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TABOO TUESDAY: Preparing for Death with Author and Global Editorial Director of IDEO, Shoshana Berger
Episode 404th October 2022 • Emotionally Fit • Coa x Dr. Emily Anhalt
00:00:00 00:40:37

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Death is the most guaranteed part of life, yet it’s a topic most people avoid thinking and talking about. In this Taboo Tuesday discussion, Shoshana Berger, co-author of the book “A Beginner's Guide to the End,” joins Dr. Emily to talk about how her father’s prolonged death changed her perspective on death and dying. After seeing firsthand how difficult and overwhelming the process was, Shoshana set out to explore various aspects of end-of-life care, from navigating the healthcare system and hospice to green burials and the various and strange ways grief works. Listen now to hear why you should be thinking and talking to your own loved ones about death. 

Staying emotionally fit takes work and repetition. That's why the Emotionally Fit podcast with psychologist Dr. Emily Anhalt delivers short, actionable Emotional Push-Ups every Tuesday and Thursday to help you build a better practice of mental health, and surprising, funny, and shocking conversations on Taboo Tuesdays - because the things we’re most hesitant to talk about are also the most normal. Join us to kickstart your emotional fitness. Let's flex those feels and do some reps together!

EPISODE RESOURCES:

Follow Shoshana Berger on Twitter and Instagram 

Check out Soshana’s book A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death

Learn more about green burials and Better Place Forests

Read a 1996 LA Times article Rest in Space : Company Plans to Become First to Launch Cremated Remains Into Orbit

Read The Washington Post’s A public park for ashes? As cremations soar, demand for scatter gardens grows.


Thank you for listening! Follow Dr. Emily on Twitter, and don’t forget to follow, rate, review and share the show wherever you listen to podcasts! #EmotionallyFit 


The Emotionally Fit podcast is produced by Coa, your gym for mental health. Katie Sunku Wood is the show’s producer from StudioPod Media with additional editing and sound design by nodalab, and featuring music by Milano. Special thanks to the entire Coa crew!


JUMP STRAIGHT INTO:

(01:16) - How Shoshana first got interested in the topic of death - “If you think of death as an experience like every other experience we have in life, giving birth; falling in love; getting married; maybe getting divorced; raising our children; all of these huge life cycle events, death is one of them and it is a transformational event. It was kind of stunning to me how unprepared I was for it.”


(05:24) - Investigating our biases about end-of-life care - “You do not have to be dying to take advantage of palliative care. It's about making you more comfortable, and so you can be far from death. The one criteria you have to have to engage with palliative care is that you are suffering.”


(07:20) -Why Shoshana wanted to start researching and sharing about death - “In the midst of that chaos, my instinct is always, ‘Man, how is it possible that someone with a graduate degree can be so clueless about something so elemental in life?’ It's like you're book smart and completely life clueless. And I thought to myself, ‘If I'm having this much trouble, there's probably a lot of other people who are having trouble with this experience.’”


(12:29) - The benefits of being prepared for death - “We die every night that we close our eyes and we trust that that's okay. We're going to close our eyes and we're going to kind of go into oblivion, and there's something beautiful about learning from that too, that we've been practicing this our whole life.”


(22:13) - How Shoshana's perspective on death has changed - “The fear part is tricky because you have to kind of dig into what you're really afraid of. Are you afraid of oblivion? Are you afraid of just going into the darkness and what's there? Are you afraid in a much more kind of religious way of, like the fiery ovens of hell? Like a lot of people are really afraid of judgment on what that's gonna look like.”


(29:18) - Shoshana’s message for thinking about death - “One beautiful way of getting engaged with it is just really paying attention to how the world works. So, there is a natural life and death cycle to every day, every moment, every season. We are shedding thousands of cells every day. Parts of us are dying every day. Leaves falling from the trees, insects and animals dying in our midst. Death is all around us all the time, and so is renewal. So is rebirth.”


Transcripts

Shoshana (:

There is a natural life and death cycle to every day, every moment, every season. We are shedding thousands of cells every day. Parts of us are dying every day, leaves falling from the trees, insects, animals dying in our midst. Death is all around us all the time, and so is renewal. So is rebirth.

