Donald Rosenstein, MD is Professor of Psychiatry and Medicine at the University of North Carolina where he is Director of the Comprehensive Cancer Support Program and Vice-Chair of the Division of Hospital Psychiatry. Dr. Rosenstein earned his undergraduate degree in psychology from Wesleyan University, his medical degree from Northwestern University School of Medicine, and completed his residency training in psychiatry at Yale University. He is the former Clinical Director of the National Institute of Mental Health (NIMH) and Past-President of the Academy of Psychosomatic Medicine. He is currently President of the American Psychosocial Oncology Society. He is coauthor of the book, The Group: Severn Widowed Fathers Reimagine Life which offers a singular perspective on grief by telling the true story of seven men who were raising children on their own after the deaths of their wives.
Justin Yopp is a clinical psychologist and Assistant Professor in the Department of Psychiatry at UNC. He is a member of the UNC Comprehensive Cancer Support Program at the North Carolina Cancer Hospital where he provides inpatient as well as outpatient assessment and therapeutic services for children and adolescents with cancer. He also works with children whose parents have serious medical illnesses such as cancer. His research is in the area of children’s adaptation to cancer. He is coauthor of the book, The Group: Seven Widowed Fathers Reimagine Life.
Discussion Questions for this conversation are available, here.
Justin and Don’s The Widowed Parent organization offers amazing resources for grieving parents, kids, and spouse. Click here to access all of the resources available.
Find Justin and Don’s book The Group: Seven Widowed Fathers Reimagine Life, which tells the actual stories about that first support grout that met (with permission, of course).
Here’s a great explanation of the Dual Process Model of Bereavement.
Read more about D.W. Winnicott’s notion of the good enough mother by clicking here.
Read Don and Justin’s piece in TIME Magazine: How 7 Widowed Fathers Overcame Their Fear That The “Wrong Parent Died.”
Kate Bowler: Hi, I’m Kate Bowler, and this is Everything Happens. Look, the world loves us when we are good, better, best. But this is a podcast for when you want to stop feeling guilty that you’re not living your best life now. We’re not always having the juicing spree of our lives. I used to have my own delusion of living my best life now. I’m a Duke professor, wine and cheese enthusiast, wife and mom. Instagram gold. Then I was diagnosed with stage four cancer. That was four years ago and I’m still here. And now I get it. Life is a chronic condition. The self-help and wellness industry will try to tell you that you can always fix your life. Eat this and you won’t get sick. Lose this weight and you’ll never be lonely. Believe with your whole heart and God will provide. Keep this attitude and the money is yours. But I’m here to look into your gorgeous eyes and say, hey, there are some things you can fix and some things you can’t. And it’s OK that life isn’t always better. We can find beauty and meaning and truth, but there’s no cure to being human. So let’s be friends on that journey. Let’s be human together.
Kate Bowler: Sometimes we talk about grief and loss. Like it’s a story about the past. Oh, look, that’s over. It’s gone. He’s gone. She’s never coming back. Our dream job will never come around again. Our kid has moved a few states away and we used to have dinner together every Sunday. When our dad died, he seemed to take everything with him. But sometimes we lose more than the past. We lose the future. The people we imagined ourselves being and loving, that little glimmer of who we could have become if everything had not come apart. Loss is about the past, the present and the future. And today’s episode is about how we start to swim around in the deep waters of where that leaves us sometimes drowning. Today, I feel so lucky to get to talk to two experts on the subject. Dr. Don Rosenstein and Dr. Justin Yopp, who both work at my school’s rival, the University of North Carolina. But don’t worry. I think we can still be friends. Dr. Don Rosenstein is director of the UNC Comprehensive Cancer Support Program and serves as the head of General Adult Psychiatry. He came to UNC from the National Institutes of Health, which is a really big deal. Dr Justin Yopp is a clinical psychologist and assistant professor in the Department of Psychiatry at the University of North Carolina. He came to UNC from St. Jude Children’s Research Hospital, which is also a really big deal. Don and Justin co-lead the widowed parent program at UNC and coauthored the book, The Group: Seven Widowed Fathers Reimagined Life. Don and Justin, it is such a gift to be able to talk with you today.
Justin Yopp: It’s wonderful to be here. We’ve been looking forward to this and are really excited to have this time with you.
