On Being with Krista Tippett

Rachel Naomi Remen

How We Live With Loss

Last Updated

June 2, 2022


Original Air Date

August 11, 2005

The conversation of this hour always rises as an early experience that imprinted everything that came after at On Being. Dr. Rachel Naomi Remen is one of the wise people in our world. She trained as a doctor in a generation that understood death as a failure of medicine. Yet her lifelong struggle with Crohn’s Disease and her pioneering work with cancer patients shaped her view of life. Becoming whole, she teaches, is not about eradicating our wounds and weaknesses; rather, the way we deal with losses, large and small, shapes our capacity to be present to all of our experiences. That arresting notion, and the distinction Rachel Naomi Remen draws between curing and healing, makes this an urgent offering to our world — of healing we are all called to receive and to give.

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Guest

Image of Rachel Naomi Remen

Rachel Naomi Remen is founder of the Remen Institute for the Study of Health and Illness and a Professor of Family Medicine at the Boonshoft School of Medicine at Wright State University in Ohio. She’s also a Clinical Professor Emeritus of Family and Community Medicine at UC San Francisco School of Medicine, that’s where she developed “The Healer’s Art,” her course for medical students. Her beloved books include Kitchen Table Wisdom and My Grandfather’s Blessings. And in September, 2022, she will publish her first book for children: The Birthday of the World: A Story about Finding Light in Everyone and Everything.

Transcript

Transcription by Heather Wang

Krista Tippett, host: We are nearing two decades of this show, and as I’ve been looking and listening back to ponder and to celebrate, the conversation of this hour always rises as an early experience that imprinted everything that came after. The physician Rachel Naomi Remen is one of the wise people in our world. She trained as a doctor in a generation that understood death as a failure of medicine. Yet her lifelong struggle with Crohn’s Disease and her pioneering work with cancer patients shaped her view of life and medicine. With a vantage point on the brilliance and the boundaries of science, she embodies a message I have heard, in some key, from every wise and graceful life I’ve been privileged to draw out. Living well — becoming whole — is not about eradicating our wounds and weaknesses. In fact, she says, the way we deal with losses, large and small, shapes our capacity to be present to all of our experiences. That arresting notion, and the distinction Rachel Naomi Remen draws between curing and healing, makes this an urgent offering to our world: the healing we are all called to receive and to give, even in a universe of loss.

I’m Krista Tippett, and this is On Being.

[music: “Seven League Boots” by Zoë Keating]

Dr. Rachel Naomi Remen’s beloved books Kitchen Table Wisdom and My Grandfather’s Blessings have been translated into 23 languages. A course she developed, “The Healer’s Art,” is taught in medical schools around the world. I spoke with her in the earliest years of this show, in 2005, which is brought home to me by my mention of my 7-year-old son, who is now 24.

You grew up, I believe, as you say, “surrounded by doctors and one mystic.”

Dr. Rachel Naomi Remen: [laughs] Doctors, a few nurses, and one mystic.

Tippett: And a few nurses.

Dr. Remen: It’s true.

Tippett: And that would’ve been your orthodox rabbi grandfather.

Dr. Remen: And student of kabbalah.

Tippett: Student of kabbalah, before it was a fashion trend. [laughs]

Dr. Remen: Very much so. [laughs] And he was a flaming mystic, and he was also a magnificent storyteller.

Tippett: Well, what do you mean when you say he was a “flaming mystic”? I mean, describe that to me.

Dr. Remen: What that means — oh, it means many different things. It can mean a scholarly thing, like the study of a school of mysticism, like kabbalah. But it’s also a way of seeing the world. My grandfather felt that the world was in constant communication with him; that there was a spirit in the world, a God in the world that could be spoken to and could respond, at all times; that there was a presence in the world that was holy and sacred, and that he was in constant dialogue with this as he went through the events of his day.

I think mysticism can be defined in many different ways. I didn’t know that my grandfather was a mystic.

Tippett: No?

Dr. Remen: I just knew that the world that he lived in was the world I wanted to live in, too.

