The Many Flavors of Grief

Frank Ostaseski is considered one of the most important representatives of the hospice movement in the United States. Inspired by Elisabeth Kübler-Ross and the teachings of Zen Buddhism, he is one of the co-founders of the Zen Hospice in San Francisco and for decades has shared his insights and knowledge in lectures and workshops worldwide. Ostaseski’s book The Five Invitations: Discovering What Death Can Teach Us About Living Fully does not provide any ready-made recipes for better living in the face of the finiteness of life and death. Rather, its author—sometimes in the guise of a poet and storyteller, sometimes as an existential psychologist, then again as a phenomenologist of concrete experience—provides tools and suggestions for how to bring your full self to being with people who are dying. The media scholar Bernhard Poerksen met Ostaseski on his houseboat in the harbor of Sausalito, California.

Poerksen: You are one of the key voices in the American hospice movement and have spent all your professional life thinking about dying and death. In recent years, because of the pandemic, illness, dying, and death have dominated the public discourse. My question is: How has the pandemic shock changed how we feel about dying and death? Has there been a societal learning process?

Ostaseski: I see a double effect. On the one hand, thanks to the virus, the insight that we are all interconnected has been transformed into an experience. Today, we have to acknowledge that such a pandemic can only be met collectively and globally, only through cooperation, mutual consideration, and through vaccinating as many people as possible. On the other hand, dying and death have come out of the closet, so to speak, and moved to the center of public attention. By now, pretty much everyone knows of at least someone who has died of COVID-related illness.

We are talking about more than one million Americans and more than six million people worldwide so far. That’s right. Of course, death has always been there; it is, after all, part of life. But now it has an undeniable presence—and it is cutting across all classes and milieus.

So would it be fair to say that the pandemic has democratized the risk of losing one’s life? For suddenly each and everyone was at risk, irrelevant of social power and position, status and hierarchy. I would put it differently, because the certainty of death has always been democratic. After all, everybody must die. But now death has got our attention. Suddenly, the elephant in the room is visible everywhere. Whether this will lead to a permanent shift? I am at best cautiously optimistic, for cultural change is slow, sluggish, and rarely traceable to an individual event such as a pandemic. So I would say that, on the one hand, death has become more present. On the other hand, throughout the pandemic, most deaths were not concretely visible, death was not tangible as an immediate, direct experience. It was and is death at a distance, an impersonal, sanitized death, as it were.

What do you mean by that? When the AIDS virus was raging in San Francisco in the early 1980s, death was in our face, so to speak, on a daily basis, and it was very concrete, because it was possible to sit with the dying person in their home, hold their hands, wash them, change their diapers. This highly immediate, direct experience triggered an enormous wave of empathy and compassion. During the COVID-19 pandemic, people died lonely and invisible deaths on some intensive care unit. We learned about their death from the media and in the form of abstract numbers and statistics. We received second- or third-hand accounts of their suffering and were confronted with their dying through the stories told by exhausted nurses and doctors. We developed empathy with these health-care providers, because it was them we saw and because they had to work so hard. But we could not be close to the dying people themselves, we could not see them or touch them, we could not be there to experience their last breath. The risk of infection had forced them into isolation and removed their bodies from our sight and touch.

You have repeatedly collaborated with nurses and doctors working in emergency rooms. How was it for them who in fact had contact with their dying patients? My proposition is that they suddenly became ambassadors and reporters for the media and the families, going back and forth between the hospital beds, the relatives, and the public… …and in this new multiple role as intermediaries and carers, they also had to take on, time and again, the tasks of loving family members, because the real family members were not allowed to come inside the hospital. As a result, there was much more intimacy between them and the people who were dying. And much less intimacy between the people who were dying and their actual relatives.

In my view, there was an ambivalent virtualization of dying and death at the height of the pandemic. On the one hand, we had final messages via FaceTime calls, livestreamed funerals, the shared grieving via Zoom and in the form of candles that you could light online for others. On the other hand, all of this lacked the immediacy of direct experience. May I tell you a story? A while ago, a friend came to me asking for my advice. She was in a kind of shock, for she had experienced her father’s last breaths on her iPad, her face pressed to the screen, in a desperate, surreal attempt to produce closeness that was, however, quite removed from direct experience.