Don Rosenstein: And we’re also fans of your work in a big way.
K.B.: Oh, thanks, friends. Well, that’s it. We can wrap it up. That’s pretty much all I needed so thanks.
J.Y.: Thanks, Kate.
K.B.: You’re both clinicians who work specifically with cancer patients. Don, I think there’s something really special about working with cancer patients. What kind of care do you think they need?
D.R: You know, everyone comes to their cancer experience with their unique background, life trajectories, set of expectations. It’s just so clear the longer I’m in this business that the most important part of this work is understanding who is going through what they’re going through. There are lots and lots of ways in which the cancer experience, the breast cancer experience, the lung cancer experience, whatever it is, it has a lot of similarities from case to case in terms of, you know, the choreography of diagnosis and treatment and so on. But what it means is it’s infinitely unique and special and a real privilege to try to uncover that and to appreciate what, what this all means for the person going through it. Because every time I make assumptions about it, I am humbled.
K.B.: Mm hmm. I like too that what I hear in your answer is not like meaning. Hear the quotation marks. I feel like meaning is like a gritty it’s a gritty thing that plays out in, like, all the particularities of people’s lives.
K.B.: I think too, there’s a story that we’re increasingly as a society realizing is a myth. And I certainly believed it, which is that young, seemingly healthy bodies are immune to cancer. But that isn’t what you see, is it, Justin? You’re nodding here.
J.Y.: No, we, we don’t. So cancer strikes all ages, including kids, young adults and young parents. And to kind of piggyback on what Don said. I’m just so struck at how when we have the opportunity to meet with people very soon after their diagnosis just how their lives are turned upside down. And like so many of us, we have this imagined life of how things are going to unfold for us and how things are going to go. And then in all kinds of ways during our lives that, you know, that that road changes.
K.B.: Yeah. Yeah.
J.Y.: And there’s a lot of loss there. Right? There’s a loss of your expected future. There’s a loss of your health security. Along with the more tangible losses. And, you know, Don and I are, I think, very grateful we are in the position to help people when they are at their lowest and really when they’re trying to to chart a new path.
K.B.: There is no clear math for enoughness. You know, you don’t get to be like, all right. Well, you’re this age. Congratulations. You’ve experienced the summation of. There’s no easy way to, like, help people achieve that feeling of completeness when like it just like we’re always just hungry, like hungry to live.
J.Y.: Yeah. And and Don and I both have patients who are in their 70s and 80s and above, and they’re receiving treatment and they’re pushing forward like anyone else. And apparently not that they’ve had enough of life by any means. That being said, when it is a young person who has cancer, or certainly a young parent, the unfairness of it, and the potential future loss and tragedy is certainly more striking.
K.B.: Yeah. Yeah, I always picture like the people who stand in line at the mic that I’ve met, like a zillion of them and it’s like the mom with the little baby on her hip. She’s in the world I understand, so she’s like stage four, colon cancer. And I know there’s like a less than 10 percent for someone like that. And all she wants to know is like, yes, but.
D.R: Right. Yeah.
K.B.: A few years ago, you had a series of young moms who died at the same time leaving bereaved dads in their wake. And you wanted to refer them to a support group. What did you find?
J.Y.: Yeah, this happened when Don and I had several young mothers who sadly did die from their cancer and we got to thinking about their husbands and wanted to refer them to a local support group and for widowed fathers, and very quickly found that that type of support did not exist. And it didn’t take much for us to begin to imagine what a young father who had just lost his wife and his children at home, grieving his own loss, trying to help his children grieve, and trying to even imagine the next day that those men would be really be hurting. And so, Don, I took the opportunity and thought, you know what, if there’s nothing else out there, why not just start one ourself? And that’s really where our work in the widowed parent program began was with that realization and that decision to put together a support group with those few men. And we found a few others. And it’s actually been 10 years now since Don and I started that first support group. And that that was an eye opening experience for me and even for Don, who’s been doing this longer than I have to, to really, some of the unique pain that these men were feeling and some of the shared pain that we all experience when we suffer what feels like unimaginable losses.