Tippett: You recount this idea of the kabbalah — which I had known, but, I don’t know, I think maybe because you’re a storyteller, it was very vivid for me — this idea that at the beginning of creation, the “holy” was broken up. Right?

Dr. Remen: Oh, the story of the first day of the world. [laughs]

Tippett: Flew into sparks at the beginning of things.

Dr. Remen: The story of the birthday of the world, yes.

Tippett: Is that how he told it to you?

Dr. Remen: Yes, exactly.

Tippett: And how would he describe it?

Dr. Remen: Actually, Krista, this was my fourth birthday present, this story. And if you’d like, I’ll tell it to you.

Tippett: Yes, do.

Dr. Remen: So this is the story of the birthday of the world. In the beginning, there was only the holy darkness, the Ein Sof, the source of life. And then, in the course of history, at a moment in time, this world, the world of a thousand thousand things, emerged from the heart of the holy darkness as a great ray of light.

And then, perhaps because this is a Jewish story, there was an accident. [laughs] And the vessels containing the light of the world, the wholeness of the world, broke. And the wholeness of the world, the light of the world, was scattered into a thousand thousand fragments of light. And they fell into all events and all people, where they remain deeply hidden until this very day.

Now, according to my grandfather, the whole human race is a response to this accident. We are here because we are born with the capacity to find the hidden light in all events and all people, to lift it up and make it visible once again, and thereby to restore the innate wholeness of the world. This is a very important story for our times, that we heal the world one heart at a time. And this task is called “tikkun olam,” in Hebrew — “restoring the world.”

Tippett: Is there a connection between the story of the sparks and tikkun olam, in Jewish tradition? Are they bound together?

Dr. Remen: They’re exactly the same.

Tippett: I did not know that those two come together.

Dr. Remen: Tikkun olam is the restoration of the world. And this is, of course, a collective task. It involves all people who have ever been born, all people presently alive, all people yet to be born — we are all healers of the world.

And that story opens a sense of possibility. It’s not about healing the world by making a huge difference. It’s about healing the world that touches you, that’s around you.

Tippett: The world to which you have proximity.

Dr. Remen: That’s where our power is. Many people feel powerless in today’s situation.

Tippett: I mean, when you use a phrase like that just out of nowhere, “heal the world,” it sounds like a dream — a nice, sweet ideal, completely impossible.

Dr. Remen: It’s a very old story; it comes from the 14th century. And it’s a different way of looking at our power. And I suspect it has a key for us in our present situation — a very important key.

Tippett: Say some more about that. Think that through for me.

Dr. Remen: Well, I don’t want to talk politics here. I’m not a person who is a political person, in the usual sense of that word. But I think that we all feel that we’re not enough to make a difference, that we need to be more, somehow — either wealthier or more educated or, somehow or other, different than the people we are. And according to this story, we are exactly what’s needed.

And to just wonder about that a little, what if we were exactly what’s needed? What then? How would I live if I was exactly what’s needed to heal the world? And I think these kinds of questions are very important questions.

Tippett: And exactly what’s needed is precisely the given story of your life.

Dr. Remen: Exactly. Exactly. And the story — people will say, about a story like the story of tikkun olam, the birthday of the world, Well, how can I make a difference, when I’m so wounded myself? How can I make a difference, when I feel so not-enough?

But it’s our very wounds that enable us to make a difference. We are the right people, just as we are. For example, my own wounds, my own sufferings, have enabled me to feel compassion for the sufferings of others. Without my suffering, I wouldn’t understand the suffering of others or be able to connect to them. My loneliness enables me to recognize the loneliness in other people, even when it’s covered over; to find them where they have become lost in the dark, and sit with them; and to know that just by sitting with them, eventually they will find what they need in order to move forward.

There was another story in my family. My grandmother — my grandfather’s wife, the rebbetzin — in Russia, they were quite poor, and they often fed members of the community. Being the rabbi’s home, people came there. So my grandmother was used to making things stretch and go a long way. And in this country, her icebox was filled with food, when they came over to America, because she had been hungry in Russia. The kitchen was the center of the house. The icebox was filled with food. Every nook and cranny was full to the brim.

