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Most of us who have experienced grieving in a family or social group know that it's a complicated process. It's messy. It feels like nobody feels exactly the same way you do and some people just cowboy up and don't show what's in their heart. And knowing about the social process of grieving is helpful as you try to work through the grief in your family or help another person in a family or group.

So today in The Scope Virtual Studio we have an expert to help us think about this and what we think we know about the social aspect of grieving.

is a PhD and licensed clinical social worker. She's director of the , a hope and comfort in grief program at the University of Utah. And she teaches at the College of Nursing.

She reaches out to families and to people and to groups who are grieving to help them not get through this process, but be fully in this process.

Dr. Jones: So thanks for joining us, Dr. Supiano, or Kathie. Let's talk a little bit about your work with grieving people and families. Tell me about the Caring Connections.

Dr. Supiano: Well, thank you. I'm so pleased to be here. So Caring Connections is a nonprofit service located in the College of Nursing at the University of Utah, and we've been here since 1997. I've been the director for the past 10 years or so. And we offer multiple services to grievers and to their families.

So what we're mostly known for are grief support groups. We offer loss-specific groups, different types of loss, like loss of a spouse, loss of a child, loss by suicide, loss by overdose death, for example. Our support groups are conducted by licensed clinicians. So they're not drop-in groups. They're not peer support groups.

We also have a therapy group for people with very serious and disabling forms of grief that are referred to as prolonged grief, which is a whole other story. But we also offer public-facing services that help families. In November, we do Grief and the Holidays to help families and grievers get through the holiday season. In the spring, in May, we offer Seeds of Remembrance to help families and grievers look back and remember and have a space to remember.

So we do a lot of that. We do a lot of grief education because families and their social networks also have a role to play in supporting a griever. So you were right, and I'm really grateful that you shared that grief doesn't just happen to an individual person. It happens in a social context. And if you think about the family and then the friends and then maybe the workplace, the church, all these settings where we can grieve collectively, it's really important that we do that.

I would have to say one of the most dangerous experiences a griever could have is social isolation. It's very dangerous. And I think you and I have spoken before about unexpressed grief can leave people at risk for depression. If people are isolated and unsupported, or perceive that that's the case, they're really going to struggle.

But when it comes to families, it is sort of different because . . . Well, if you think about if you were in a fender-bender and you wrecked your car, someone else in your family would say, "Hey, borrow my car while yours is in the shop." So you'd reach out probably to your family first.

But when it comes to a death in the family, sometimes the people who would be our natural first line of support are themselves grieving deeply and they may actually be less available.

So most families actually do this well, because a death in the family means everybody's roles are changing, everybody's jobs are changing a little bit. And I think this is a key point that you made. Everyone in the family is grieving differently. Even two boys in a family that lost the same father are going to have very different grieving experiences from each other, because each of them had a different relationship with their father.

Wise families recognize this and navigate this and also respect people's coping styles, etc. But I would say in even the most loving families, grieving individuals also need support in that next ring of support, which is usually our friend community.

We know when teenagers grieve, they want to hang out with other teenagers, right? Children benefit from exposure to other children. We know that well-trained schoolteachers and guidance counselors can be extraordinarily beneficial and impactful when children are grieving.

Parents need the support of other parents who've had these sorts of losses or experiences, and even just the language to use, developmental awareness, and so forth.

So the best way we help grieving people is to augment that entire social network. We need to help churches know how to better talk about these things. And we do tell people, "Push on, get through it, just soldier on," and that doesn't really help. So I appreciate that you acknowledge the social context.

Dr. Jones: Well, we did a 7 Domains of Crying, and I had the chance to interview or have a conversation with a cultural anthropologist who spent her time in two very different cultures, one in South Africa among the bush people and one in New Guinea. And she said in New Guinea, people wail. They wail. In fact, in some cultures you hire . . .

Dr. Supiano: Professional mourners.

Dr. Jones: Professional mourners. And clearly, there's a cultural aspect to grieving. Can you talk about that? In this state, we thought ourselves as being kind of a white, middle-class state 50 years ago, and it's not that way now.

Dr. Supiano: Yeah. And isn't it wonderful that it isn't?

Dr. Jones: It's amazing.

Dr. Supiano: So the beauty of living in the United States is that we are richly and deeply multicultural. And different cultures do in fact have different norms, languages. And in some cultures you don't use the word death. You might use the word passing on. In other cultures, you're quite forthright about death. Other cultures just don't talk about feelings at all. So people can be grieving in a way that's normative to their culture.

It does help to remember that there are more individual differences within any culture, with any person in the culture, than there are kind of stereotypic norms, but it does help to know their practices and languages and so forth.

There are also generational differences in how grief is managed. And I don't mean age differences. I mean different generations. I was raised in a generation where this wasn't really talked about, and succeeding generations have been more forthright and more transparent, which is, I think, a good thing. But it can shock in these intergenerational conflicts sometimes. But that's okay. That's how we grow.