D.R: We didn’t get into this work kind of, in a sense intentionally. We got into it because we didn’t feel that we could not do it. In other words, the cancer support program at UNC just like it is anywhere is principally focused on people living with cancer and their loved ones and how you can help them through their cancer journey and hopefully with a really great outcome. I was not hired to be a bereavement expert. Right? And certainly the leadership of the cancer hospital, I mean, you know it’s a house of hope, as it should be. And, you know, when you’re talking about young, widowed parents, that is a obvious reminder that it doesn’t always go the way we want it to go. And it’s not really what our day jobs were. And so I didn’t even know the term side hustle until one of the research assistants kind of I heard it once and said what’s a side hustle said, oh, kind of like, you know, because. So Justin and I did this in the evening, and neither one of us was a grief or bereavement expert.
K.B.: Yeah. So, Don, am I right? You guys initially scheduled six sessions. You’re like yep, that will start this off.
D.R: We had some notion that we would have a time limited monthly support group where Justin and I might give a brief little mini lecture for a half an hour on what do five year olds know about death as opposed to 12 year olds and kind of and what do we know about what predicts better and worse outcomes for grieving parents? And then we’d open it up for discussion. And after the first very, very poignant, very painful session that we had where each of the men shared their stories about how they got there, the very next meeting when we kind of had this little lecture planned out and one of the guys before his bottom hit the seat said, Guys, I got a problem. Friday night is the anniversary of my wife’s death. And I thought we would go to the cemetery and have a little moment. But my teenage daughter wants to go to a hockey game with her friends, and I don’t know what to do.
D.R: And they were off and running. And so we just scrapped that. And then I think later Justin talked about what the plan had been for how many sessions we’d have. And one of the guys in the group said why? You know, this seems to be valuable and worthwhile and helpful and so why stop it necessarily? It went on for four years.
J.Y.: Don, and I went into it with an idea of what we’d be doing. And we learned that first night and the second night that the fathers had just as much to teach us if not more than we had to teach them. And really what they needed to hear from was not a couple of shrinks as much as each other. And so some of the best work that Don and I did was to just shut up and listen and let the men steer the conversation, let the men decide what they wanted to discuss with each other in the group’s.
J.Y.: You know, those seven guys, just just beautiful men, amazing fathers, each of them came into this not knowing, you know, what to do from one day to the next and feeling extremely isolated in their grief and really alone.
J.Y.: And to sit with other people who could kind of get it and could know what they were going through and didn’t give them some platitudes or didn’t tell them things that just wanted to make them roll their eyes or, you know, clench their fist. But people who really got it. People who they could celebrate successes with along the way and who they could empathize and support at the inevitable setbacks.
D.R: Not to mention joke with each other in ways that in ways that they couldn’t joke with anyone else. I mean, if you were someone walking by the hallway during any one of those, you know, support groups, you would very likely hear some raucous laughter and they could say things to each other and laugh about it that they would be deeply offended by if somebody else said it to them. But they knew each other well enough and they knew everyone’s heart was in the right place. And there were, there were actually very funny, tragically funny things that they all experienced and they can kind of share together. So that was that was actually really amazing to see for us.
K.B.: Yeah. Yeah, yeah. As a historian, whenever we do like history of mourning and grieving, we always say grief is women’s work. This is the stuff that historically women show up for and make meals for and have language for. And sounds like so much of what you were exploring was how rare it is to create space for men to dig into language that’s not just handed to them.
D.R: You know, I’ve I’ve actually wondered about what it is that’s the active ingredient in a group, because when I’ve studied this, one of the things that’s fascinating to me is that somewhat intellectually unsatisfying but fascinating is that it almost doesn’t matter kind of whether it’s a educational group or a psychodynamic group or a cognitive behavioral therapy group or a faith based group.
K.B.: Yeah, yeah.
D.R: There’s something about the groupness.
D.R: That I think and the group cohesion that’s most important. And so what was amazing to me is watching these guys come together as a group, become coherent as a group, feel like they were responsible to each other in a way beyond themselves.
D.R: And if you were a fly on the wall in any of those nights, you would have seen people in pain being honest with each other, crying with each other, challenging each other sometimes when they had an experience that didn’t when someone describes something that didn’t resonate with the other, but always feeling like we are experiencing something similar and we’re going to help each other. That groupness is magic when it happens.
K.B.: That’s exactly the word I was thinking. Like the magic of moving from I to we.
K.B.: Is a really powerful thing.
J.Y.: And I think part of that magic was that it gave these men the chance to give to others to give to each other.