And it was told, in my family, that if someone opened the door of the icebox without caution, an egg might fall out and break on the kitchen floor. [laughs] And my grandmother’s response to these accidents was always the same. Apparently, she would look at the broken egg with satisfaction and say, Aha — today, we have a sponge cake.

Tippett: [laughs] Oh, that’s good.

Dr. Remen: And so perhaps this is about our wounds, that the fact is that life is full of losses and disappointments, and the art of living is to make of them something that can nourish others.

And, you know, when I first was diagnosed, I was 15 years old.

Tippett: With Crohn’s disease?

Dr. Remen: Yeah. And the doctors came and told me that I had this incurable disease, nobody knew what caused it, I would have multiple surgeries, and I could expect to be dead by the time I was 40. Not my dream of the future, as a 15-year-old.

I went into shock. And my mother was with me, and she did not comfort me or cuddle me. She took my hand, and she reminded me of this story. And she said, Rachel, we will make a sponge cake. And it’s taken me a long time to find the recipe that’s mine, my own recipe for this. But I had a sense of what might be possible and that I needed to look, to find the way for myself. And that’s what a story can do.

Tippett: I want to turn a corner, but before I do, I want to tell you a story, briefly …

Dr. Remen: Oh, good.

Tippett: … which is just that I went home, having all this in my head, and my son, who’s seven, has something of a mystical bent, I think. I mean, children do, in a way, but he really — he’s got a lot of depth, and he’s thinking hard. And I told him this story about the beginning of the universe, and about the sparks and the holy, flying out. And he just listened to me so raptly, and he said, I like that.

Dr. Remen: I was told this story, let’s see, 63 years ago, and my response to it was exactly the same. And that’s very important about stories. They touch something that is human in us and is probably unchanging. Perhaps this is why parables — the important knowledge is passed through stories. It’s what holds a culture together. Culture has a story, and every person in it participates in that story. And so story and not facts are the way the world is made up. The world is made up of stories; it’s not made up of facts.

Tippett: Although we tell ourselves facts to piece together the story.

Dr. Remen: Well, the facts are the bones of the story, if you want to think of it that way. I mean, the facts are, for example, that I have had Crohn’s disease for 52 years. I’ve had eight major surgeries. But that doesn’t tell you about my journey, and what’s happened to me because of that, and what it means to live with an illness like this and discover the power of being a human being.

And you know, whenever there’s a crisis, like 9/11 — do you notice how the whole of the United States turned towards the stories, in order to —

Tippett: You mean, “where I was …”

Dr. Remen: Where I was, what happened, what happened in those buildings, what happened to the people who were connected to the people in those buildings — because that is the only way we can make sense out of life, is through the stories. And the facts are, a certain number of people died there, but the stories are about the greatness of being a human being and the vulnerability of being a human being.

Tippett: I think you make such an interesting contrast, also, with the fact that we live with all kinds of stories in our culture — forms of entertainment, as well as information — but that those stories always have beginnings and endings. And you say that the stories of our lives, stories as they function in life, take time. Real stories take time.

Dr. Remen: There’s a powerful saying that we tell each other stories — sometimes we need a story more than food, in order to live. They tell us about who we are, what is possible for us, what we might call upon. They also remind us we’re not alone with whatever faces us and that there are resources, both within us and in the larger world and in the unseen world, that may be cooperating with us in our struggle to find a way to deal with challenges.

And when I say a story doesn’t have an ending, for example, part of my story is you telling your little boy the story of the birthday of the world. That’s also part of my grandfather’s story, right? And your little boy has never met my grandfather, but perhaps my grandfather will be woven into his life in some way. It may be a very small way, or it may not; I don’t know. But in that sense, no one’s story is ever finished.

[music: “Pianoflikkan” by Nutid]

Tippett: I’m Krista Tippett, and this is On Being, today with Dr. Rachel Naomi Remen.

