology Association that may well inspire "an international response mechanism for when there's a situation where trained folks familiar with the culture of schools are needed," Feinberg says. "We've met with people all over the world, and all of them have been quite interested in the work we're doing. So we're hopeful that our work in this country continues and expands, and that maybe the world in general will become a safer place for children."
But what about grievers who don't want counseling?
If there's anything that divides grief pros, it's this question. The politically correct line is to argue that while potential patients must be informed about the availability of counseling, they should never feel that they're being forced to do anything for which they aren't psychologically ready. But in reality, this probably happens every day. Many banks require employees who've been robbed to undergo debriefings, and a policeman who's been wounded or who's wounded another is all but guaranteed to have a debriefing in his future whether he wants one or not.
That's certainly the case in Littleton: Dan Stocking, public-information officer for the Littleton Police Department, says the chief of police there has the power to order his charges to be debriefed. A 28-year veteran of law enforcement, Stocking adds that he can't remember any objections, in large part, he believes, because mental-health examinations are now such an integral part of an officer's life; they must undergo psychological testing before being hired, and they are often persuaded to seek help when they're having difficulties at home. As a result, Stocking notes, a badge-wearer who's been on hand for something traumatic understands in advance that talking with a debriefer will be on the menu.
Among metro-area units, the therapist conducting such sessions will almost certainly be from Nicoletti Flater Associates, a collection of twelve police psychologists overseen by Dr. John Nicoletti and his wife, Lottie Flater. The group has contracts with police or sheriff's departments in most area municipalities -- Denver, Arvada, Aurora, Wheat Ridge, Englewood, Edgewater, Thornton, Adams County, Jefferson County, Arapahoe County and more -- and Nicoletti confirms that most of them require officers involved in shootings and the like to be debriefed. But in his view, the obligatory nature of the service tends to ease worries rather than provoke them.
"It takes away some of the stigma," Nicoletti says. "There's the potential for both external and internal stigma -- external being someone who asks, 'Hey, why did you have to do that?' and internal being the person asking that of himself. But if it's something everyone has to do, the person doesn't have to feel something's wrong because they have to talk. And also, if it goes to court, some attorney can't really say, 'Isn't it true you had to talk to somebody?' because that's required. It just makes it a little cleaner if it's mandated, if it's just something you have to do."
Most often the debriefing consists of a single session, with an option for more depending upon the opinions of the clinician and the patient. To Nicoletti, such conversations are especially important when it comes to trauma, which he describes as "an abnormal event" that may be followed by grief but certainly isn't synonymous with it. "Trauma is a type of stress, but whereas some stress you can get out by exercising or going to a movie or whatever, trauma doesn't get resolved that way. Trauma has to be purged, and there are basically only two ways you can purge it. One is to write about it, and that can be effective as long as the person isn't putting filters on and sanitizing what he's writing about. And the other one is to talk about it.
"This doesn't have to be done with a professional," Nicoletti goes on. "Some people can process trauma by talking to friends or mates. They just have to make sure that person won't be judgmental; they won't say something like, 'Why would you do that?' or 'That was a stupid thing to do.' But the important thing is that they get it out -- because if they don't, there can be real problems."
For Dr. Feinberg of the NEAT team, the incident that best illustrates this point was the first one to which his people responded: the abductions and murders of three young girls (one in 1996, two in 1997) in Spotsylvania, Virginia, by an assailant who remains unknown. After the disappearance of the last two girls, Feinberg says, "we immediately called the community and asked if we could be of assistance, and they declined -- which is certainly their right. Sometimes the press has indicated to its readership that people like us are just crisis junkies waiting for these kinds of occurrences to descend on communities, but we don't believe in that. We only go in at the invitation of a major player in the community -- a mayor, a chief of police -- and if they say, 'No, thank you,' we respect that. Even if we don't agree with their decision-making, they ultimately decide."