Dr. Emily (:

Welcome to Taboo Tuesday on the Emotionally Fit Podcast. I'm Dr. Emily Anhalt, and I've always loved talking about taboo subjects: Sex, money, drugs, death. Because being a therapist has taught me that the feelings we're most hesitant to talk about are also the most normal. So join me as we flex our feels by diving into things you might not say out loud, but you're definitely not the only one thinking.

Dr. Emily (:

Quick disclaimer that nothing in this podcast should be taken as professional advice, diagnosis or treatment. Because while I am a therapist, I'm not your therapist and I'm not my guests' therapist. So this is intended only to spark interesting conversation. Thanks for tuning in.

Dr. Emily (:

Hey there, Fit fans! I am so excited to be here today for Taboo Tuesday with Shoshana Berger, who is the global editorial director at IDEO, where she tells the story of how design can help us create the change we want to see in the world. She has worked on all kinds of amazing topics, everything from end of life to modern Judaism to school lunch, and she is the co-author with Dr. BJ Miller of a Beginner's Guide to the End: Practical Advice for Living Life and Facing Death. She's written for the New York Times, Time, Fast Company Wired and Courts, and she's just an absolute delight to speak with. Shoshana. Thank you so much for being here with me today.

Shoshana (:

I'm so glad to be here with you.

Dr. Emily (:

It is such a true pleasure and of all of our topics, the topic of death is interestingly one of the harder ones to find people who really want to dive into it. It seems like if I want someone to talk about sex, I can find it. If I want someone to talk about money, I can find it. But when it comes to death, I think as a whole we are not so great at confronting it head on. I really appreciate you being here. I would love it if you start with just tell me a little bit about you and how you got to this point in your very alive life up till now. We'll go from there.

Shoshana (:

Well, my whole career has been in publishing and I started out as a journalist. I was a tech and music journalist in my early twenties, and I started writing on a year of what I call a room spring. You know, go off and sew your oats. When I was just out of college, I went to Prague for a year and was slumming and writing and teaching English and pints were 25 cents and it was like the glory days of Expatriate Europe. I, through my twenties, kind of honed my writing craft and was writing for the New York Times and Wired and Salon and all those places and ended up starting my own magazine. The magazine was called Ready Made. It was a do it yourself design magazine, which was inspired by Bay Area garage resourcefulness and entrepreneurialism and the whole earth access movement where in the seventies, which is, I'm going to date myself here, but it was very much about taking the reins and owning the means of production and being self-directed and having agency in life.

Shoshana (:

I actually think it's not unrelated to where I ended up with this book, A Beginner's Guide to the End. Because if you think of death as an experience, like every other experience we have in life, giving birth, falling in love, getting married, maybe getting divorced, raising our children, all of these huge life cycle events, death is one of them. It is a transformational event. It was kind of stunning to me how unprepared I was for it when people close to me were dying and specifically when my father died. So, the book we wrote was really kind of a ready made approach to death, an instructional guide to this experience.

Dr. Emily (:

Wow. Had anything like that been written or created before?

Shoshana (:

Well, we have What To Expect When You're Expecting for the other side. But no, we didn't have a what to expect When You're expiring, if you will, which is what someone suggested we cut title the book. So no, there really wasn't a step wise approach to thinking about how you prepare yourself in terms of your own fear and dread in terms of having conversations with your family.

Shoshana (:

What do they want for the rest of their lives? How do they want their end of life experience to look? So we wanted to fill that gap and I ended up teaming up with one of the nation's great hospice and palliative care physicians, BJ Miller, who was actually a client at the global design firm where I work, IDEO and I met him on a project to think about rebranding hospice. Hospice is this incredible suite of free care we have. It's a Medicare benefit, and yet there's so much baggage and so much stigma attached to it. People think it's actually a place you go to die and that it's a death sentence and that there are private institutions that are going to take advantage of you as a patient.

Dr. Emily (:

I think I have to check my bias right here. I think if I were to describe what a hospice is, I probably would've said it's a place that you go to pass away comfortably. Will you maybe reteach me? What would you describe it as in a different way?