There is another kind of grief, an ambiguous, strangely diffuse grief, brought about by this pandemic.

We are talking about a distant intimacy enabled by the media, which is actually an utterly paradoxical phenomenon. It is an attempted but not really achievable intimacy. This friend wanted to kiss her father who was in a hospital in a different country, so she kissed the screen and the image of her semi-unconscious father. And he was dying that very moment. You could say that she kissed an idea of her father, but she missed the immediate experience of touch, of smell and bodily presence.

The screen and the iPad are what the internet sociologist Sherry Turkle has called “evocative objects.” Because they so obviously shape our experience, they make it possible to experience what is at the core of human experience—the closeness, the physical touch, the sudden, surprising depth. What’s more, the screen and the iPad show us what it means to be fully human—precisely because we cannot live our full humanity under the inevitably constrained conditions of digital communication.

What are the consequences when intimacy and contact—like in the example of your friend—cannot be lived and experienced fully? One consequence of such an experience is that grief is highly delayed—because you could not see the death, because you don’t have the certainty of seeing these last moments for yourself. Another consequence is a hard-to-define feeling of loss that is not only about the death of a loved one. What have you lost when you could not say goodbye to someone who is lying on their sick-bed or death-bed, when you could not give your father a real kiss, no longer see your own father, and thus authenticate his death? What I am trying to say is that there is another kind of grief, an ambiguous, strangely diffuse grief, brought about by this pandemic.

What is this other kind of grief about? It is about the loss of familiarity, of normalcy and tradition. Suddenly, we were sitting in our homes, isolated and bewildered, separated from friends and family; we had strange haircuts, were unable to lead the lives we used to live, stop by our favorite pizza place in the evening. Weddings were postponed. And postponed again. Graduations were canceled. Birthday and dinner parties no longer took place. And our normal everyday life—the separation of work and leisure time, of one’s work life and one’s personal life—dissolved. Was this simply inconvenient or already dramatic? Did we even have the right to be sad, especially compared to those who had lost their parents without being able to say goodbye to them, bury them, and grieve together with relatives? Wasn’t our own bewilderment a luxury problem, compared to those who got seriously ill or who had to bury their career dreams basically overnight?

What are you getting at? My point is that there were many individual, accumulating stories of loss, big and small. But there was also a comparing of the very different sufferings and fates and the question: Is my own sadness even legitimate when I have not lost anyone and have not become seriously ill myself? And there was a curiously ambivalent, not really quantifiable and qualifiable pain, caused by the ambivalence and indeterminacy of the whole thing.

So if I were to distill a key conclusion from our conversation so far, would it be correct to say: In times of pandemic, it was rare to have a good death and to have the fortune of grieving successfully together with a community of friends and relatives? I guess you could say that. In hospitals and nursing homes, crematoriums and cemeteries, strict rules applied. Sometimes only a handful of people, if any, were allowed to attend the funeral, and they had instructions not to touch or to hug under any circumstances. I am a little allergic to the idea of a good death, to be honest with you. Dying is messy, exhausting. It is a labor to die just like it is a labor to be born. And each death is unique and different. The romantic expectation of a good death and the hype about the last moment of one’s life only create enormous, unnecessary pressure—as though there was a universal assessment grid and as though it was a personal failure not to leave this earth smiling, in a state of bliss in the lotus position.