K.B.: Yeah. Yeah.
J.Y.: Because for years during their wives illness, they had been just been on the receiving end of help from others. And then certainly after the wives had died, whether it was casseroles or sympathy or people offering to take their kids to carpools, all that was needed. But it was also a lot of receiving and that wasn’t always easy for these guys. And the chance to turn those tables a little bit and and and to give back and to help someone else.
J.Y.: And I think was was really restorative and is part of that groupness magic that we were just talking about.
K.B.: Yeah. Yeah. The move to mutuality, that makes sense because it does feel terrible to just feel persistently tragic, I get over being tragic pretty quickly. So out of this experiment, you co-founded the Widowed Parent Project. What kind of support do you all provide?
J.Y.: There are tens of thousands of newly widowed parents in this country alone each year. And the number of resources available for these parents is scant at best. And so that’s really why we created the Website widowedparent.org. That’s why the fathers and the mothers in our support groups have volunteered to be videoed and and are on the Website, speaking in their own words, offering support to those who may who may check out the Website. You know, there’s really no reason why support groups and other resources shouldn’t be available to these young men and young women. It’s crucial not just for the widowed parents, psychological health and coping and moving forward, but also, of course, for the children. The single strongest determinant of how a parentally bereaved child copes is how the surviving parent copes. And so by helping the parent, you’re by extension helping the child and the family unit.
D.R: The fantasy that we had was that there might be a dad who finally got his kids to bed and kind of went upstairs and opened up a computer and Googled widowed father and might land there and actually be able to find something that would be helpful.
J.Y.: Our hope is that this work that we’re doing locally in Chapel Hill is going to take root and expand everywhere. And there’s some signs of that. There are, I think, about seven or eight support groups around the country that we know of right now. And those are listed on our Website.
D.R: And there’s really no reason why they shouldn’t be everywhere and our in our personal experience. And certainly the testimony from the guys and the women who we have worked with would tell you just how invaluable their presence in each other’s lives has been and how it has helped them not move on, but move forward.
K.B.: Well, and you’re speaking to this historian’s heart that what you’re describing is both experiential and research driven, which just makes me so happy. One of the things I love about doing this podcast is I learn new language and I learned some really helpful vocabulary from your book. You describe two different types of stressors for grief. Can you tell me a little bit more about the dual process model?
D.R: So when we were first getting asked this, Justin and I kind of felt a little embarrassed that we didn’t know more about grief and bereavement. And so, you know, we’re academics. And so we tried to teach ourselves.
K.B.: Totally, I will learn everything. Leave me alone for one summer, I’ll come back. I’ll have something to say.
D.R: Right. We started reading more. And Justin came across this model called the Dual Process Model of Bereavement, which was first written about by two psychologists in the Netherlands. Shoot and Stroebe. What people who have suffered a substantial loss contend with are two different sets of stresses. One set of stresses has to do with the loss itself, just what you would imagine, something you had and lost, a person you had and loss, a job you had, a limb you had an ability, a house you may have had, you know, looking backwards, missing something, longing for something, needing to deal with what it is like to be currently living without someone or something that was important to you.
D.R: And that was contrasted with what they called restoration oriented stresses, which have to do with restoration of life moving forward. What needs to happen now? So in the case of the fathers in our group, this fit perfectly because they would miss their wives terribly. There would be an empty seat at the dinner table. There would be, there was one story was the kid wanted, one of their kids wanted to know if they should put up a Christmas stocking for mom after she had died. There are just so many reminders of the intact family that you had that you no longer have. And so there was a lot of looking back. But from the day after their wives died, these men had to get their kids up in the morning and bathed and dressed and ready for school and lunches made. And they had to keep their jobs and they had to do the laundry and they had to basically keep the trains running with forward thinking, restoration oriented stressors. And then eventually at some point, consider whether they wanted new relationships.
D.R: And the idea behind this model is that rather than passing from one stage of grief in a linear fashion to the next, the way things actually work is that people will oscillate back and forth between those two different types of stresses. Is that if you get stuck in one of those set of stressors or the other exclusively, then you’re going to struggle more. And it’s healthy to go back and forth.