[music: “Pianoflikkan” by Nutid]

Did you train, also, as a psychiatrist?

Dr. Remen: No. [laughs]

Tippett: But you have really become a professional listener as well as a physician, haven’t you? Is that fair?

Dr. Remen: Well, I would say yes; I’m trained, but I have no credentials. I have spent, I would say, 3,000 hours in humanistic psychology workshops, learning various techniques — imagery, symbol work, sand tray work, poetry, art — anything that would enable people to discover the strength in them, discover who they are. And so I have a very extensive training, but I don’t have a degree in psychology or psychiatry. I have taught in schools of psychology; I’ve taught health psychology and all of this. But I am a physician; I am an M.D.

Tippett: It seems to me that you have — at the same time, that you have had a medical practice, worked as a physician, and specializing, I believe, in working with people who have cancer. Is that right?

Dr. Remen: Yes. That all came about — I think I’ve made very few decisions in my life. It’s like I find myself in a situation, and it’s very clear what the next step is. [laughs] And I take that step. And I think this is basically my modus operandi for leading my life.

But I wanted — well, we had grants to study the doctor-patient relationship. And then a new administration came in, and we couldn’t get the final piece of funding to finish this work. And I spent six months writing grants and then ran out of money. And people had been calling me up, because I’d been writing about these things, and saying, Can I come and talk to you about my problem?

And I’d say, No, no, no, I don’t do that. I’m not a psychologist. I’m not a psychiatrist. I don’t do that.

Tippett: Other physicians, right?

Dr. Remen: No, these are people, sick people, friends, friends of friends — all sorts of people.

And then, when I ran out of money, I said, Well, [laughs] I guess I do this. So I found a little office on a houseboat in Sausalito, the first office, and a few people came by. And I decided I would go and speak to my colleagues in the medical community and tell them that I wanted to work with sick people and with their emotional issues and their struggle to live with disease, and also to recover from disease.

And most of the physicians in the community said, Terrific. Who has the time to talk to these people? Once I run out of treatments, I have nothing more to offer anyone — and that’s another whole story in and of itself, of course — and let me send you over my patients.

And within months, I had a completely full practice, and most of the people were people with cancer. And I began to work as a person who focused my efforts on working with people with cancer.

Tippett: Why do you think that most of the people your colleagues ended up sending you were people with cancer? Was that a particular life experience that they weren’t equipped to handle in its fullness?

Dr. Remen: The hospice movement is fairly recent in all of this.

Tippett: So this was before hospice.

Dr. Remen: This was before that. I mean, you knew how to treat the cancer. That’s what we were trained to do, in medical school. We’re trained differently now. The issues of the person with the cancer were something that — we would refer people to psychiatrists

But these aren’t people who have psychological illness. These are people who are confronted with a very, very challenging life situation and who need to mobilize their full strength and the strength of their families, in order to meet with these things, to live well despite cancer.

Tippett: As you say, you probably didn’t plan this. I’m sure you didn’t plan this. But what you said earlier, about how we’re all given the lives we have and that that’s good enough, and even what’s wrong with us is part of what we have — it seems like it’s been really important in your medical practice, and also in how you’ve helped other physicians, how you’ve reflected on your profession, that you also have struggled, in your life, with this debilitating illness of Crohn’s disease, which you were told was fatal, also, earlier.

Dr. Remen: But Krista, I don’t think it’s what’s wrong with us. Sometimes what appears to be a catastrophe, over time becomes a strong foundation from which to live a good life. It’s possible to live a good life, even though it isn’t an easy life. And I think that’s one of the best-kept secrets in America. [laughs]

Tippett: You say that the pursuit of perfection has become a major addiction of our time. I mean, we throw that word “addiction” around a lot, but I’ve never heard anyone talk about our pursuit of perfection as an addiction.

Dr. Remen: Well, I think perfection is the booby prize in life, actually. It’s very isolating, very separating, and it’s also impossible to achieve. So you’re always struggling to become something you’re not.