Three months later, Feinberg's instincts were proven accurate, he feels, when a Spotsylvania representative phoned NEAT "to tell us that they were emotionally paralyzed, and they needed us to come down and help them sort out the unresolved issues." Shortly thereafter, NEAT, in cooperation with the National Organization for Victim Assistance (NOVA) staged a "group crisis intervention" for locals at which the police chief, whose own daughters had been playmates of the girls who'd been killed, "broke down into uncontrollable sobbing," Feinberg recalls. "She'd been working feverishly, seventeen or eighteen hours a day, to find the perpetrators of this terrible crime and had been unsuccessful, which made her feel terribly guilty. But no one in the community thought she wasn't doing her job, and she might not have gotten their affirmation if she hadn't shared what she was feeling."
Such tales only confirm to proselytizing grief therapists what they've contended all along -- that while not pressuring people to get counseling may sound nice, backing off isn't necessarily in their best interest.
The Center for Loss's Wolfelt thinks most people live in a state of denial about mortality ("One of my European friends says, 'The first thing you should know about North Americans is that they think death is optional'"), and when they're confronted with it, their conditioning, which teaches them to embrace the ideal of rugged individualism, causes them to bury their genuine responses for fear of looking weak. Yet he says those not burdened by this theory often have problems as well, particularly if they don't have any firsthand experience with mourning. He claims that a considerable portion of the populace lives in "the world's first death-free generation" because many don't experience a close personal loss until they're in their forties or fifties -- and when these shocks finally come, they're unprepared to deal with them.
"That's why I do outreach," he says. "I don't buy into the philosophy that we sit back and wait. I believe in the role of advocacy in bereavement counseling."
In other words, anyone certain he doesn't need grief counseling probably needs it very, very badly. But this opinion isn't universally held. No scientific consensus has been reached regarding the value of grief counseling, debriefing or its various affiliates, but controversial data is surfacing that suggests it may do more good for outsiders wanting to help than it does for the mourners themselves.
Little of this info is coming from the United States, where relatively few studies expressing reservations about grief counseling and debriefing have stirred waves; only a modest splash was made by a 1998 report by New York psychologist George Bonanno showing that grievers who continually share their distress with others tend to have more difficulty coping than do less demonstrative types -- a blow to the if-it's-kept-inside-it-will-fester supposition. But researchers and thinkers in other countries have taken up the slack, foremost among them Simon Wessely, a professor at London's Institute of Psychiatry who's just published a survey of eight separate studies about debriefing that reaches some damning conclusions.
"There is no evidence that single session individual debriefing reduced psychological distress nor prevented the onset of post traumatic stress disorder," Wessely wrote. "There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety. All the modern studies fail to show any advantage to debriefing."
Even more disquieting were a pair of in-depth trials -- one looking at patients at a Cardiff burn unit, the other focusing on victims of traffic accidents in Oxford. In the former, Wessely reports, post-traumatic stress disorder rates were higher for those who were debriefed than for those who weren't; in the latter, no statistically significant differences between the well-being of the counseled versus the uncounseled were documented, with one exception: Visibly upset victims who were debriefed were worse off than analogous subjects who didn't receive this treatment.
Via e-mail, Wessely acknowledges that researchers haven't pinned down the precise reasons for these results, but he's got no shortage of hypotheses. He speculates that debriefing, which is supposed to warn individuals about the emotional responses they could experience, may actually increase the occurrence of the symptoms by creating expectations, thereby implying to impressionable sorts that they need professional help when support from their network of family and friends might actually be more beneficial. Even if these conjectures prove to be inaccurate, however, he feels the scientific clues are strong enough to warrant an immediate end to compulsory debriefing, which may inoculate organizations against potential litigation but also has "the capacity to do harm as well as good."
How likely is this to happen? Not very, as Wessely understands full well. He knows that most therapists believe strongly in the worth of grief counseling and debriefing, guessing that many of them are drawn to these arenas because of what he terms "the glamour of disasters. They are exciting, and can be a lot more interesting than the often tedious routine of mental-health work." Money, he believes, isn't nearly as much of a motivator: "I think pecuniary motives are less relevant."