Shoshana (:

Oh, Emily, thank you for that prompt, because that's really good to investigate our biases around healthcare. That one's a really strong one, and I think I might have said the same before I had the experience of engaging with hospice and learning from BJ. First of all, let's talk quickly about palliative care. You do not have to be dying to take advantage of palliative care. It's about making you more comfortable. So you can be far from death. The one criteria you have to engage with palliative care is that you are suffering. Then hospice is a subset of palliative care where it has to be determined by a physician that you're dying within the next six months. That can be fairly fast and loose, right? Because prediction around prognosis is notoriously faulty. But the idea is that you are terminal and that once you've gone through palliative care, that hospice is where you decide that you are no longer going to pursue treatment.

Dr. Emily (:

That ultimately can last as long as it does.

Shoshana (:

It can. A lot of people graduate out of hospice and it turns out they're not really dying and they feel a lot better. Sometimes that's about saying no to treatments.

Dr. Emily (:

Or maybe getting the care and support you needed all along.

Shoshana (:

Exactly. Exactly.

Dr. Emily (:

That's powerful. Well, one thing I learned when looking around at my classmates in grad school about what everyone was doing their dissertation on is that if you're going to write thoroughly about something, you probably have some powerful personal connection to it. So I'd love to the extent they're comfortable here about what led you to this topic, what made you want to dive headfirst into it and share the wisdom you gained with the world.

Shoshana (:

Sure. So yes, it's write what you know. What I knew was that my dad has suffered with dementia. He was a professor at Berkeley for 50 years of bioengineering. He was basically a walking brain and we ended up in a situation where his colleagues emailed us and said, "Your father is a danger to himself and really needs to stay at home." It turns out he had been spotted at the elevator, inside the elevator with the doors open and closing, not knowing what button to push or lost in the parking lot. So he came home and he ended up living for another five years, but he faded pretty precipitously. So, it was shocking. It was shocking for my sister and I to see this man, this lion, this intellect just lose his identity. Then, we had to take his keys away and slowly people are stripped of their independence and their freedom and their sense of self.

Shoshana (:

In the midst of that, I felt so confused, so completely unprepared for how to give him the best care that we could have conversations with his doctors, navigate the healthcare system, navigate insurance, navigate long term care. It was like the most difficult thing I think our family has ever taken on. In the midst of that chaos, my instinct is always like, "Man, how is it possible that someone with a graduate degree can be so clueless about something so elemental in life?" It's like you're book smart and completely life clueless. I thought to myself, if I'm having this much trouble, there's probably a lot of other people who are having trouble with this experience and how could I take what I know about the gaps in learning and preparedness and try to help other people through this?

Dr. Emily (:

That's amazing. I'm curious, I think sometimes when something painful has happened to us and we turn it into an opportunity to learn and to teach, we end up talking about it so much that I wonder in this instance, is your relationship to it different? Is it still really painful to think about that time with your dad? Have you told the story so many times that there's distance there?

Shoshana (:

It comes in waves. I think that's what you start to know intimately about grief is that there are times when you can talk about it with a totally straight face and it's like you were talking about what you're going to eat for dinner and there are times when there's this surge and you don't even know where the wave is coming from. I was at a talk recently and I read a letter that I wrote to my daughter in the book, something that I want her to discover if I walk out of this building and I get hit by a bus. It was basically a pep talk, like, "You've got this, you don't need me. You are a fully formed human being." She's 13 years old and it was an incredible experience just writing this letter. It was such a relief to have down on paper some just a moment of transition and hand off to her. "I love you so much, I did everything I could and you've got this."

Shoshana (:

Reading that letter in public just completely broke me. I just started sobbing on stage and I kept apologizing and everyone was kind of nodding at me, reassuringly like, "Don't apologize. This is what it is. This is real." But I couldn't help but feel some shame and some embarrassment about getting so overwrought in this moment. Because again, it's like I've a veteran, I'm a journey woman, I wrote this book. But the fact is that we never know when something's going to break us. Thank God that I felt safe enough in that room to do that. Because I do think when you open up a conversation about this stuff, people are desperate to talk about it. The floodgates just open and everyone has this story.

Dr. Emily (:

Feel so poignant and meta actually, because I get the sense that the whole message is every single one of us is going to die. It's the most inevitable thing. Yet none of us is prepared. Even the person who is the expert. There just ultimately is no getting out of the fact that it's going to happen, that it's difficult and painful and scary. We so badly want that not to be true, but I almost think there's something really beautiful about, "Hey, even I am not immune, even the one who has devoted so much of my time and energy to this thing."