The challenge of living in such a multicultural setting, though, is people really stumble on how to support each other. And you can say something that would be edifying in your culture or particularly in your faith community, but would be harmful in another culture or faith community.

And so this is really where cultural humility . . . something we're always, always, always working on, there's no finish line . . . can really help when we say, "Help me understand what would be comforting for you. Help me understand what this means to you." Then that can start that language, the expressions of this.

If you had asked me 35 years ago if I would ever go to a funeral where there were balloons and doves released and things like that, I would have said never. All these practices are directed by individuals and families and friend groups, but they do make it so that there's no absolute thing to do anymore.

We don't all know exactly what to wear and exactly when the receiving line works and exactly who shows up when. And in a way, that's challenging, but in another way, it's so much more sensitive to the needs of each griever to say, "Tell me what you're doing."

And if other people are doing ash sprinkling and other things, I want to affirm those practices, but also just ask for guidance about, "What's the right thing to do." I mean, if you're going out into the middle of a field for an ash sprinkling, I wouldn't wear my church shoes. Those are the sorts of things that can help.

But I do think we want to be respectful of cultures and we have so much to learn from other cultures about what works. I just think that's really exciting.

So I'm a very ordinary protestant, but I remember going to a shiva of a friend whose father died, and the conservative tradition of sitting and receiving guests and accepting comfort. No expectation that you're going to be a good griever. You're just there. You just receive support from well-wishers and comforting people. I thought, "Whoa, that would be great."

It's not something that my own faith community does, but I can bring some of the concepts. And the concept is lovely. Show up and demonstrate that you care, that you respect that the family is suffering, you respect that they lost someone important.

So I think we can learn from each other's cultures and I just think this is a wonderful opportunity in the United States to celebrate our diversity instead of having it be something that's divisive.

Dr. Jones: I hear the upper Midwest in your voice.

Dr. Supiano: Oh, yes, you certainly do, don't you?

Dr. Jones: And it reminds me of funeral potatoes. Now, funeral potatoes could be just a Utah thing, but I think not.

Dr. Supiano: Well, Lutherans are famous for basement casseroles too.

Dr. Jones: But funeral potatoes. We talk about it when we have breakfast sometimes with the group. They say, "This has nothing to do with grieving, but what are you bringing?" "Oh, I'm bringing funeral potatoes."

The concept of the big meal where everybody brings something, which is kind of a Midwestern or a white Protestant cultural thing. But then there's the Irish wake where there's a lot of drinking that goes on.

Dr. Supiano: I would say in traditional religious black communities, the food, the meal is also very significant. In many indigenous cultures, the meal accompanied by storytelling is very significant.

Yeah, drinking . . . I have Irish heritage myself. I don't want to endorse that to excess, but yeah, I think when we shift in our grieving to the scaffolding of traditions that support us but also have the freedom to change it up a little bit, make it our own, that's ideal.

But people do feel comforted knowing that some things are going to happen, and I think that's fine. But if you're in doubt, then you just ask. "I'm here to just check in and offer my support and see if there's a way I can be helpful."

Dr. Jones: Well, there are stereotypes that men and women might grieve differently, and I don't know if you see this. I don't think it's helpful. It doesn't honor men or women or the people who define themselves that way to say that, "If you are this gender, you have to do it this way, and if you're that, you have to do it that way." I don't know what your experience is.

Dr. Supiano: Especially in older generations, men and women were socialized to behave in certain ways. And sometimes that was congruent with their temperament, and sometimes that was in violation of their temperament and they had to sort of fit into a mold. I'm grateful that we're freeing ourselves from those expectations that are uniformly gender-based.

Just to give an example, in marriage, there used to be sort of this dad's got to be the strong one and mom's going to be the one you can cry with. It's nice to get away from that.

And that happens in partner relationships when people are forthright about their needs and their style. Many a young boy has been edified for the rest of his life by seeing his father cry, and I think these things are really important.

But for that to happen in a partner relationship and then to have that respect permeate out through a family, people have to talk about how they grieve and then generate that respect for each other's style of grieving.

And sometimes those aren't even gendered roles at all. Sometimes the person says, "I'm an exercising person. I'm going to do well with my grief if I can get on my sneakers and pound the pavement for miles and miles and miles. That will help." Another person in that same family would say, "That is not going to work for me. I'm all about ice cream." And both of those things are fine, but the gender could apply to either.

And so I think we honor our grief more by just getting out of those sort of stereotypes and saying, "This is what I need. This is how I'm expressing my feelings. This is how I'm coping. I want to support what you need and you need to do, and if you can support me and what I need to do, we'll be able to figure it out."

Dr. Jones: I think about your teams who help people, whether they're in support groups or . . . Are you called into the hospital sometimes?

Dr. Supiano: We are not. So we are the grief support that happens afterwards. In the setting of a more sudden or traumatic death, even outside the healthcare system, we want to be quickly responsive to those grievers.