Tana Dineen couldn't disagree more. A licensed psychologist living in Canada, she stopped seeing patients in 1993 after more than twenty years because "I view it to be unethical to practice when so many bogus ideas are being sold to people." Since then, she's remade herself as arguably the planet's preeminent psychotherapy critic via her book Manufacturing Victims: What the Psychology Industry Is Doing to People, first published in 1996, and regular columns in the Ottawa Citizen. "I think that as a society, we've just bought into this idea that we need experts to fix anything," she says, "and grief is something that we've come to view as needing to be fixed. So we pour money into fixing it, even though these technologies don't have a basis to them.
"I saw progressively more people calling me or coming to the office who had the idea that they needed help, and they'd gotten the idea by listening to a TV show the night before where some therapist was on talking about how if you don't handle your grieving properly, you'll never get on with your life. That presents the idea that there are therapists who know the right way to do it, when we don't know the right way. But instead of admitting that, we make people helpless to help each other, and turn something that's often entirely natural into a medical-sounding problem."
That, Dineen adds, expands the market for professional grief counselors. Yet she doesn't reserve her bile for people who make a living doing grief work; she also chastises charitable organizations that support and promote it, charging that they do so in part because it's become such a reliable magnet for donations. She's especially critical of the Canadian Red Cross, which got out of the blood-collection business, previously one of its primary functions, following confirmation in 1997 that hemophiliacs had contracted HIV and hepatitis C from transfusions. In a column the following year, Dineen suggested that the organization was hyping its grief-counseling component in order to prevent its cash flow from ebbing.
"They were nearing bankruptcy," she says, "so they shifted their focus to grief counseling, which was very popular at the moment, and gave people the idea that they were doing something to help. So instead of sending something practical to disaster scenes, like blood and blankets and the things the Red Cross is known for, their priorities are now being shifted into these phony 'helping' services, which is absurd -- an incredible waste of money and resources.
"What we have now," she continues, "is a large industry that basically thrives by getting more and more customers -- and the way you get more customers is to expand the concept of who is grieving. And you can expand it seemingly endlessly. We've reached the point where you just have to have heard of somebody dying. You don't even have to have known them anymore."
In Dineen's view, the mental-health response in the aftermath of Columbine ably illustrates her point.
The outpouring of donations to a plethora of charitable sources after the shooting was staggering: The pile ultimately exceeded $9 million, topping the hauls raked in following any other tragedy, according to an April 19 Rocky Mountain News article. The Healing Fund, operated by the United Way, took in about half that total -- $4.6 million -- and when divvying it up, the organization gave the largest check, over $775,000, to the Jefferson Center for Mental Health, which used it and other monetary sources to broaden the scope of its services to an unprecedented degree.
Before long, the center was issuing national press releases at a steady clip that hadn't slowed a full year after the original attack: An April 26 missive was headlined "Mental Health Professionals in Jefferson County Concerned About Release of Columbine Videotapes," while a May 4 salvo announced "Jefferson County Organizations Concerned About Reporting of Suicides in the Media." Meanwhile, grants funded operations such as S.H.O.U.T.S. (Students Helping Others Unite Together Socially), a teen center that precious few teens ever visited (it's since closed its doors), plus the hiring of a batch of additional counselors to treat 4,800 locals between May and December 1999 alone.
Nevertheless, representatives of a Columbine task force formed at the behest of Governor Bill Owens (including Jefferson Center head Dr. Harriet Hall) believed that even more Coloradans were in need of assistance: In August 1999 they requested $3.9 million for additional mental-health funding, which they wanted to make available to an estimated 3,701 Columbine students, teachers and others at high risk; 17,952 Jefferson County residents and/or students at other schools in the moderate-risk category; and, at low risk, anyone in the state who may have been traumatized by either media coverage or an excess of empathy.
These predictions may seem extreme, but they reflect the thinking of most grief-counseling proponents contacted by Westword, who believe that even people who experience grief by association can have complicated responses that may not surface for months or even years and could well require therapy. But Governor Owens wasn't sold, and he reacted to the totals with a memorable sound bite: "The people who need their heads examined are the people who wrote this report," he was quoted as saying. "The class of people most at risk from this report are the taxpayers."