Shoshana (:

Totally, totally. There's this great Woody Allen quote that we have in the book. "I'm not afraid of death, I just don't want to be there when it happens."

Dr. Emily (:

Wow, that feels really. That resonates with me.

Shoshana (:

It's true what you say. I mean so many of life experiences we just can't be prepared for. Parenting is one of those two and childbirth. There's no way that someone can transmit what that's going to feel like in a way that you can really absorb it. You just got to do it. Of course, there are entire parts of our population that devote their lives to preparing for this one climactic event. I mean, Tibetan Buddhist meditate on death five times a day in a way of practicing. I remember watching the George Harrison documentary, The Beetle, and he took up meditation specifically to prepare himself for death.

Dr. Emily (:

Do you think he was any more prepared for death? I mean, I guess that's my big question is what's this change? What's the benefit of devoting more of our energy and focus and time to really looking at this thing that we all turn away from?

Shoshana (:

Well, the answer is, I don't know.

Dr. Emily (:

That's fair.

Shoshana (:

I will say that there seems to be a piece that comes at the very end that even if people are fighting it tooth and nail and going down swinging and have a lot of dread, there seems to be some kind of, I don't know if it's a biological response, if it's some kind of transcendental intervention, but there seems to be a kind of peace that comes in the final days and moments. When you think about it, we die every night that we close our eyes and we trust that that's okay. We're going to close our eyes and we're going to kind of go into oblivion. There's something beautiful about learning from that too, that we've been practicing this our whole life.

Dr. Emily (:

I love that. I even think about being in the womb and you don't know what's out there. You don't know what's going to happen to you. No baby could probably predict this insane world they're born into. So who the hell knows what happens when we leave this particular world?

Shoshana (:

Exactly. Exactly. From one dark warm space to another.

Dr. Emily (:

Wow. So how did things shift for you as you started researching and writing this book? What are things that you learned or what were unexpected feelings or anything you can share? What a process.

Shoshana (:

So many things. So first of all, I learned a lot about the mechanics of death. What happens to the body as it's shutting down?

Dr. Emily (:

Have you read Stiff by Mary Risk? That was eyeopening.

Shoshana (:

Yes. That was so good. Yes, yes, yes, yes. Also the industry around death. So the funeral industry, how people have to make a lot of choices at a moment when they're really thick in grief. So again, that's stuff that you can really decide in advance. Tell your people, "I know I want to be cremated and this is where I want you to dispose of my ashes. Or I would like to be buried in this place and I've actually put some money away for you to do that. Or I found this beautiful conservation forest and here's the tree where I want to be composted." There are lots of options out there. Now, there are all kinds of interesting options for green burial, for shooting your ashes out into space. I mean, whatever is your flavor of this. The mechanics and industry of death are really, really fascinating.

Shoshana (:

I also, on a very personal and human level, learned a lot about how many secrets people keep, which is some of the interviews turned over rocks that we were not expecting like a woman who had a police officer knock on her door and report that her husband was dead. That's the first shock. Then to hear that how he died was by self asphyxiating. Second shock. The self asphyxiating happened in a gay bath house. First shock, my husband's dead. Second shock, he did it to himself. Third shock, he was gay. So imagine what that woman's grief looked like. Not only is she mourning just losing her partner, but suddenly their whole life together feels like kind of a lie. What they call that is complicated grief because it's not what they'd say is a clean grief where it's like, "Okay, you're mourning and that lasts for a certain period of time, but then it fades."

Shoshana (:

With complicated grief, there's so much other stuff that you're dealing with so much confusion around, "How could he have not confessed this to me? This whole time I thought we had one kind of relationship and now I see things completely differently." That can attenuate grief so that it doesn't let you go, so that you are in its grip for much longer. It's a traumatic thing. It takes a lot more therapy and a lot more figuring out how to let go of this person because you of course can't blame them, can't go to them and have a conversation with them. You can't settle the score. I mean,

Dr. Emily (:

Yeah, I see that with patients a lot. Patients who have lost parents that mostly met their needs have a really different kind of grief than patients who have lost parents who failed them in some way because with the parent who has failed you when they die, also die as any hope for the wanted parent to emerge. So you're mourn the one you had and you're mourn the one that some part of you always hoped might appear.