But this is one of the great — it sounds funny. I was going to say, one of the great joys of working with people on the edge of life. The view from the edge of life is so much clearer than the view that most of us have — that what seems to be important is much more simple and accessible for everybody, which is who you’ve touched on your way through life, who’s touched you. What you’re leaving behind you in the hearts and minds of other people is far more important than whatever wealth you may have accumulated.

Tippett: Now, what is your understanding of why that simple truth that we’ve all heard said — and it makes so much sense — why is that hard for us, for human beings, to take seriously before we get to that edge of life — or, for many of us?

Dr. Remen: I think we get distracted. We get distracted by stories other people have told us about ourselves: that we are not enough, that we will be happy if we have material goods, that material goods will keep us safe. None of these stories are true. What is true is that what we have is each other.

Tippett: And again, that’s so — it’s lovely and it’s clearly true, and yet we don’t…

Dr. Remen: We don’t live there.

Tippett: We don’t live there.

Dr. Remen: And this is why I see people with cancer, and other people who have encountered very difficult experiences in their lives, as teachers, teachers of wisdom. It’s as if the wisdom to live well is, at the moment, the repository of this wisdom are the sick people in our culture, the ill people in our culture.

[music: “Alice” by Grandbrothers]

Tippett: After a short break, more with Dr. Rachel Naomi Remen.

We are in a season of growth, of endings and new beginnings, here at On Being, as you may have heard. We will be here on public radio for a few more weeks, and then take a rest, and recharge, and come back with a season of new shows — only as a podcast — in the fall. So On Being is not ending, but the next adventure will create space for me to be differently present in a changed world.

And I very much hope you’ll come with us, and, for now, help us celebrate these first 20 years. So on Wednesday, June 15, you are warmly invited to an online listening party to some of my favorite voices and moments of conversation across the years — and some of yours.

Go to onbeing.org/staywithus to register and learn more. Again, that’s onbeing.org/staywithus.

[music: “Alice” by Grandbrothers]

I’m Krista Tippett, and this is On Being, today with the wise physician and lyrical writer Rachel Naomi Remen. Her lifelong struggle with Crohn’s Disease shaped her practice of medicine, and she in turn has changed the art of healing and medical training. This is a defining conversation from the earliest years of this show, and I hear it now as an urgent offering to our world of healing we are all called to receive and to give, even in a universe of loss.

What have you learned through your work with other physicians, your attempt to listen to other physicians and to, let’s say, work on the healing of the field of medicine? How did that come about, that you started doing that, actively?

Dr. Remen: Well, there are a couple of — again, the next step appears. [laughs] In listening to the people with cancer at the retreats, I would hear stories about their experience with the medical system and with the people in it. And every so often, someone would go back and tell their doctor what they had experienced at the retreat, and the doctor would call. And I was the medical director — I am the medical director, still, at the retreat. And the doctor would say, Aren’t you doing anything like this for us? [laughs]

And I began to realize how wounded I had been by my training. It’s a very, very, very difficult experience.

Tippett: Medical school?

Dr. Remen: And it’s a 24/7 — medical school and medical training. It goes on for years — seven, eight years. And I began to realize how I had been healed by these people with cancer; how I had moved from a person focused on curing, and truly coming to understand that we are all healers of one another, that people have been healing each other since the beginning, and that my power to cure was a small part of my power to help people — and wanting to help my profession, as well.

The people who go into medicine are extraordinary. I developed a course called “The Healer’s Art” — gosh, that was in 1992. And I taught it at UCSF. It’s a very unusual course. It’s an experiential course. You usually don’t do these things — certainly, not back then — in medical school. And it’s about enabling young people to recognize that who they are is as important as what they know, in terms of what they’re going to be able to make a difference in people’s lives. It is validating, for students, the human agenda in illness. It reminds them that healing is a different relationship than a curing relationship. And it reminds them of their power to make a difference through their human response and connection to their patients. It basically reminds the students of the lineage of medicine.

