Book Review

Before and After Loss: A Neurologist's Perspective on Loss, Grief and Our Brain by Lisa M. Shulman, MD

"I expected grief to be unbearable sadness, but it wasn't that at all. It was profound instability." (preface, page xi)

The above is the quote that starts this book. I read it. Stopped. Read it again. I can relate to that, I thought.

I actually thought that many times throughout this book - which is what I liked the most. I saw myself in the pages. That, combined with the science she describes, helped me understand my own experience of grief and trauma in a much deeper way. Not only that, this book is a rabbit hole of quotable quotes and excellent references. The bibliography is pages long...a gold mine for a book worm like myself. 

Anyway...

Lisa Shulman is a Neurologist, and this book is a memoir of her own experience with grief before her husband died, and after, as the title indicates. Her personal experience is  combined with her knowledge of how the brain works to organize our reality...and in the case of grief, how it it becomes disorganized and damaged after a loss. The neurology of grief. 

Before:
Lisa writes about her life with Bill (her husband) when he was sick and dying. The one thing that struck me was how their intimacy with each other was a barrier throughout his illness. "We're stumbling because we care to deeply for each other" (page 6).  I found it heartbreaking to look into such an intense and personal time in their life and relationship...but, as Lisa writes later in the book, the trauma and disorientation of loss is based not only in the biology of sorrow, but the biology of intimacy. Our brains are wired a certain way because of our relationships and intimate bonds. Reading about Lisa's life with Bill before his death helps to illustrate this point in the "After" section of the book. 

After:
There is something about how Lisa Shulman writes. It is surprising - she captures perfectly, states, emotions and thoughts that I've had, but a) haven't been able to put into words, or b) hesitant to talk about for fear of...I dunno...judgement maybe? For example, her disdain for condolence cards (I remember feeling this way) and her desire to be more a part of "the other side" with Bill, than the side of the living (yep, I've felt this too). In her words: 

Condolences: Hundreds were received - all unwelcome. "I'm moved when I sense the grief of others, but i envy how they touch down in my world and return to theirs. Condolences don't begin to fill the canyon of loss" (page 42).
After his death: "I continue to live with Bill, in an inner world where, from moment to moment, i’m conscious of his response to the day’s events, to how my life unfolds. He continues to guide me. I was his muse; now he is mine" (page 46).

*As I write this, I'm finding it hard to limit myself to just one example of a piece that "hit home" for me...*
​
She captures a lot of the nuances of the grief experience that are irrational, heart centered and spirit based very clearly and wholly. 

Hence, when Lisa shifts from writing about her personal experience of grief, to one more of science and reflection on the neurology of loss I got tense. I was worried that this beautiful piece of writing was turning cold...rational...cerebral. But, in the end, it didn't at all - she was able to still be both - rational and irrational. Head and heart. Mystical and scientific. She still used her personal experience to illustrate her points, but she refers to many studies, outcomes, and sciencey things, like the neuroplasticity of the brain. The overall effect works.  I was fascinated by the science that explains so much of what I experienced personally with grief. Everything from dreams to mindfulness to post-traumatic stress. 

I've learnt over the years that I don't need proof of anything beyond my own personal experience when it comes to grief, but it really was  reassuring to understand some of the biology and neurology behind grief.

“[G]rief is a manifestation of neurologic trauma, and is evidence of injury to brain regions that regulate emotions. Grieving is a healthy protective response. It’s an evolutionary adaptation to promote survival in the face of emotional trauma, one where the injury goes undetected since daily function is preserved.” (pg 142)

I found the end of the book very hopeful. She  writes extensively on the science of emotional restoration and healing - from meditation to medication. She illustrates how a heightened nervous system post trauma can be tamed by periods of meditation, and warm companionship, where a healthy outcome is self-exploration and growth. She believes in both mindfulness as a way to immerse oneself in witnessing their grief, but also periods of distraction which give much needed rest. 

"Since grief and loss cannot be avoided, how can we manage stress to increase our potential for growth and reduce the risk of maladaptation? Encourage the protective benefits of stress and avoid the harmful effects. Right balance of periods of distraction with periods of mindful meditation where we recall our difficulties." (page 100)

Do you know the phrase, "don't tell me how much you know, until I know how much you care"?
​Well, by the end of this book I truly believe that Lisa Shulman doesn't only know about how the brain changes after a death, but she cares. ​​

“As i walk the line between my own experience of bereavement and my background in neuroscience, I confess my “scientist hat” doesn't’ always fit quite as snugly as usual. Instead, this hat is cocked to one side, leaving room for special moments that defy explanation and bring comfort” pg 101.

In summary, this is another book I'd like to add to my shelf permanently (the copy I read was from the public library). It's a book I'd refer to again and again....and, of course, to tackle that bibliography :)

​Sandy