Draft Four: Be ready for everything

On private suffering and collective trauma.

I was running errands Friday morning, so I turned on the latest episode of On the Record, my favorite Romanian news product. With the death of journalist Iulia Marin as a hook, it engaged with a question sparked with by the vitriol with which the cable channel România TV blamed her former employer, the newspaper Libertatea, for her death (arguing in bad faith that she couldn’t be expected to be a functional journalist while struggling with severe mental illness).

Anca Simina, the podcast host, then asked her guest, psychologist Cătălina Dumitrescu, the obvious: can we live in the world while suffering from mental illness? Of course we can. Why do many think we can’t? Partly it’s a heritage of communist Romania, where everyone that didn’t fit the regime’s definition of “normal” (in body and mind) was to be hidden behind closed doors, in private homes or in institutions. This added terrible shame and stigma to existing suffering. Private grief compounded and led to silence, collective suffering compounded and blended with other pain.

With this past, trauma is a given.

We’re a traumatized society, Dumitrescu was saying. We’ve been one for a while – the pandemic and the war in Ukraine just added to the ledger. Because our trauma and suffering are unacknowledged, we’re perpetuating them through daily careless actions, sarcasm, cynicism, and a lack of compassion that manifests in myriad acts of psychological violence (in traffic, at work, in hospitals, in schools). We punish those who are weak because we’ve not come to terms with our own weakness. We process our pain by inflicting it on others. We respond to sincerity with sarcasm because it’s safer. In this context, the sharing of suffering is dangerous, because it implies we’ve seen it in us, and we’re working through it.

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Iulia Marin was among those strong enough to share her suffering in a social space where pain largely goes unmentioned. She wrote on her social media, on her blog, and in essays about battling depression, bipolar disorder, and an uncaring mental health system. Many cherished her for speaking for them, for articulating private suffering they couldn’t.

This is her legacy: the willingness to tell a private story of pain to a community who struggles to look at its own.

But it’s getting there. Slowly.

Ten years ago, together with photographer Andrei Pungovschi, we did a bunch of stories as part of the Carter fellowship for mental health journalism. We chose anxiety as our topic, and our project was called What if…. We wrote features, profiles, and interviewed people living with generalized anxiety disorder, struggling with OCD, negotiating panic attacks, and so on.

Most went about their daily lives, their suffering largely a secret. Some wanted to help lift the stigma and wanted to be named, and having their faces shown.

So much has changed in the past decade; today we could easily do the project with everyone willing to speak – even on camera. Yes, mental health is still taboo at a societal level, but so many more individuals talk openly about their own struggles. Some do it on social media, in news articles, in documentary movies, in books. Since the pandemic, talk of therapy abounds. Many of the therapists I know talk about not being able to take on more clients.

We’re getting better, and in dark times it’s important to point out that we’ve made enormous progress in just 10 years. But since we were starting from far behind, we have a lot more to go. (A study said a third of Romanians wouldn’t accept a close relative or friend with a mental health affliction).

Empathy, compassion are muscles that need training, and it’s not a workout we enjoy.

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I don't remember when I first heard the word “empathy”, but the idea was present in our house. My parents, both doctors, often talked about how their patients and their families were doing, and how the jumble of feelings and relationships was sometimes just as malignant as the tumors they were fighting – my father, in the brain, my mother, wherever cancer struck.

In the mid 1990s, my mother became more and more interested in understanding the pain her patients were going through. She started reading and teaching about pain, putting pharmacology, which had been her primary focus, on the back burner. She embraced her work as an oncologist, although it turned her, as she put it, into “a soldier bearing bad news”.

Her message to students and nurses was simple: sooner or later, cancer kills, so, beyond what we already know needs to be done – radiotherapy, chemotherapy, tons of medication –, we should learn to listen to patients, and teach their families to do the same. She talked about the needs of people in pain and about listening, about how they should be able to choose what happens to them and when, about how much and under what conditions they should suffer, all concerns of palliative care, a practice focused on increasing quality of life for the terminally ill.

What she found frustrating is how families often wanted to learn the diagnosis of a loved one first, and then hide it from them. They thought they were protecting a cancer patient from extra suffering, when they were just perpetuating the silence, trauma and shame that accompanies it.

This wasn’t easy for my mother, who often stood out as the resilient and reserved type. Some even thought she was cold. (Some have told me I’m like her). It seemed that way because she rarely offered herself as a subject, and almost never talked about her feelings. But over time – as she worked to ease the suffering of her patients – she began to understand how sharing could ease suffering.

One experience was especially important to her – a palliative care workshop she attended in Poland, taught by a Spanish professor. Everything she and the other oncologists did on that journey was experiential: they roleplayed Jewish children on a train heading for a Nazi concentration camp. They were the actors of a circus, whose old and dying ringmaster had asked for one last show. They attended a faux funeral in the basement, where they all took turns presenting their condolences to a bereaved relative.

One day, the professor didn't allow anyone to eat. Then, at sundown, he told them a patient coming in for examinations feels just as helpless: he doesn't know what and when he may eat, he goes from one exam room to the next, without anyone asking if he needs anything. When he made them wear diapers, it was hours before one participant said she couldn't hold it in any longer. The message was similar: patients are ashamed to ask because they are at their most vulnerable.

What my mother learned on that trip and afterwards is that people suffer in silence. Her job as a doctor was to relieve some of the burden. Empathy, as she practiced it, embodied what many experts say we should aim for: a blend of cognitive empathy (understanding that others hurt), emotional empathy (feeling what they feel), and compassion, which leads to action meant to improve others’ well-being. Without this other-centered action, empathy can turn into pity at best (poor you), selfishness at worst (now I’m suffering, too).