Shoshana (:

There's this amazing moment that we had with Ira Byock, who's another palliative care physician. He wrote the book, The Four Things That Matter Most. Those are the four things that you want to make sure you say to someone before you die. "Please forgive me, I forgive you, thank you, and I love you." It turns out just those four things can make a world of difference in how people are able to let you go and how you are able to let go. We asked, I promise this is coming back around to what we were talking about. We asked Ira, "Hey, it's been 10 years since you wrote that book. Is there a fifth thing in your research? Have you discovered a fifth thing?" He said, "Actually, yes." He said, "There are people in my practice who I talked to, 65 year old men who say, I still wish that I had heard from my father, 'I'm so proud of you.'"

Dr. Emily (:

That's the most human thing.

Shoshana (:

So heartbreaking. Those simple things that kids spend their entire lives hoping to hear from their parents. So, just to your point about the complication of not having those reconciliations, those resolutions, and the fact is that not everyone is going to. Sometimes resolution is impossible. Sometimes there's too much that's broken and there's too much hurt.

Dr. Emily (:

I also think about, people often feel a lot of pressure when they give a gift because they think the gift is supposed to sum up the entire relationship. I also think something like that happens with death. It's like the last thing you said to me has to somehow represent our entire relationship or whatever happens in your death, has to be everything. That's so much pressure.

Shoshana (:

Totally. Can we not put more pressure on the dying? Also, again, the way it was with my dad was he had not been conscious for two days. Before that he had not been able to communicate with us for a good couple of years. So he was gone.

Dr. Emily (:

Wow.

Shoshana (:

We had done a lot of pre grieving, my sister and I, where we felt like we had had good sit on the edge of the bed together, holding hands, just sobbing our eyes out about our dad who was gone and he was still alive. He was still walking the earth, but we had had to let him go because the father we knew was gone. People go through these profound chronic illnesses and they are not the person that you knew and you've already grieved losing them. So the moment of death can actually feel much more like a relief. There's a lot of shame around that out there. Everyone's going to expect you to be dressed in black and not be able to function for a while. We were certainly sad when my father finally died, but we're also a little bit relieved. It was the end of his suffering. It was the end of us having to care for this person who was no longer there.

Dr. Emily (:

I'm so glad you say that. I think it's extremely true in the situation you experienced, which is, it sounds like you lost your dad in phases. But then I even think it's pretty normal and healthy that we might have relief even just because we have mixed feelings about the people in our lives and it just doesn't feel like there's a lot of room for both feelings. Can't we be devastated and relieved at the same time? They're not mutually exclusive.

Shoshana (:

I mean, you're a therapist so you know this, but I think that's such a valuable life lesson. When are we ever not ambivalent about anything?

Dr. Emily (:

Never.

Shoshana (:

It's always kind of in process of figuring it out.

Dr. Emily (:

So having gone through this with your father and then you wrote this book, I can only imagine how many stories that you heard and firsthand experiences you got to witness, what changed in terms of the way you think about your own death?

Shoshana (:

So that was surprising because I really thought this was going to cure my fear.

Dr. Emily (:

That'd be nice.

Shoshana (:

You get closer to something and it's like that exposure therapy. Afraid of flying, go take a bunch of flights and work through it. And I think to some extent it did round off the corners of my fear because I feel much more prepared for the whole experience. The fear part is tricky because you have to dig into what you're really afraid of. Are you afraid of oblivion? Are you afraid of just going into the darkness and what's there? Are you afraid in a much more kind of religious way of the fiery ovens of hell? A lot of people are really afraid of judgment on what that's going to look like. Are you afraid of missing out? FOMO, I'm not going to see my daughter get married, have her first baby, whatever it is.

Dr. Emily (:

I'll add mine, which is none of those things scare me as much as suffering.

Shoshana (:

I'm so glad you brought that up.

Dr. Emily (:

Life is more about suffering than death is.

Shoshana (:

Yes. I think a lot of people share that fear. It turns out on that one you're probably okay. It's not that you're not going to suffer at all. Of course dying involves suffering. But BJ was a huge comfort to me in knowing that we are really, really good at pain care now. So we can really make people very comfortable towards the end of their life. It's not going to alleviate all suffering of course. There is the suffering of just dread of not knowing what comes next. But, in terms of the pain part of the suffering, we've really covered that off in many ways. So, that's comforting to know. So once you unpack where your fear really lies, then it's helpful. Okay. So for me it's the oblivion part and it's also the fear of missing out. So that just makes you much more able to think about, okay, knowing that I really don't want to miss out. Am I really living it now? Am I really showing up for every moment.