J.Y.: And, you know, when when we mentioned this to the men, they all start nodding their heads and it makes sense right away. You know, they all oscillate back and forth within the span of minutes. Right. You know, they’re lost in thought about their wife and then their kid is banging on the table because they don’t have any food. And so they have to cook dinner. But that reminds them that mom used to cook a special dinner and they can’t do that. And then it’s just kind of this back and forth, especially early on. And over time that attenuates and the oscillation back and forth isn’t as dizzying. And it starts to settle down a little bit. And that’s when people, I think, start to feel like they’re getting a little handle on it. And then, you know, a song comes on the radio or for whatever reason, it’s a tough day or a tough moment. And rather than feeling like it’s a setback and questioning, oh, my God, what’s wrong with me? I thought I was past this. This model, the dual process model accounts for that and allows for that and it doesn’t categorize it as a setback. It’s part of the natural flow. Looking back and moving forward.
J.Y.: No one’s ever over this kind of loss. And when we talk about it with the guys, I think the realization that they don’t have to be over it or they don’t have to be better or that they can have a bad moment or a bad day or a bad week and that doesn’t mean that they’ve backslid all the way back to day one. That’s such a forgiving notion and allows these men to have, be compassionate toward themselves and in the group toward each other.
K.B.: Yeah, yeah. Because it’s so much more dynamic for people who have that kind of before and after the fault line in our lives have been drawn. And just giving us a little more permission to kind of be on both sides of that line is really compassionate.
D.R: You can also lose something that you’ve never had.
K.B.: Yes. Yes. Say more about that, Don. That’s so good.
D.R: So the notion there is that all of us have a, an idea of how our lives are going to unfold. And and we project out into the future. And of course, the future isn’t promised to any of us. But you still have to kind of know, you know, have a general sense that, you know, there’s the next step is you’re going down the steps. And sometimes when you miss count or whatever, then you’re jolted by that. And so this idea of having a loss of an imagined future was at the heart of this work, because I had a professor once in residency, a guy named Jeff Lustman, psychoanalyst, and he was the first one to really kind of turn me on to this notion. But the idea of loss being as much about the future as about the past. And I didn’t get it at first. And part of it was I was working at the time with a, in a V.A. hospital, with a number of Vietnam veterans who were really stuck. And they kept session after session, they’d want to talk about the things that they had seen or done during the war, and they were always backward looking. And then in my supervision with Dr. Lustman he kept talking about how their notion of what their life was going to be disappeared in the war. And they don’t they don’t have a new imagined trajectory. And that’s what they need help with. And boy, is that true of any widowed parent. Right? It’s like, okay, I know what I had and I know what I thought I was going to get, but that doesn’t exist anymore. So how in the world?
K.B.: Yeah. All my horizons are off. Yes.
D.R: Yeah. Because you got to do it again knowing more than ever before that, that it’s it’s not guaranteed.
D.R: So you have to start to try to rebuild a new future, reimagine your life. And that is hard, hard work that takes a long time. And is absolutely possible but we see it time and time again. And that kind of came one night when I shared my experience with having a son with profound autism because that was my experience of having to essentially mourn the loss of who I imagined my son would be. And he’s someone different now. But early on. My son didn’t die. But my fantasy of being able to play tennis with my son, that did die. And I had to mourn that and figure out a new imagined future as a dad.
K.B.: That is so real, asking people to reimagine hope after they’ve lost something is so different than if you’re just a regular, beautiful, oblivious person who is never, like, felt themselves bleeding out. Getting up is easy. Getting back up is hard.
J.Y.: Good way to put it.
K.B.: Like there’s such a courage. I wonder how you feel being around these people and the way it’s resonating your lives. I love being around that kind of courage.
J.Y.: Yeah. Don and I, at the end of each session, we usually sit and talk about what we heard from the guys or what we learned that evening. We will sit and talk for a long time. And it I think it I think it energizes us. I think it jazzes us, which sounds maybe unusual to have that feeling after grief support group.
J.Y.: And I think it really informs our work here in the cancer hospital. It’s a different kind of loss here, but there are some parallels. And and the idea that you have to, you know, for people who go through treatment and and maybe get better and try and move forward in their lives to trust that they’re OK or to trust that they can move forward when they’ve had the rug pulled out for them already. That that takes that takes a little bit of a leap of faith. It take a belief in something in which you don’t have proof and once you’ve already been bitten, it takes a little courage. And I think that’s part of our job as mental health clinicians and became the work of group when we were in the groups themselves for these men to encourage each other to do this and to set examples for each other of how they can take some risk and moving forward and whether it’s whether it’s daring to love again, whether it’s learning from your peers and seeing people do it, supporting them, and then and then get a little shot of courage from that yourself. Invaluable, invaluable.