The professor teaching that workshop tried to instill four rules into the doctors present: Be simple when you communicate with the patient. Believe what they say. Be flexible. And the most important one: Be ready for everything.

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My mother died 16 years ago this weekend.

It seems so near, and yet so far, almost like it happened in a different life. She was 57, and she herself had battled cancer in her final three years.

She did a lot to make sure we – especially me and my brother – were ready for everything when she passed. I’m not sure we did enough in return, although we tried to do what she taught us: don’t turn away from suffering, try to anticipate needs, try to meet them. She would sometimes ask me for a cigarette, and I rolled my eyes, knowing how her lungs were torn up by the cancer. But I gave in.

One thing she left us with is something she wrote in a medical textbook: “You have to enjoy every day of your life, and you can only do this if you don’t suffer”. This was hard found wisdom: my mother had a tough childhood and tried to build a life and a career in an unstable country. When I left for graduate school in the US, 20 years ago now, we began (playfully) fighting about the future. She would tell me to never ever come back. I would tell her I thought I could be useful upon my return, make a difference.

She didn’t necessarily want me to have a better car or a better apartment than she was able to acquire – although she did bring those up as well. She kept talking about Maslow’s hierarchy of needs and insisting that outside of Romania I could spend less time worrying about safety and security, and more time creating. I could, she believed, suffer less.

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It’s only recently that I understood something I didn’t when I was in my twenties. A country – or a cultural space – with a history of repressed trauma will push back against those who want to unpack it. Empathy will sometimes be met with sarcasm. Sincerity can crash into cynicism. Or, as Iulia’s death shows, tragedy is met with terrible cruelty.

I remember that in my mother’s final days we used to sit in bed and watch TV. The president at the time had been suspended, and the country was preparing for a referendum. The coverage was mean-spirited, to say the least. It was all conflict and attacks, nothing that would be helpful to the average citizen. That’s how you journalists are, I remember her saying.

It hurt, but she was right.

I tried hard over the next years to not be one of those journalists who thrives on being a conflict entrepreneur (I wrote about this last week). I tried to tell stories that build on what we shared, not on what separates us. I tried to publish reporters and writers who believed telling untold stories of shame and pain would help the rest of us get better or be better. We all knew they might not heal the person who was suffering or had suffered, but they might heal the rest of us, as individuals and communities.

I didn’t get to publish Iulia, but I published other brave storytellers. What I’ve learned over the years is that vulnerability and sharing can also bring people closer. That we can diminish the trauma by acknowledging it. That irony and cynicism are defense mechanisms and that there is a place for storytelling that doesn’t deploy them. To make private suffering part of the public conversation is how one can transform society – it’s what philosopher Hannah Arendt believed. Stories de-privatize one’s experience; storytelling becomes a social act. The traumatized can recover their voice in relation with others. They can make the private public, and this can create change.

Existential anthropologist Michael Jackson has written tons about what it feels to perpetuate silence about one’s traumatic experiences:

The sense of shame that condemns one to remain silent about experiences that cry out to be told is a function of the impossibility of converting what is felt to be private into a story that has public legitimacy or social currency.

Over the years I also learned that countries like mine change slowly, that any political progress made today can be undone at the next election, that local journalism will never go through a golden age, that it might not get rid of corruption, it might not change healthcare or improve education, but just because one story can’t make it all good, doesn’t mean it’s not worth it.

The stories we tell about our world and our lives are what bind us. They bring hope where before there was fear, they bring joy where before there was pain. I have felt this in my own life, and I have seen it in the lives of others.

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We will get better.

In fact, we are getting better, Cătălina Dumitrescu also said in the podcast. People like Iulia, people like those of us who have sought therapy over the years, people who try to understand themselves and their emotions are paving the way. Individually, there are more of us getting better, finding balance, being able to be in the world without bruising others.

And, Cătălina added, we will become more compassionate as a collective. But it might take another couple of generations, especially if we don’t start taking our collective traumatic experiences seriously.

My former partner and best friend recently asked me what I miss about my mother. It was early April, and we were walking in Vienna, which happened to be a city my mother loved. I had just learned that one of my mother’s two remaining sisters was found dead in her apartment, a freak accident nobody was ready for.

I teared up as I remembered those days watching television many springs ago. I’m sad she didn’t see me as an adult, I replied. I did my best to not live cynically over the last 15 years, to not give into sarcasm, to anticipate the needs of others, and to tell stories of private and public suffering to help us heal. I wish she saw that I tried, that many people try today – artists, journalists, educators, doctors –, that maybe one day so many of us will try that we won’t need to ask ourselves whether we can ever be better, because, guess what, we will already have gotten there.

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SIDE DISHES

1. A couple of stories of private trauma that became collective conversations. Ioana Burtea writing about the trauma of sexual abuse. Mădălina Dimitriu writing about the pain and stigma of bipolar disorder.

2. Feeling melancholy? The National just put out their newest record of heartbreak tales, First Two Pages of Frankenstein. Interested in a Romanian language version? Eyedrops just released Găsit. Rătăcit. Regăsit. Pierdut.

3. If you want to understand more about empathy, I loved Jamil Zaki’s book The War for Kindness.

4. If you’re more into meditating on empathy, read Leslie Jamison’s The Empathy Exams. Some of the paragraphs in the letter above are taken from a foreword I wrote for the Romanian edition. Here’s an important reminder from Leslie on why empathy is something you work to exercise:

Empathy isn’t just something that happens to us — a meteor shower of synapses firing across the brain — it’s also a choice we make: to pay attention, to extend ourselves. It’s made of exertion, that dowdier cousin of impulse. Sometimes we care for another because we know we should or because it’s asked for, but this doesn’t make our caring hollow.