Dr. Emily (:

From FOMO to JOBI. Fear of missing out to joy of being in.

Shoshana (:

Nice. Gosh, I wish we had met before we wrote this book. That's a good one. Yeah. Are you really showing up in your life and are you looking people in the eye and putting down your phone when you're in conversation and taking people in? It really changed the way that I say hello and goodbye to people. When I say hello to people, I really look at them and see them and try to absorb their energy for, I'm going to sound very California and woo woo for a minute. But when I'm saying goodbye to people, I really look them in the eye and say, "I love you and I want you to acknowledge that we're saying goodbye right now." Because it's all practice. It's all practice for that bigger goodbye.

Dr. Emily (:

So it sounds like emotionally what's shifted for you is a refocus on being present for the time you are alive. Then logistically, what has it change for you in terms of the way that you plan for your own death? Have you already figured out what you want and you've told people about it? What's that look like for you?

Shoshana (:

I'm kind of the most annoying person around this, around talking about death because I have drilled it down to a science and I've actually written a very elaborate advanced directive about what happens if I lose my cognitive capacity like my dad did, which I'm fairly certain it's going to happen. I did my 23 and me and I've got the genetic marker.

Dr. Emily (:

Me too.

Shoshana (:

So, you're just aware of that and you're like, "Okay, knowing that that's more probable than the general population, what do I need my loved ones to know?" What I wrote to my husband, because he's my healthcare proxy, my healthcare agent is "Look, if I don't recognize you and I can't do the things that I love on my own, eat, and walk, I want to have comfort care only. What that means is that if I get the flu or pneumonia, please do not give me antibiotics. Please do not give me treatment. Don't send me to the hospital unless I fall and break my arm, yes, I'll take a cast. But I don't want curative help if I'm in that state. I want to kind of let whatever little bug comes along take me in a natural way."

Shoshana (:

Also, I'm pretty clear that, I mean, I haven't done this yet, but there's this great new conservation land green burial movement. There's A Better Place Forests in the South Bay, near Santa Cruz where you can walk through a forest and choose your tree and get cremated and you're composted into the root system of that tree. There's a page in our book about how nature dies. It turns out in say the 300 year life of an old tree, it spends the first hundred years growing, the second hundred years just sharing intelligence through its root system with the forest network that it's in and transmitting its best nutrients to the ecosystem around it, allowing the fungi to eat up any toxins. It's an incredibly intricate forest floor intelligent network. So the next hundred years are spent in that conversation. Then the last hundred years of a tree's life are actually the most productive and it's actively dying.

Dr. Emily (:

Third of its life. Wow.

Shoshana (:

Yeah. These are not exact numbers, but if you think of it as a kind of arc that last third of the tree's life is an active dying period where instead of hoarding its nutrients, the tree is actively shedding its most valuable nutrients into the soil around it to incubate new life.

Dr. Emily (:

That hit me somewhere. That's so beautiful.

Shoshana (:

It's a really beautiful metaphor.

Dr. Emily (:

What's the human equivalent of that?

Shoshana (:

Right, exactly. So what can we learn about tree centered dying? Tree centered design? Could we think about the end of our lives as being a time of mentorship, generosity, giving, pairing down our own lives and giving it back to the people we love and the communities that we're in.

Dr. Emily (:

That's really powerful. So I'm curious if you have any words of wisdom for people who maybe haven't spent a lot of time thinking about death beyond whatever they might have experienced in their family life, whatever it might be. I think even people who've experienced death don't always spend a lot of time thinking about it. Where might a person start?

Shoshana (:

Yeah, it's really hard when you're in your twenties to feel like this is a relevant conversation. I mean, some people are just naturally drawn to that heat. I've seen a lot of young people at our talks and I was like, "What brought you here?" They're just curious. I think a lot of those people find their way to it because they've had some kind of experience. A grandparent died, or an uncle or an aunt, or maybe a sibling died. It turns out one in seven of us will have someone in our immediate family die by the time we're 18.

Dr. Emily (:

Wow. One in seven.

