"We are a grief illiterate society": A psychotherapist on how to navigate loss in an era of excess

Grief doesn't always arrive in predictable stages. You can mourn before a person has even died. And you can feel guilty for starting to feel good. Because as licensed psychotherapist Gina Moffa explains, grief can be a real "sneaky jerk."

As she writes in her new book "Moving On Doesn't Mean Letting Go: A Modern Guide to Navigating Loss," whether it's for a loved one, a relationship, or a job — grief is a complicated and deeply individual experience. "Our histories will teach us how we perceive our loss," Moffa, who is also a mental health educator and author, explained in a recent conversation via video chat. "The way that we grieve will often echo the way that we cope with hard things in our life." 

Drawing on her research and her own candid experience of loss, Moffa's book is a balm for anyone who's ever fumbled through the darkness of grief or felt they were somehow doing it wrong. "We are a grief illiterate country and society," Moffa says. But we don't have to be. With self-compassion and an understanding of how and why are brains are making us feel this way, we can weather the pain even if we can't stop if from coming.

Moffa and I talked about how to grieve for someone we had a complicated relationship with, coping with those unexpected "secondary losses" and why we need to understand that "Grief takes a lot of endurance." 

This conversation has been edited and condensed for clarity.

You start by talking about this idea of letting go, which is often ingrained in our concept of what grief is supposed to look like. What are these mindsets that we can get ourselves into when we're faced with loss — and how can we reframe them in a way that is more healing and constructive?

I think we are a grief illiterate country and society. We are just not in a place where we're adept at losing in any in any part of our definition of the word. We're also really bad at emotions. In the book, I even say that I was really bad at it. I wouldn't know what to say when people are going through a loss. And you learn by getting it wrong. 

From the standpoint of the brain, we really actually aren't equipped at knowing how to continue the bonds. We're attached to something or someone or an animal that's significant to us. In our brains, we have an idea that it's predictable, that they're in this place at this time. This is how our attachment is defined. When they're no longer in that place and no longer in that time, we have to figure out how to keep the attachment. That's so hard for people that they shut down and they don't know how to deal with the emotions that come up. 

Grief is not linear. There are anniversaries, there are things that bring it back up again, and the circle comes around. How do we prepare ourselves for that? And how can we be more sensitive to other people about that as well?

We're talking about all of the triggers and awakenings that come up that are unpredictable. It's really hard to prevent that from happening. It's understanding that it will happen — and how to react in turn. I talk a lot about self compassion. I talk a lot about reaching out to people and about understanding what our triggers are. But we can't understand them until we have them and they throw us off base. From there, the best way to do it is not necessarily prevention, but getting really clear about what those things could be ahead of time. 

We come face to face with these things, they can smack us dead in the middle of a street. The body will tell us when something is coming up before our brain will register it. I've had an anniversary of my mother's death. I almost forgot about it, because I'm in the middle of like launching a book. I'm sitting there, and I'm like, "But what is this feeling?" Then I inevitably see something on the calendar and realize that something is coming up for her.

A lot of it is very biological. So I don't think we can prevent grief, we can just be compassionate with ourselves when it comes up and be as in tune with our body as we possibly can be, because grief lives there. And once we know something will hit us in a certain way, we can do whatever we can to then prepare. 

Grief rarely walks alone. You talk also about the side effects of grief, including anticipatory grief and secondary grief, where you miss certain rituals, or you miss the house. It is a unique thing that a lot of us who've lost parents or who've lost friends to disease have experienced. Talk to me about what those what those other kinds of side partners of grief are that you may be blindsided by.

With all due respect to Elisabeth Kübler-Ross and the five stages of grief, I think it does make it seem like it's very clean. You have these five stages and then you're done. One of the big misunderstandings is that we miss all of the layers and all of the things that come along with a primary loss. 

If we're talking about losing a parent to an illness, I may have taken some time off work to help care for my mother. Now I've lost that sense of meaning that I had. I may no longer have perhaps the money that I had and I have to rearrange where I live, so then I lose my livelihood and my home. Maybe I woke up and had coffee with my spouse every day and we did it in a certain way. Everyone has these little threads that lead us back right back to our losses. It's about the relationship and the bond. 

Most of the time, the secondary losses or attachments don't come up right away. That's the sneaky jerk that grief can be. You don't really think about it until much later, after the funeral and after you've paid things off and after you've called the credit card bills or the lawyers. It's when you sit and you think, "I'm just making this coffee by myself now." It's both tangible and intangible — and so innumerable. It comes up over the years. I didn't realize I lost the only person who would call me at midnight on my birthday and think of me in these specific ways. 

So many people are ashamed to talk about these additional losses, because they don't seem important. But a lot of the time, they really help define the intensity of that grief and that loss. It's really important that we acknowledge as much as we can to the people around us, because each one of those layers holds so much meaning for us. 

You talk in the book distinguishing trauma from grief. Explain to me why they're important for us to get clarity on, within those spectrums.

You can have grief without a trauma. You can't have trauma without grief, because there's so much loss inherent within a trauma, especially safety. The most common and probably the biggest part that relates them is the nervous system. 

Our histories will teach us how we perceive our loss. If your nervous system, which is a smoke alarm, is always looking for danger, if you've already had trauma or neglect or abuse in your life, instances where you haven't felt safe either in your body or your environment, you're going to then perceive whatever comes next as more traumatic than it is, as per your nervous system. 