We have to remember that most people who die don't actually die in a hospital. And so we have to bring this grief awareness all the way out into now that next ripple in the social domain, which is the larger community. We want police and EMTs to be grief-sensitive, grief-aware. We want death investigators who have to come to the house in the setting of an unexpected death to be sensitive to that. We want teachers to be aware.

We do a lot of work educating mental health clinicians in the schools. That's part of a lot of our work now. And we just find them incredibly compassionate individuals. We want to equip what they already care to do properly.

So that big final ring, that entire community, it's my goal that we would become a grief-literate, a grief-aware society. But until that happens, I think it's important that we not pile on the griever and tell them what to do or tell them what to feel, or say, "It's been a week. Why aren't you back at work? Why are you crying at your desk?" We have to get away from that and bring a lot more compassion and awareness to this.

Dr. Jones: I think one of the many tragedies of the COVID epidemic at its worst was that so many people were dying, but we were not getting together. There's one thing to have Zoom and to have memorial services by Zoom or memorial services just postponed for a year and people come together later. And it really, unfortunately, transformed, I think, a lot of expected kinds of things that you might do around a death, because you can't get together.

Dr. Supiano: Right. And it did deny people a lot of the comforts that we normally get in a memorial or funeral or life celebration event. But I think the biggest thing of all is just what you referenced, the getting-together, the human touch.

And even when we were starting to get back into allowable open/outdoor kind of services and things like that, but before the vaccine, people still couldn't hug. Or we saw these catastrophic infection surges when people sort of broke with public health guidelines.

I myself am saddened that in the United States, unlike other countries, we have had very few formal acknowledgments of the magnitude of the losses that we had in COVID.

In my recollection, there were lots of spontaneous displays, like empty chairs on the National Mall, which is an international sign of mass casualty, and flags put out, but those were all groundswell of the community.

But the United States has only had two real formal recognitions of the death. One is the chiming of the funeral bell at the National Cathedral when every thousand-increment of deaths goes up. But again, you can only hear that in about six city blocks from the cathedral.

And then the other was when then-President-elect Biden and Vice President-elect Kamala Harris had the memorial event on the National Mall with the luminaries, if you remember that, the night before they were inaugurated.

But other than that, we as a society have not formally grieved. That's a space that people have not had. So you're right, we haven't had the family funerals, but we haven't really had a suitable national really kind of reckoning with all that we've lost.

Dr. Jones: Yeah, absolutely. And there are so many losses actually happening. And media brings the social aspects of death and losses right in your face so much, you think, "Oh, that's just another mass shooting," or, "That's another this." But to lose millions and millions of people over a period and so many in a long and prolonged way in isolation, it just . . . Oh, gosh.

Dr. Supiano: I cannot speak more highly of the healthcare professionals who dealt with this, and I just want to shout out three. In the hospitals, the nurses, doctors, and the entire team down to the custodial staff, caring for people and these deaths first in the ICU and then as they came into regular medical units. People who kept up this care in nursing homes. And then I have to say our community health workers throughout the state who were still out in the community working with families, supporting families, and they're our frontline people.

Dr. Jones: Oh, I remember stories. The Scope did a podcast called "Clinical," which was about the people who were on the front lines.

Bringing a semi-sterile computer pad to the bedside of the person who's going to be saying goodbye because they're going to be taken off the ventilator, and they're saying goodbye to their family via some kind of Zoom or something.

The nurse is right there. She's the living intermediary between the person who's going to die and the family that's going to be . . . Oh my god.

Dr. Supiano: And so we do know that many of our clinicians and community health workers are still deeply traumatized by all of this. Many have left the profession. We can talk boundaries all we want, but a lot of that gets in and it impacts ourselves, our selfhood, our view of the world, our sense of personal safety.

So the other area that's important to supporting grief is that community of carers who themselves are grievers. They may not be grieving a family member, but accumulated death is a lot of grief to bear.

Dr. Jones: Well, early on in this conversation that we've been having, you talked about humility and what you know or don't know about someone's experience, and you said you just ask, "How can I help you with what you're feeling? Tell me, if you can, what's happening with you and how I can be of help."

I think that open-ended question to be there for someone, whatever their culture, their family, whatever role they might have is giving them a space to say their words about how they're feeling. And being receptive and listening is a big part of this social domain, I think.

Dr. Supiano: Yeah, showing up, right? And showing up in the social domain, I think of it as taking responsibility for your participation in the community. If you're a member of the community, when someone in the community is suffering, you pitch in. That's what we can bring.

Dr. Jones: Well, we all grieve differently across persons and cultures, and we may need help traveling in this different country that we travel in as observers of grief and experiencers of grief. Knowing that there's help out there is reassuring, and I really am grateful for the work that you do and your team does. Thanks for joining us, Kathie.

Again, Dr. Supiano is head of the Caring Connections program at the University of Utah, and this is a hope and comfort in grief program.

Thank you for listening, and check in with the other "7 Domains" wherever you get your podcasts, or at womens7.com. Listen to the other domains in this powerful concept, this powerful idea of grieving. I look forward to having you listen with us. Thanks so much, and thanks, Dr. Supiano.