Shoshana (:

One in seven. So, that's a pretty staggering statistic. So people have pretty immediate experience pretty early on. What we tried to remind people of in the book is that there are moments throughout life when it's a good time to engage. So first time you step into the DMV and you're asked, "Do you want to be an organ donor?" Great moment, great touch point for people to actually think about, "Huh? What does that mean? What does organ donation do for the world? You save eight lives every time you donate your organs, and that's a pretty direct and heroic way to give back."

Shoshana (:

If you think about life, of course, having a family, having a partner, you become responsible for each other. You start thinking about what does that responsibility look like if something happens to me? But I'd say if you feel pretty immune to this, one beautiful way of getting engaged with it is just really paying attention to how the world works. So there is a natural life and death cycle to every day, every moment, every season. We are shedding thousands of cells every day. Parts of us are dying every day, leaves falling from the trees, insects, animals dying in our midst. Death is all around us all the time. So is renewal. So is rebirth. Just tapping into that, I feel like, is such a powerful awakening to the cycles of life. I'm so much more aware of it now.

Dr. Emily (:

So I have to say this conversation has just been really special. For whatever reason, perhaps my Jewish heritage death has always kind of been on my mind, my sort of hashtag.

Shoshana (:

Jews are obsessed with death.

Dr. Emily (:

We really are, man. We really are. My hashtag is, "Don't forget about death." But for all of the reasons that you said that when you look at the things that are scary, it opens and unlocks other beautiful things. There is no birth without death. So it's really nice to talk with a fellow death obsessed human. The way that I end each podcast episode is I give you a list of taboo questions that it kind of spam the gamut of sex, drugs, death, therapy, money, all of it.

Shoshana (:

Love it. Let's do it.

Dr. Emily (:

You can just read them over and when you have one that you feel comfortable or comfortably uncomfortable answering, read it out loud and then share your answer. you can pick one in the death category or just whatever strikes you.

Shoshana (:

Wow, this is a good list. Okay, I got it. What is a taboo topic you love speaking about when you find like-minded people?

Dr. Emily (:

Nice.

Shoshana (:

So I think the most underserved conversation, if a conversation could be underserved in our culture, is the one about how fucking hard it is to be married and to be in partnership.

Dr. Emily (:

Yes.

Shoshana (:

I'm going to ask for forgiveness from my husband for talking about this though, he'll probably never hear this podcast. I think the institution is set up to fail. I think there's way too much pressure on married people to get it right. I don't think anyone really knows how to. I think the people who say they are, it's completely beyond my knowledge. I don't know how they figured that out and some secret part of me thinks that they're lying or deceiving themselves. I think it's the hardest thing we do. I think that when I find people who feel equally broken in relationship and feel like they just don't want to get divorced and don't want to throw a grenade into the middle of the room, but often feel like this is just untenable.

Shoshana (:

I don't know how to feel good in this situation. Part of that is me. I know that half of that is my own baggage, my own hooks, my own familial stuff that I'm bringing to this relationship. Yet, I can't find my way out of that. Of course, therapy can help and it has helped us, but I don't think people talk nearly enough. In the perfect world, I feel like couples would be in a room together doing group therapy on a weekly basis. 10 couples in a room, just having it out and then sharing strategies for how they get through it. I do that with my girlfriends, but you know, you kind of need to be in a place where you are in an equally broken relationship. So, sometimes I end up saying things out loud that I can't even believe I'm saying out loud to my friends and some of them are like, "Oh yeah, totally, I'm in the same place." Some of them are like, "Oh, I'm so sorry." Then I just feel like the pathetic one who couldn't figure it out.

Dr. Emily (:

Well, I mean the whole institution was created at a time when we were living literally half as long.

Shoshana (:

Exactly, exactly. So now we're supposed to have 50, 60, 70 year marriage. Really?

Dr. Emily (:

That are totally sustainable. Yeah. I'm with you there.

Shoshana (:

Yeah.

Dr. Emily (:

I also really appreciate what you're saying, that we are pretty good at convincing ourselves that we're alone in a particular thing. Sometimes just being in a room with other people navigating it makes a difference because you're like, "Oh, it's not so bad if I'm not the only one," kind of thing.