I happen to see medicine as a spiritual path; that’s my personal thing — that medicine is a spiritual path, which is characterized by compassion, harmlessness, service, reverence for life, courage, and love. The basic qualities of the Hippocratic Oath are not scientific qualities. They are the qualities of human relationship, and they are spiritual qualities,  very profound spiritual qualities. And we remind the students of the lineage. And this is young students. And we enable them to see that they belong to it, exactly as they are — that they are already the right people to become physicians; all they need to do is learn the science and learn the facts, without allowing themselves to be changed by that process in any way.

Tippett: What is it, in that process? I mean, it seems ironic, and the stories you tell about how destructive medical school can be — seem ironic. We do think of people who go to medical school, as you say, as extraordinary …

Dr. Remen: They are.

Tippett: … as people who are giving themselves over to this profession that is about healing; and what you describe is an experience that is —

Dr. Remen: We learn how to cure.

Now, this is changing. I mean, obviously, 10 years ago this course would not be in any of these schools. UCSF was forward-looking enough to give it a home. But I think the world is changing. I think we’re recognizing the limitations of our science. Our science — you know that little phrase, “living better through science”? There’s no question that we live better through science. But to live well is going to take something more than that.

I mean, if I look at myself, without the eight major surgeries and the many medications — and I still take many medications that keep me alive — I wouldn’t be here. But with only these things, I’d be an invalid.

Tippett: Right. I wanted to ask, a minute ago — when you said you think about medicine as a spiritual path. And yet it seems that — medicine is also a science, at least in our culture, and it seems that at some point, somehow, the science overwhelmed — or the scientific mindset, even among those of us who are outsiders, how we view science, overwhelmed whatever spiritual element there is in that.

Dr. Remen: Well, you have to understand how natural that is. I’ll tell you about myself. When I was a child, I had severe otitis media …

Tippett: An ear infection.

Dr. Remen: … and developed an abscess in the bone of my skull. And sulfa drugs were available in the nick of time.

And that power was a very heady power. There was insulin for people with diabetes. I mean, you have to think about what this meant for people.

Tippett: You’ve seen all of this in your lifetime.

Dr. Remen: Oh my God, yes. This meant a huge amount for people. We thought we could cure everything. But it turns out that we can only cure a small amount of human suffering. The rest of it needs to be healed, and that’s different. It’s different.

I think science defines life in its own way, but life is larger than science. Life is filled with mystery, courage, heroism, love — all these things that we can witness but not measure, or even understand, but they make our lives valuable anyway.

Tippett: I would say the destructive aspects of life are also mysterious and unmeasurable, right? I mean, we can also observe evil.

Dr. Remen: I think that’s true; of course, that’s true. But the issue is not to eradicate evil. I’m not sure evil can be eradicated. I think it’s part of the human condition. The issue is to commit yourself to what’s important to you.

Tippett: You question the term “objectivity” that is part of a scientific framework. I think that word — as a journalist, I’ll say, it’s also — it’s a value that’s been held up in many disciplines in our culture. And it’s coming into question in many disciplines. You know, is it enough? Or, are we kidding ourselves when we say we’re objective? And if we’re kidding ourselves, then do we need to look at it all over again?

Dr. Remen: Objectivity is cognitive, in a funny kind of way, isn’t it? But the thing that seems important is that in order to understand life, we need to look at it through many different dimensions, and that sometimes we understand another person the best and know how to help them the best, when we are not objective.

Tippett: Well, there’s another simple statement for you, but we don’t always act on it.

Dr. Remen: But look, objectivity is a bias, like anything else. [laughs] I mean, the funniest story in — I think this one is in Kitchen Table Wisdom — [laughs] this happened at Sloan Kettering, many, many years ago, when I was an intern, first-year doctor, and we had a man come into the hospital to die. And people used to come into the hospital to die — there wasn’t a hospice movement then — so that if your care was too difficult to achieve at home, you were admitted to the hospital to die. And this man came in riddled with cancer. He had an osteosarcoma, and his bones looked like Swiss cheese; all these lesions were cancer, and there were big snowballs of cancer in his lungs. And in the two weeks or so that he was with us in the hospital, all of these lesions disappeared, and they never came back, Krista.

