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Grief and independence with BJ MIller

BJ Miller is a hospice and palliative care physician and the co-founder of Mettle Health, a team of doctors, nurses, social workers and chaplains that helps patients and caregivers reframe the way they think about the road ahead. He’s an expert in making the big, heavy topics that often feel unapproachable accessible. Team Bold was thrilled to sit down with BJ to learn a bit more about him and his work. 

Bold: Hi, BJ! We’re so excited to connect with you today because we’re fans of your work. Tell us a bit more about yourself and your career. 

BJ: My career path has shifted from working at the UCSF teaching hospital and to being more out in the actual community by founding the Zen Hospice Project and the Zen Caregiving Project, where we help caregivers navigate their own well-being and compassion. 

Now I’ve founded Mettle Health, where we provide online palliative care consultations.

More broadly, I’ve just been trying to get people to think and feel and talk about the end of life. 

I usually hear people talk about independence as their goal for aging well, but one thing you’ve talked about is the idea that, “independence is an illusion.” Can you talk to us about that?

Yes — I truly believe that there is no such thing as independence – independence is an illusion, and for me that’s one of the beautiful things that happens when you wrestle with this big heavy subject of our own mortality. With independence, it’s all relative — and we should be clear with ourselves about that. We’re naturally connected and social beings, so we don’t need to feel shame if we’re not as fully independent as we think we should be. You’re always going to depend on someone, somewhere. And that’s OK.

You also speak a lot about grief. Why do conversations about grief often feel shameful?

I think it’s safe to say that in the US with the way we’ve been going since the technology revolution, there’s a mindset that goes along with such rapid development. As an example, our approach to health is often you name the problem, you go to war against the problem, you kick it out of your system. But there can be fallouts from that approach. 

We have not had a very mature take on grief in this country for a very long time. The US is a young culture, and it shows in how we handle aging and death. Any culture that’s been around longer has had to make peace with the fact that you age, you die, and it’s sad. Older cultures have had to create pathways and structures to help hold us through these pathways. Here in the US, we’ve medicalized the issue of death — you used to go to your church for answers, but now you go to the ER. You used to sit down with three generations of your family and see how aging worked in real time, at the table, and now we’re so alienated from that. We need to reacquaint ourselves with grieving. 

How do we reacquaint ourselves with grieving?

  1. Simply normalize grief. Grief is part of the human experience. You have to remind people of that — otherwise you take on the more medical approach which is that you have two weeks of feeling bad, and then if you still feel bad beyond that you’re probably depressed, and you take a pill. We don’t have family leave, so you’re expected to go back to work the next day. And I don’t think that’s right. A lot of the work I do is simply normalizing grief. Grief is an essential part of the human experience — it’s OK to feel bad! Also, people have experience with grief even if they don’t know anyone who’s died — let’s  help bring that up, and normalize it.

  2. Explore what grief is. Get yourself in a curious point of view versus an “I need to be kicking and screaming.” This gets us to the link between grief and love — it helps to remember that the source of the discombobulation of grief is love. Grief is part of what we get for being loving, attached humans. To name this and to honor this can lend a different texture and color to the feelings. 

How can we adapt to grieving in this time? For instance with Covid, a lot of people haven’t been able to meet with family for shared grief. 

First off, explore whether there are any preexisting rituals that you can tap into. If you or your family or friends don’t have any existing rituals, think through reinventing rituals so that you can have your own ritual and pathway to help you get through this time. Reimagine is a nice organization that can help you with this. 

Second, acknowledging the times — virtual stuff is fine for now but it ain’t the same thing. It’s something for now, and when we get out of this, we can plan for something in person. And sometimes, that time difference between the loss and the memorial can be helpful. 

Finally, whenever I hear someone say “If only….” Like — “If only I could have been at their bedside” I invariably need to remind people that part of grieving includes regret. As part of the process you’re going to find yourself with some magical thinking — if only I could have done this. So I tell people that even if you had been at the bedside, or done that one thing differently, you would still have regret about something. Don’t seduce yourself into thinking that everything would have been different if you had been there. 

Lastly, your connection to the person is in you. Part of the grieving process is that the person becomes an internal connection, an internal part of you. The person who has passed is now within you. Go there. 

What does having a bold attitude about aging mean to you?

Reframe the myth of independence. Reframe your vulnerability into strength. When you get sick, this is not nature screwing up — this is what nature does. We are healthy, we are sick. This is natural. To help with this, become your own frame of reference - you are healthy and then you’re sick, and then you’re going to change again. You don’t have to internalize the junk that people throw at you. Healthy compared to who? Be your own frame of reference.