Shoshana (:

Yeah, Yeah. Part of the problem with these institutions like marriage and the nuclear family is that they're isolating. They depend on people being siloed in the perfect suburban house with 2.5 kids and the Volvo and the whole model is really about isolating yourself and making this little platonic ideal of a relationship and a family work. I don't think it's set up to work. I think it's set up to be under pressure at all times.

Dr. Emily (:

There's also so many examples out there of these faux perfect marriages and then so many examples out there of just marriages exploding into a million pieces. I'm like, where are all the examples of people hurting and fighting and then repairing and moving on and then doing it again, which is so more true

Shoshana (:

Such a good point. That is such a good point. That's why I love that showtime. It's in counseling or in treatment?

Dr. Emily (:

In treatment.

Shoshana (:

Oh my God, that show is so satisfying.

Dr. Emily (:

It's great.

Shoshana (:

Because you're actually in the room where all the shit is hitting the fan and you're hearing people talk about the real stuff. But how many people actually see that show? That should just be common parlance. I think people should be talking about this and workshopping this all the time in the same way that you're in a mother's group when you have a baby, because of course it's hard. Of course it's isolating and nobody knows how to do it and there's no instruction manual.

Dr. Emily (:

Even the way parents will go to some private place to make up, but they fought more publicly. How powerful would be if the next day after kids kind of witnessed their parents not doing too well, the parents came back and said, "Here's how we work through that together." There's just not a full life cycle. I mean, to bring it all back to birth and death. It's the same thing with conflict. There's conflict and repair and conflict and repair, and we're just not really taught how to get through the whole cycle.

Shoshana (:

No, no. Just sweep it under the rug. You're reminding me that I need to do some work with my kids and explain to them why we fight and how we repair. Cause all the evidence and data show that if kids see you repair, then fighting no longer becomes this apocalyptic thing where it's the whole sky is going to fall. Right.

Dr. Emily (:

I think about it, conflict in a relationship is exercise to a muscle, like exercise damages the muscle, but then if you repair it with fuel and rest, it grows back stronger. Not only can it withstand more pressure next time, but it also heals better the next time. Right.

Shoshana (:

That's a good metaphor.

Dr. Emily (:

Yeah. If we can repair conflict in a relationship, the relationship actually ends up stronger than it was before the conflict. But if you don't do the repair, then it damages permanently. Well, this conversation's given me life. I realized one more question I have to throw out there, which is a whole conversation about death. I want to know what makes you feel most alive?

Shoshana (:

What makes me feel most alive is dancing.

Dr. Emily (:

Oh my gosh. I have the same answer.

Shoshana (:

Really?

Dr. Emily (:

Yes. One time I was sitting with a patient and I kept having these visions of myself dancing. When I took it to supervision, I realized it's because I felt this deadness with the patient and I had to bring myself to life somehow. That's how I did.

Shoshana (:

That's amazing. Yeah. Yeah. I just recently, we had a big party and we were dancing for probably four hours straight and I was wearing high heels and usually I can't wear heels. I didn't feel anything. I didn't care about anything. It was total freedom, total elation.

Dr. Emily (:

That's amazing.

Shoshana (:

Yeah. That's good stuff.

Dr. Emily (:

Thank you so much.

Shoshana (:

This was so fun. Thanks for having me.

Dr. Emily (:

Absolutely. For everyone listening, you need to check out this book. What's the best way? Are you a Amazon promoter?

Shoshana (:

Yeah.

Dr. Emily (:

Should people go to Barnes and Noble and actually get a copy?

Shoshana (:

Yeah. Well support your independent bookstore and go buy it in the store. A Beginner's Guide to the End.

Dr. Emily (:

Perfect. Thank you so much. Thank you. Take care. Thanks for listening to Emotionally Fit hosted by me, Dr. Emily Anhalt. New Taboo Tuesdays drop every other week. How did today's taboo subject land with you? Tweet your experience with the hashtag #EmotionallyFit and follow me at @DrEmilyAnhalt. Please rate, review, follow and share the show wherever you listen to podcasts. This podcast is produced by Coa, your gym for mental health, where you can take live therapist led classes online from group sessions to therapist matchmaking, Coa will help you build your emotional fitness routine. Head to joincoa.com. That's join-c-o-a.com to learn more, and follow us on Twitter and Instagram at @joincoa. From StudioPod Media in San Francisco, our producer is Katie Sunku Wood. Music is by Milano. Special thanks to the entire Coa crew!

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