Countertransference, General, Grief

On Sadness

I recently went through an exercise of connecting deeply with sadness and how wonderful it can be.  In May, I closed my psychotherapy practice in New York City, and I had to say goodbye to all of my patients, most of whom I had been working with for over three years.  I was bereft.  I absolutely adored all of these individuals, and I hated the idea of not seeing them every week anymore.  We processed termination for four months, and in that time we talked quite a bit about sadness — their sadness, and mine as well.  I felt the sadness deep in my heart, like a longing.  And, as I shared with my patients when they asked me about my own feeling experience, I treasured that sadness just as deeply.  While I had always found deep meaning in my relationships with my patients, feeling the depth of my sadness at having to leave them brought me to a whole new understanding of how much those relationships meant.  It was like a gift, and one that I could never have allowed myself to open if I hadn’t embraced my own sadness, and felt its preciousness.

Sadness is, of course, a very important emotion in end-of-life care.  There are lots of differences of opinion among hospice music therapists about what we are supposed to do with our patients’ and family members’ feelings, especially feelings that can’t be described in words like “peaceful” or “content.”  Often this comes up in the context of treatment planning.  Regarding sadness, for instance, some of us talk about goals of “improving mood” and others use something more like “facilitating grief.”  This might be a difference of philosophical orientation — the former is more cognitive-behavioral, and the latter is more humanistic.  Some would argue that the different orientations will all take you to the same general end point.  And maybe in this case it’s true.  Whether you want to improve your patient’s mood or facilitate their grief process, often what you are hoping is that you can help the patient “feel better.”  And this, of course, implies that some feelings are “better” than others.

The idea of some feelings being superior to others is, I think, pretty usual in our culture.  The wonderful film Inside Out ultimately sent some powerful messages about the importance of all emotional states, but it still played into this cultural bias.  Joy is the character that we want to identify with — she is the protagonist, the leader.  Sadness isn’t just sad, she’s also kind of pathetic for much of the movie.  She has very little confidence, and is often ineffective.  She messes things up, and needs Joy to keep her moving.

In our culture, and sometimes in our field, we are not clear on the differences between sadness and depression.  They are not the same thing.  Sadness is a feeling state that moves and engages our being, while depression is stuckness.  Often people who are depressed are not feeling their sadness (or anger, or fear) enough, or not feeling it authentically enough.  The problem in depression isn’t the feelings, it’s the way that the feelings are split off.  Our cultural discomfort with sadness is more of a contributor to depression as a public health problem than sadness as a feeling in and of itself.  There is nothing pathological about sadness or suffering.

Individual and collective feelings about sadness definitely creep into the clinical space, through our patients and also through our own psyches.  I have certainly had patients apologize to me when they started to cry, and I have sometimes tried to reassure with a statement such as “that’s okay,” as if agreeing that crying is something that requires forgiveness.  As therapists, we need to be comfortable with our patients’ expressions of sadness, knowing that those feelings are important and necessary.  We also need to be comfortable knowing that we can cause our patients to be sad sometimes.  The patients that I said goodbye to in May were sad because I was abandoning them, and they and I had to sit together in that for months.  With hospice patients, we can bring up sadness by playing music that elicits those feelings, or sometimes just by having to end the session on time, or by taking a sick day.  Sometimes we are asked to rescue our patients from sad feelings by “playing happy music,” and it may be tempting to think that we have that kind of power, that when we play happy music the sad feelings just go away, rather than being pushed down to rise again another day or to emerge later as anxiety, depression, or somatic symptoms.

Prejudice against sadness is in our personal spheres too, not just the larger collective ones and the clinical ones — it’s all around us.  Just recently my mother-in-law told me that she doesn’t think Bambi is an appropriate movie for young children, because it’s “too sad” (incidentally, my husband is quite sure that she took him to see it as a young child).  The imploring phrase “please don’t be sad” is one that we all must have heard at some point in our lives, and that may contribute to a tendency for people to sometimes apologize when they are seen crying or sitting sadly.  There can be a worry about sadness in proximity to others — that others will somehow feel implicated by the sadness (“I made you sad”), or overtaken by another’s sadness (“now I’m sad too”).  Perhaps worse, I think there is sometimes a fear that the person who feels sad will be judged by those who observe them in that state.

Interestingly, “sad” has become a word with very common usage in our culture through the media presence of Donald Trump.  He uses the word “sad” quite frequently, typically as an insult to imply that someone is pathetic or inept.  Another force at play propelling us against sadness.

I learned a lot about the word “sad” from a podcast called Lexicon Valley, distributed by Slate, which explores the world of language and linguistics from many angles, often including etymology.  In this specific episode (which I highly recommend), the hosts trace the meanings of the word “sad” across the centuries.  Its use as a deliberate insult, as Trump uses it, harkens back only to the 1930’s.  Prior to this, “sad” carried a host of other meanings.

According to Lexicon Valley, the earliest known written use of the word “sad” comes from the 900’s CE, and its meaning is “weary or tired of something, sated, having had one’s fill.”  It was used by Chaucer in The Canterbury Tales with this meaning, describing the ways that alchemists never grow weary (sad) of alchemy.  In the 1300’s, the term started to shift as metaphorical outgrowths to the meaning of “extreme satiation.”  In Paradise Lost, Milton used “sad” to mean “steadfast.”  In other sources, “sad” was a term often applied to knights, to indicate their bravery — “sad” meant “valiant.”  Sad (meaning brave) was something you would have to be in order to have the dedication to stick with something to the point of being sad (meaning sated).  At the same time, the word “sad” was also becoming connected with meanings related to gravity and weightiness.  Something must be sad (meaning weighty) in order to make you feel sad (meaning sated).  It was used to refer to a heavy rain, a heavy sleep, a heavy blow, and eventually, a heavy heart.

Today, those other meanings of the word “sad” have become obsolete.  The sads that we’re left with are Donald Trump’s insult and that emotional state that we’re so often afraid to approach.  But I wonder whether it would be helpful for us as clinicians to hold in mind the etymology of “sad.”  Sad is heavy, weighty, and therefore full of meaning.  Being sad does require bravery, especially in this culture that wants to pathologize it, implicate others with it, or turn it into an insult.  As music therapists, we need to hold in our hearts the bravery and weightiness of sad, so that we can help our patients feel entitled to those feelings — not only to have them, but also to explore them deeply and fully.  Sadness helps us to find meaning, and sadness is incredibly precious.

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