Now, were we in awe? Certainly not. We were frustrated. Obviously, someone had misdiagnosed him.

So we sent the slides out to pathologists all over the country, and the pathologists sent back the slides, saying, Classic osteogenic sarcoma. So then we had a grand rounds. And the slides were shown, the X-rays were shown, the man himself was shown — [laughs] and the conclusion of this large group of doctors was that the chemotherapy, which had been stopped 11 months before, had suddenly worked.

Now, the embarrassing part of this story is that I believed this for the next 15 years. I never questioned this conclusion. I think too great a scientific objectivity can make you blind.

Tippett: What do you think now?

Dr. Remen: I think that that was one of the purest encounters with mystery that I have ever had in my life. It makes me wonder about who we are, what’s possible for us, how this world really operates. I have no answers, but I have a lot of questions, and those questions have helped me to live, better than any answers I might find.

[music: “Hem” by Tvärvägen]

Tippett: I’m Krista Tippett, and this is On Being, today with Dr. Rachel Naomi Remen.

Something that I found interesting, when you write about working with physicians — that you try to make them comfortable with loss and to understand that as a part of their jobs, their lives, their working lives. But again, you’re talking about physicians, but you end up making interesting observations that apply to all the rest of us, about loss. Talk to me about what you’ve learned about loss.

Dr. Remen: Well, [laughs] now we’re going to initiate a five-hour — smaller, Krista. Make it smaller. [laughs]

Tippett: Here’s the sentence that I wrote down: “The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life.”

Dr. Remen: I think this is absolutely correct.

Tippett: That is such a shocking thought, really.

Dr. Remen: I think it’s correct. I also think that no one is comfortable with loss; that being that we’re a technological culture, our wish, or our first response — let’s put it this way. Our first response to loss is to try and fix it. When we are in the presence of a loss that cannot be fixed, which is a great many losses, we feel helpless and uncomfortable, and we have a tendency to run away; either emotionally or actually, distance ourselves. And fixing is too small a strategy to deal with loss.

What we teach the students is something very simple.

Tippett: The medical students?

Dr. Remen: Yeah. We teach them the power of their presence, of simply being there and listening and witnessing another person and caring about another person’s loss — letting it matter. Letting it matter.

We do six hours on loss, two three-hour sessions, and the students have a very simple instruction, which is they are asked to remember a story of loss from their own lives. And loss — let’s put it differently: a time when things didn’t go their way; when they were disappointed; when they lost a dream or a relationship or even a family member; a death.

They get to choose that, and then they spend six hours in small groups, talking about their loss. And the group has one instruction: listen generously. Now, prior to this exercise, we do another exercise with them, where we ask them to remember a time of disappointment and loss and to remember someone who helped them. What did that person do? What did they say? What message did they deliver that was helpful to them at a hard time in their lives? And they write these things down very concretely.

And then we ask them to remember a time of loss in their lives and remember someone who wanted to help them but was not of help to them. What did that person do and say, and what message did they deliver, and how did they deliver the message?

And they write that down. And then we make a big list. What are all the things that helped? Listened to me for as long as I needed to talk; talked to me in the same way after my loss as they did before my loss; sat with me; touched me; brought me food. What were the things that didn’t help? Gave me advice without knowing the full story; made me feel that the loss was my fault. So we gather up the wisdom about what helps loss to heal, from a group of about 100 students and faculty. And it’s all very simple stuff. And the only instruction is: listen generously.

Tippett: Again, it takes me back to how we began, talking about the power of stories in human lives, and your analogy that the stories are the flesh we put on the bones of the facts about our lives. And I also hear — I think it’s so powerful just to think about this obvious fact, but again, one of these obvious facts we don’t name very often — that loss is not just catastrophic death; that there are many different kinds of losses in our lives all the time, and then this kind of stunning idea that you bring forth: that the way we deal with those losses, large and small, can really help or get in the way of the way we deal with the rest of our lives — with what we have, not just what we’ve lost.