K.B.: It sounds too like lowering the bar in a kind and helpful way has been also really productive. You championed the idea of the good enough father. What is that?
D.R.: So Donald Winnicott was another psychoanalyst in England, and in the 1950s he introduced this notion of the good enough mother. And my interpretation of large literature was that perfect parenting is neither possible nor desirable, that if you’re going to have healthy children who grow up with the ability to tolerate frustration, to handle adversity, to be flexible in their thinking, to kind of handle what life throws your way and to not somehow have every need met, the nanosecond you identify and call for that need, what you have to do is you kind of have to miss a little bit. And so it’s good enough sounds kind of like average, but that’s not really what I think he was getting at. That there has to be the meeting of basic needs, empathy and responsivity and kindness and love and fun and all the things you think of as a good mother, a good father. But it sure can’t and even shouldn’t be perfect. And that a lot of people have in health and in sickness and in bereavement have these ridiculous notions of what it is that they are supposed to provide for their kids. So when these guys heard this idea that you don’t have to be perfect, you can’t be perfect, you don’t even want to be perfect as fathers because they were feeling, like they had to be father and mother and good cop all the time, whereas they may have, like, been good cop, bad cop from time to time with their partners. And I think it was another liberating notion for them.
K.B.: Yeah, that sounds liberating to me.
D.R.: It should be really to any parent.
K.B.: Well, it’s it’s you know, because what you’re saying about grieving the future is I just didn’t have a category for cancer mom in my head that felt acceptable. It felt like, you know, that a vision of who I thought I was gonna be as a mom just wouldn’t be able to be possible and that I would do my best. You know, you have like like a like salvaging model. And I I love people who’ve given me vision and language for the idea that, like, it’s in the moving through that we can help give our best gifts and that maybe as a parent, like protecting them from everything is not the ultimate goal. That there can be other beautiful things that happen just because we’re glitchy and just because things didn’t turn out the way we we hoped they would. I’m grateful for the way that you like are opening up new language and permission for people in the middle of loss to say that we we put each other back together.
K.B.: Don and Justin, I love your giant research brains and your big soft hearts and the way you’ve been walking people through really complicated grief. Thank you so much for having this conversation with me today.
D.R.: Kate, what you’re doing is really, really cool.
K.B.: Oh, thanks.
K.B.: Don and Justin in their research and their work with patients, and their absolutely adorable friendship, have a really profound reminder for all those of us who feel like we have to put ourselves back together. People are taken apart all the time. As their book reminds us, 10,000 people become widowed parents in the United States every year. And between cancer and bereavement and raising kids with disabilities and caring for aging parents. And, you know, just growing old itself. We are losing things every day. But Don and Justin learned something quite profound. There was a magic in togetherness. There is a magic in moving from an “I” to a “WE”. Yes, it’s risky. Telling your story, being known, complaining again about the thing you worried might sound cliche by now. Shouldn’t we be over it already? But we know, we who are on the other side of loss, that we are moving all the time between the people we thought we’d be and the person we are today. Right now. Still not sure if you’re ever going to take your vitamins and get eight hours of sleep or not cry when you think about all you’ve lost. But when we are together, we remind each other. Yes, you’ll get back up again today. Yes, you’ll get those kids cereal or you’ll rub lotion on your mom’s hands. Yes, you’ll go to work or come up with something better to do with retirement hours. You will try again. You know, you will, because someone else is pretty damn sure you can. If you’re more alone than you meant to be today, hang in there. We can’t wait to see you try.
K.B.: This podcast wouldn’t be possible without the generosity of the Lilly Endowment. Huge thank you to my team. Jessica Richie, Keith Weston, Harriet Putman and J.J. Dickinson. OK, before I go, my team here at the Everything Happens project would love to learn more about you. Would you be willing to answer a few questions through a quick online survey? If so, head over to tinyurl.com/ehlistens. We’re so grateful for the gifts of this listening community and want to continue to bring you conversations and guests you’ll enjoy. Thanks so much. This is Everything Happens with me, Kate Bowler.