As founder of the Zen Hospice in San Francisco, you have companioned more than 1,000 dying people, many of whom were homeless, drug addicts, dying of AIDS, and without any money or health insurance when they came to you for help and support. At the height of the AIDS epidemic, sometimes 30 to 40 people were dying in your hospice in a week. At some point, when your work became better known, a documentary filmmaker invited you to a conference to talk about death and dying. On the flight there, you noted down five key principles—your key insights and experiences from being with dying people—which you later turned into a book. Would you mind telling us these principles? I’d be happy to. I call them the five invitations, because it would be absurd to see them as provisions. The first invitation is: “Don’t wait.” Waiting for a better future makes us miss the present moment and life in all its fullness and abundance. And at some point it is too late. The second invitation is: “Welcome everything, push away nothing.” This call for radical openness and a fearless, loving acceptance of life as is sounds impossible, maybe even a little bit foolish. But it means taking the situation of the dying person seriously and accepting as it is— its wretchedness, its messiness, but also its beauty. The third invitation is: “Bring your whole self to the experience.” When we are with someone who is dying, it is all about showing ourselves as a whole human being and getting in touch with our own fear, grief, and helplessness.

That means letting go of an ideal of perfection, of the illusion that we have everything under control… …and it means opening up the space for real dialogue, real encounters. The fourth invitation is: “Find a place of rest in the middle of things.” We always think that we should treat ourselves to a break only when the circumstances are perfect, when everything is under control, when everything is finished. But this is not true, this does not work. So why not find a moment of rest here and now, for example during this interview? And finally, the fifth and last invitation: “Cultivate a don’t-know mind.” When we carry around too much knowledge, ready-made concepts and seemingly one-size-fits-all recipes, there is no room for surprises, curiosity, and a sense of wonder. The idea is to cultivate a beginner’s spirit, as the Zen Buddhists say, to be awake, seeking, and ready to learn.

What these principles suggest is that the art of dying and confronting the finiteness of one’s existence is in reality an art of living. Because everything that you described are not just maxims for dying well but also… …for living a life of meaning and purpose. Yes, of course. What I have learned from people who are dying is that death can be a teacher hiding in plain sight that shows us what’s really important, which is leading one’s life deeply and authentically, with vulnerability and compassion. For this, you need no grand, highly complex philosophy, no esoteric knowledge, and no spiritual idealism leading us away from who we are really. Actually, it is very simple: Living deeply into our humanity makes life fulfilling and dying easier.

And what comes after death? That is and remains a mystery.

The philosopher Ludwig Wittgenstein said, “Whereof one cannot speak, thereof one must be silent.” Is he right? Not really, no. We could talk forever about the mystery of existence after death. We could talk about this until the cows come home, as we say here. Depending on tradition and religion, we will encounter different stories, attempts to bring light to the mystery, and to ward off the horror of death. However, we will not find the single, definitive answer. But it does not matter. Life itself is a mystery that cannot be fully solved—so why shouldn’t this also apply to death? I personally don’t believe in the reincarnation of my personality but I have faith in the idea that impermanence is not simply about loss and that every ending gives rise to a becoming, an opportunity for transformation—like a tree that falls in the woods and rots and gives rise to more becoming.

You said recently that for some years you have experienced the proximity of death also “from the other side of the sheets.” That’s true. I have survived a heart attack and five strokes and I am half blind. I had temporarily lost my sense of time and had difficulty finding the right words and keeping up with a conversation. And let me tell you, it’s damn hard for me, too, to accept my own helplessness. And yet it is instructive, also for others. When I returned home after my heart attack, one of my students who saw me as his Buddhist master came to help care for me. One day, he helped me get into the shower. And I felt so completely helpless and powerless that I began to weep. I remember crumbling onto the floor and weeping. First, he did not know what to do, because for him I was not an ordinary human being but his teacher and role model. But then something wonderful happened. All this specialness that separated us was suddenly gone, and there was simply Frank who was crying. Suddenly an entirely different dynamic was possible.

How do you feel today? I am in fairly good shape. Of course, since I live on a houseboat, I am sometimes afraid of stumbling and falling. But I take good care of myself, I am practicing mindfulness, I give online lectures and seminars, and I have the privilege of living in this very beautiful environment defined by the tides, the water, and the wind. I come up and down on the tides. You see, I live here surrounded by all these other houseboats in a floating, fluid, mutable and unstable world, not in a static, forever solid universe that knows no change. It is a wonderful environment to remind yourself of the fragility of life and to tell yourself: “Make plans, but hold them lightly!” Everything changes.