Appropriately chastened, the task force backed down, leaving the Jefferson Center to moderate its wish list. But its current plan, which is slated to take it through June 2003, remains ambitious: Clinical services vice president Jo Anne Doherty says $1.6 million has been budgeted for Columbine-related services alone. Of that amount, $500,000 or so is supposed to come from the philanthropic community, and with $300,000 already in the center's coffers, there's a strong possibility that the goal will be met.
When asked if this level of funding will be sufficient, Doherty describes it as "a loaded question" before saying, "We have prioritized, and it's our hope that this amount plus benefits through victim's compensation funds, health insurance and other resources will address the highest priority needs.
"But that's assuming there won't be any other incidents in the community that re-traumatize people," she warns. "Columbine was different than Oklahoma City, where there was the bombing and then that was it for the most part. Here, there's been a number of serious traumatic events that have happened in the last year or so -- and if there are more, we don't know what our needs will be."
No doubt these events would be televised -- but could such broadcasts traumatize someone so badly that they'd need grief counseling? The Institute of Psychiatry's Wessely has a one-word answer: "Aaargh."
Alan Wolfelt bristles at such dismissals. He knows that getting in touch with one's grief works wonders from countless sessions with patients and, perhaps even more important, from his own life.
As Wolfelt tells it, he began his personal grief odyssey when he was thirteen, after the death of a friend from leukemia. "Adults often assume that children are too young to understand about these things. In a sense, then, I was a forgotten mourner. So I sought to understand my own experience" by, among other things, mowing lawns for three years at a cemetery near his home in Indiana.
He says that although he ate lunch each day while sitting on a different tombstone, "I wasn't weirdly obsessed with death. I played baseball, too." Still, he wrote his mission statement for what would become the Center for Loss at age sixteen and published his first book, Helping Children Cope With Grief, just three years later. Then, after completing coursework for a medical degree at Indiana's Ball State University and performing a residency at the Mayo Clinic, he moved to Colorado, where he'd fantasized about opening a facility dedicated to helping people with their grief -- and there turned out to be so many of them that he was able to settle onto his own personal mountain in just a couple of years.
By now, most of his dreams have come true: Not only does he have a gorgeous home, which he shares with his wife, Sue (a family physician), and three healthy children, but he's able to meet with hundreds of people all over the continent each month and preach the gospel of his personal bereavement model, which he refers to as "companioning" -- a kinder, gentler approach to counseling in which the caregiver bears witness to suffering without attempting to stuff it into any specific clinical pigeonhole. According to an article he wrote for a newsletter put out by Connecticut's Association for Death Education and Counseling, whose mushrooming membership bears witness to the growth of grief therapy as a whole, companioning is about "curiosity; it is not about expertise...learning from others; it is not about teaching them...walking alongside; it is not about leading...being present to another person's pain; it is not about taking away the pain..."
Wolfelt's also become a powerful proponent of the funeral business, writing columns in numerous industry publications, including The Director. He thinks funeral services are extremely important in helping people come to terms with death. "A lot of people tell their loved ones, 'I don't want a funeral when I die' -- but what does it say to kids if, after you die, they just get rid of you?"
A cynic would say that's the kind of thinking that warms a casket-maker's heart, but Wolfelt doesn't care -- or if he does, he's not going to let that stop him. Indeed, the relentless promotion of the grief-counseling concept that he and his ideological cousins have maintained seems to be wearing down the opposition. For instance, Time, the very magazine that bruised Wolfelt last year, put in its September 4 issue a joint review of three books aimed at helping children grieve (including Parenting Through Crisis: Helping Kids in Times of Loss, Grief, and Change, by Colorado author Barbara Coloroso) that was generally positive and only the slightest bit snippy.
Detractors remain, but Wolfelt is confident that his ideas will eventually win the day; he sees his pro-counseling philosophy branching out from Colorado, and the Center for Loss in particular, like vines in his grief-gardening model. And when they take root, everyone will finally realize that mental health can be achieved only by confronting sadness, not fleeing from it. "People say to me, 'Isn't what you do depressing?'" he admits. "But it's really more about opening up your heart and supporting people who can then go on to hope for the future.
"What I've learned," he says, "is that grief gives you an appreciation for the joy of life."
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