Dr. Remen: I think this is so. I really do. How can we put this? Most people try to hold onto the thing that is no longer part of their lives, and they stop themselves in their lives, in that way. I have come to see loss as a stage in a process. It’s not the bottom line. It’s not the end of the story. What happens next is very, very important.

And people respond to losses in different ways. When I first became ill, I was enraged. I hated all the well people. I felt that I was a victim and this was unfair. I was angry for about 10 years. I think all of that anger was my will to live, expressed in a very negative way. And people often are angry in the setting of a terrible loss; they often feel envious of other people. And this is a starting place.

But over time, things evolve and change. And at the very least, people who have lost a great deal can recognize that they are not victims, they are survivors. They are people who have found the strength to move through something unimaginable to them, perhaps, in the past. And just asking people that question — You have suffered a really deep loss; what have you called upon for your strength? — most people haven’t even noticed their strength. They’re completely focused on their pain.

Tippett: On their loss.

Dr. Remen: On their pain. And isn’t that natural, Krista?

Tippett: There’s something very hopeful all the way through your writing, even when it is about loss and the hard, dark side of being human. I mean, you do insist — and I’m not sure that modern psychiatry insists on this — that integrity is achievable for everyone, that you see it come to people, and sometimes it comes to people in crisis. You say wholeness is never lost, it is only forgotten.

Dr. Remen: Wholeness includes all of our wounds. It includes all of our vulnerabilities. It is our authentic self, and it doesn’t sit in judgment on our wounds or our vulnerabilities. It simply says, this is the way we connect to one another. Often, we connect through our wounds, through the wisdom we have gained, the growth that has happened to us. Because we have been wounded allows us to be of help to other people. So it’s not a moral judgment. Integrity simply means what is true; to live from the place in you that has the greatest truth. And that truth is always evolving, as well.

[music: “Dawn” by Jacob Montague]

Tippett: Dr. Rachel Naomi Remen is founder of the Remen Institute for the Study of Health and Illness and a professor of family medicine at the Boonshoft School of Medicine at Wright State University in Ohio. She’s also a clinical professor emeritus of family and community medicine at UC San Francisco School of Medicine. That’s where she developed “The Healer’s Art,” her course for medical students. Her beloved books include Kitchen Table Wisdom and My Grandfather’s Blessings.  And as we produce this I am thrilled to announce that Rachel Naomi Remen is publishing her first book for children in September 2022. And it is called The Birthday of the World: A Story about Finding Light in Everyone and Everything.

[music: “Dawn” by Jacob Montague]

The On Being Project is: Chris Heagle, Laurén Drommerhausen, Erin Colasacco, Eddie Gonzalez, Lilian Vo, Lucas Johnson, Suzette Burley, Zack Rose, Colleen Scheck, Julie Siple, Gretchen Honnold, Jhaleh Akhavan, Pádraig Ó Tuama, Gautam Srikishan, April Adamson, Ashley Her, Matt Martinez, Amy Chatelaine, Cameron Mussar, and Kayla Edwards.

[music: “Time” by City of the Sun]

The On Being Project is located on Dakota land. Our lovely theme music is provided and composed by Zoë Keating. And the last voice that you hear singing at the end of our show is Cameron Kinghorn.

On Being is an independent, nonprofit production of The On Being Project. It is distributed to public radio stations by WNYC Studios. I created this show at American Public Media.

Our funding partners include:

The Fetzer Institute, helping to build the spiritual foundation for a loving world. Find them at fetzer.org;

Kalliopeia Foundation, dedicated to reconnecting ecology, culture, and spirituality, supporting organizations and initiatives that uphold a sacred relationship with life on Earth. Learn more at kalliopeia.org;

The Osprey Foundation, a catalyst for empowered, healthy, and fulfilled lives;

And the Lilly Endowment, an Indianapolis-based, private family foundation, dedicated to its founders’ interests in religion, community development, and education.

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