Sunday Book Review: Anxiety the missing stage of grief, by Claire Bidwell-Smith

It's not the NYT, but it IS Sunday, and this IS a book review, so as Benny would say:
"it's not false advertising if I think it's true, Freddy!"

A few months ago Claire Bidwell Smith sent me a copy of her latest book -- Anxiety: the missing stage of grief. Full disclosure: I’ve never met Claire, but we have friends in common and her husband is close to Nina’s extended family. None of this was a factor in my assessment of the book. I have no stake except as a reader in the demographic the author is targeting. But still, cards on the table. 

First a spoiler: I have little criticism to offer. The book is practical, well-written, clear, and provides helpful resources beyond the text. I recommend it to anyone who has experienced the loss of a love one, regardless of whether your chief issue is anxiety. 

In fact, that’s my critical angle for this book. I never thought of myself as an anxious person. Nina battled generalized anxiety for years, she had panic attacks worrying that she had a brain tumor or that the kids had some hidden regressive, degenerative conditions. She worried herself sick until she learned to control it and still fought off anxiety despite artfully deploying all the cognitive behavioral tools at her disposal – that is until she was diagnosed with cancer. 

When Nina’s cancer happened, and particularly when it became terminal, she realized that this was the heretofore Terrible Thing she'd long dreaded. She also realized that, while it was terrible, it was just a new twist in her existing life, not some worm hole opening up to the terror dimension. She handled it much as she’d handled everything else up to that point, with a deep consideration for the impact on those around her and curiosity about the meaning to be drawn or created from this turn of events. 

By contrast, I never felt anxiety was an issue for me. Depression, sure. Anger, frustration, compulsive behavior. Hosts of other thigs. Enough to keep my psychotherapist from worrying about his golden years. But when it came to worrying, I always just figured why bother? 

When it becomes an issue, I’ll deal with it. As I read this book, though, I started to realize a lot of what I’d ascribed to “other issues” was really just a manifestation of anxiety. My “what, me, worry?” wasn’t so much a predisposition not to worry, but an unconscious decision to defer anxiety. 

There are a lot of ways to avoid dealing with anxiety, or even identifying it. 

If there’s any thing critical I can say about the book it’s that doesn’t contain any startling revelations or bold new theories. It is a clever synthesis of a lot of contemporary thinking on grief and anxiety. But that’s not exactly a criticism; to me it’s one of the book’s chief strengths. Ms. Bidwell Smith isn’t selling this book as a cutting edge discovery of profound genius. In fact, she appears to have very little ego involved in her project, which makes it both more digestible and effective.

Not only does she use her own struggle with grief-related anxiety as an example in the text, she defers to several experts in areas that run outside her own (she is a licensed therapist and sees grieving patients for a living). This not only lends credibility to her as a narrator and guide, it enriches the text with contributions from some really interesting voices speaking directly to the book’s themes – and they’re not just citations from other works, but also interviews Ms. Bidwell Smith conducted expressly for the book. 

Ms. Bidwell Smith’s organizing concept is guiding readers through the process of recognizing how integral anxiety can be to the grieving process. I found this concept annoying at first. It seemed to me at the outset that this was too forced, that perhaps the author was over-ascribing to anxiety what simply may have been part of the grief. 

But as I read the book I recognized two things: 1. I have a lot more anxiety than I am aware or ready to admit; and 2. Anxiety is fairly ubiquitous – it may not always be pathological or a diagnosable psychological condition – sometimes it may even help us succeed or keep us sharp -- but it is a fundamental part of human life. 

I picked up the book at what felt like a really optimal time for me. It has been 20 months today since Nina died. For the first few months after she died I felt intense grief, but also like I had a clear mission. It was about survival, but also the tangible things that had to get done: Social Security, death certificates, childcare arrangements, correspondence with friends and loved ones. Then there was Nina’s book, a whole other mission in itself. 

But that flurry of grief and loss related activity slowed and ended. Now I’m in the phase of grief where the immediacy of loss in way back in the rear-view mirror, yet the whole normalization of the world around me still doesn’t feel quite right. I am plagued by the loneliness of not having Nina and not even being ready to have a new relationship (though I tried, unsuccessfully, which only made my situation worse and more lonely). I worry about my parenting and the long-term viability of my plans for raising the boys by myself, both emotionally and practically. 