It's really tricky, because it is so individual that you really can't make a blanket statement that all grief is traumatic. But initially we have this attachment that is predictable in time and space. That fresh, brief moment is always going to be a little bit traumatic for somebody, because what was there is no longer there. And our brains have to work at trying to figure out what to do with that attachment. Over time, we do figure out what to do with it. It does take work and it takes active grieving. But for a lot of people who don't cope well with change, or who already have a history of trauma or anxiety or mental illness, they're going to have a much harder time and it will be categorized as traumatic.

It's really individual, and no one can say whether or not somebody is going through a trauma or having a traumatic loss unless they get to know them, and they're safe in order to share that and what their history is. 

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This whole book also touches on the duality and the complexity of grief. I loved Jenette McCurdy's book, because she showed you can grieve for someone who hurt you. You can grieve for a marriage that was bad. Talk to me about how those feelings and emotions play with each other, because it can be very confusing to the person experiencing it.

We are a western society that mostly deals in black and white [extremes.] It's this or it's that. Dialectical Behavioral Therapy can teach you to hold both realities at once. That's why I always say DBT should be in schools. We need to learn very, very young that we can feel all sorts of things at one time. 

It's because of that sense that we always think in black and white that people don't know how to wrap their head around the idea that somebody can be relieved that their loved one isn't suffering — and also miss the hell out of them. It is especially more common for people who have had troubled relationships with somebody they've lost. A lot of it is so nuanced. It's, "I really will miss the idea that this could have been better, or that I could have had a different experience with this person." That is where the deeper grief lies. It's in those little moments of "What if?" 

We look at a western society, and when somebody dies, we put them on this pedestal and only look at them through this joyous, beautiful way. And then you're like, "Hey, I thought  her dad was an abusive alcoholic. Now he was the best dad?"

I think it's because people couldn't accept if somebody was like, "My dad was actually not the greatest, but he did the best he could and I'll grieve for the dad I never had and never could, or the person I am now. I grieve because I wish I could have been somebody who had a better relationship." It really always boils down to, what if we could be taught to hold two opposing belief systems at the same time? And what if we allowed other people to do the same?

You talk about the fact that your needs are going to fluctuate and there are going to be days when you really need people around you and others when you need to be by yourself. Doing that kind of checking in with yourself regularly is hard, because we don't give ourselves a lot of space to do that. How can we cultivate that in the face of a loss? 

A lot of times we don't know what we need. One minute, I want solitude, the next minute I want to be surrounded by people because I'm completely lonely. Sometimes it's about slowing our world down. Sometimes it really just boils down to taking a breath, putting your hand on your heart, saying, "What do I need?" Maybe it's a glass of water. Maybe it's I need to actually like get away from my computer screen for a minute and look out the window. Maybe I need to call somebody and say, "I'm having a hard day and I don't know why." I don't think there's any shame in adjusting our expectations of ourselves and also leaning into what our rhythms are. 

That is why I talk about grieving rhythms. It's about leaning into the moments that everything can shift, because the way that we grieve will often echo the way that we cope with hard things in our life. Do we run away from them? Do we come to them head on? Do we keep things busy and moving? Or do we lean straight into that pain and get dark and emo? Are we people who isolate when things are hard? Are we people who reach out to others?

It's very multilayered in terms of understanding what we need and being able to communicate those needs. When we don't know what it is we need, let's shrink our world and just take care of our bodies, because that's the first thing that's going to go and grief takes a lot of endurance. 

I want to ask about this somewhat newly introduced idea of long term grief. It is tricky because we don't want to set timelines for ourselves, but we also don't want to pathologize grief. Are there some certain signs that can signal, maybe I need more help, or maybe I need to be looking at the grief as part of a bigger picture?

The key words associated with that would be relief and intensity. A lot of people are able to still have relief while they're grieving. That may mean that their support system is there, they're able to go to an event and let in joy or at least a laugh or two, they're able to go back to work and even if it doesn't feel good, are able to focus at times on things. The intensity will shift and wax and wane. 

Whereas if somebody is really getting themselves into a place where it would be a diagnosis of prolonged grief disorder, or getting stuck in their grief, it would be about the idea that there's just no relief for them. They're constantly in a state of vacillating between reality and the "What if?" and the sense of guilt, which keeps them in rumination. When that's the way that it is, the reality of the loss is not accepted. There's a sense that that intensity will never go away, the relief will never come. They become very isolated from their peers and their support system. That is where it's a good time to be in therapy if you're not already. That would be the time I would say, all hands on deck. 

Grief really does take a very long time. The other side of that is people can feel guilty when they start to let some of their grief go, when begin to another relationship or forget something that used to tether them to the person who was gone. Part of the grieving experience is giving yourself permission to not be grieving and to feel happiness again.

That is the biggest thing people talk about, especially after time passes. There's that fear of memories fading, or that life is coming in bigger than the loss itself. One of the things about grief is it has science and mystery in it. It's hard to figure out how we bring these attachments with us. We just know that we need to and we want to, and that it will look different all the time in how we bring that person with us.

I think about the Andrew Garfield interview where he's like, grief is love — grief is all of this love with no place to go. But it does have a place to go, and we get to create the place within ourselves and in our lives and our own rituals and how we continue that bond. It's going to be really individual and that's where the mystery lies. So I don't have an amazing answer for you on this, outside of saying that we go on, because we must.