This book brought me back to the fundamentals and walked me through some basic, well-designed exercises that I badly needed. I already knew the material pretty well, either from my own experience with death and dying or from Nina’s anxiety trials and errors. But even the stuff I felt I knew best was presented in a helpful way – manageably, clearly – that got me to re-approach it afresh from the perspective of my current circumstances—a place I’ve never been before. 

Ms. Bidwell Smith does a great job of breaking down basic psychological concepts and techniques for the reader – guided meditation, cognitive behavioral approaches, death and dying preparedness, writing as a therapeutic tool -- but she also supplements these with firsthand accounts from her own experience or that of her patients (several of whom volunteered their case studies in interviews for the book). These concrete examples serve to punctuate the lessons in the book and tie them concretely to the author’s practice, which is a helpful reminder both of her ethos and the fact that all of these techniques and concepts are practical – they’re meant to be actively worked upon. The book is not an in-depth study, but rather a guide to accessing a set of practices, organized around the theme of grief induced anxiety. 

One of the final chapters in the book is on death planning – a subject of almost universal human avoidance. As a lawyer, I can attest firsthand to the fact that MANY of my colleagues, even some of those who do estate planning for a living, sometimes have done no advance planning for their own deaths. There is also a chapter on ultimate belief (or religion). I will simply say that, as one of the most fiercely agnostic people I know, I was engaged and not one bit put off by this chapter, which simply engages with the questions that many people have surrounding meaning and the end of life without presenting or assuming any dogmatic answers (or skidding off the road into the new-age or the occult).  

What ultimately made Anxiety: the missing stage of grief a success for me as a reader was that it resonated in the details. It’s hard to fake a good understanding of grief and loss to someone who’s been through it. I found myself nodding in agreement at several passages, including this one about narrative – telling the story of grief – and the passage of time: 

The further you are from the loss, the broader the brush strokes become, but when I see clients who are in the first year or two of loss, they are still holding on quite closely to the small details that led up to the actual death. They tell me about the date their mom first discovered a tumor, the name of the first doctor she went to and the second and the third doctors, the medications, the surgeries, and a complete blow-by-blow account of the complicated aftermath that ensued. Each of the last painful days is described in detail, often concluding with a shake of the head, expressing disbelief that any of it even happened at all. 

Every moment is important to tell in the beginning … even though we can never really change the outcome, it helps to tell these stories anyway as a way of understanding and accepting them.

When Nina died I was tasked with writing an epilogue for her memoir. Not only was I nervous about writing it (the book was such an amazing accomplishment and I am not a writer, let alone a writer of Nina’s caliber), but I was also in the immediate wake of her death. In retrospect, I was in a kind of shock. Watching her die was painful, probably the hardest thing I’ve ever done, and it left a profound impression on me. My first draft of the “epilogue” was between 3,000-5000 words and described Nina’s death in EXCRUTIATING detail. I hadn’t looked at it since back in 2017 when I wrote it, but it’s really something. 

When I showed it to a friend who offered to read it before I submitted to the publisher, he gently suggested removing some of the more intense material but refrained – out of delicacy, not editorial acumen -- from giving an honest assessment of what it would mean to append something like that to Nina’s gorgeous memoir. When I sent it to the publisher the response was – thank goodness – more succinct and direct. While they appreciated the hyper-naturalist Zolaesque approach (in both volume and gory detail) of my post-traumatic stress writing, we ultimately went in another direction so as not to ruin Nina’s manuscript and spare latent PTSD sufferers any harm from reading what I’d written. 

I did my best to make Zola proud by writing things that made the few forced to read them sick with horror. 

My first draft epilogue was an obvious misstep in terms of the book, but as Ms. Bidwell Smith recognizes in her new book, it was vital to me at the time to find a narrative for my grief trauma – even if it was one that mercifully few people would ultimately read. In retrospect, I’m quite sure writing all 4,000 of those words helped me enormously by giving me a channel to pour all of my overwhelming feelings into. It is this type of exercise (though not necessarily involving your dead spouse’s publisher) that the author endorses, and this type of trauma she recognizes so keenly that made the book so worthwhile for me. It was at once validating of my experience as a grieving person, a helpful reminder of some lessons and techniques I’d forgotten or got away from, and an introduction to some new material that helped me. I’d recommend it to anyone who’s lost someone they love.