 All right. Good evening, everybody. I want to thank you all for joining us this evening for the latest installment of our Let's Talk series from the Bedford Playhouse here in our virtual Playhouse setting. My name is Dan. I am the director of development and programming. And we're very pleased to be able to bring this program to you this evening. A couple of quick things. Please feel free at any point during the presentation to ask a question. There was a Q&A button, which you can find at the bottom of your screen if you are using a laptop or PC. And I believe it's at the top of your screen if you're using an iPad or a iPhone. You will also please know there's a chat feature. Please refrain from using the chat feature gets a little confusing. So please post your questions for Dr. Lanner in the Q&A and we will have a Q&A session after his presentation and we'll get to as many of them as possible. I should mention that the Bedford Playhouse remains closed due to COVID-19. We are preparing in the hopes that we'll be able to reopen shortly in some capacity. But if you enjoy this evening's program and you'd like to see more like it, please consider making a donation to the Bedford Playhouse at our website, which is bedfordplayhouse.org. Before you shut down your devices for the evening, any amount is helpful. We're very much appreciative of it. And it allows us to do things like this for the community. So that being said, without any further ado, I would like to introduce our guest for this evening. And please bear with me because I want to make sure that we do is do Dale Zinsen and Mark. Dr. Mark Lanner is a psychiatrist in private practice in New York City and he's the founder and chief executive officer of Singula Institute, which is a 501C3 organization, which has criminologically assisted precision medicine, mental health research clinic and social impact community, whose vision is to transform mental health research clinic and social impact, transform mental health diagnostics and treatment for each individual. Singula Institute's innovative model comprises a clinical approach based on an integration of psychological and biological models of depression. This approach leverages the cutting edge technology that analyzes treatment progress to individualized clinical treatments and a social impact community that will disseminate information based on Singula's research in order to reduce stigma and foster a more mentally healthy society and I'm sure that Dr. Lanner would talk more about Singula Institute this evening. In support of his vision to transform mental health diagnostics and treatment, Dr. Lanner shares his knowledge and work by speaking on topics of anxiety, depression, substance abuse, suicide, grief and loss, and challenges in life, transitions to audiences that range from adolescents to adults ages 18 to 65, and adults over 65. In his private practice, Dr. Lanner treats adolescents and adults with depression, anxiety disorders, ADHD, post traumatic stress disorder. His basic tenant is at the brain in mind, our complex and ever changing worlds. His private practice work with his patients has been the inspiration for building the Singula Institute. He did his undergraduate work at the University of Pennsylvania, completed his medical training at George Washington University School of Medicine, while spending a significant amount of time at the National Institute of Mental Health as a research student at the clinical brain disorders branch. Based on his work at the National Institute of Mental Health and his private practice, Dr. Lanner decided to found the Singula Institute with his colleagues who share the belief that modern mental health research and practice must work for the individual patient through the use of a clinical acumen combined with engineering, technology and data science tools and methods, and it is our great pleasure to have Dr. Mark Lanner join us this evening. Hey, Mark. Hi everyone, and thank you so much Dan for such a warm welcome. Thank you to the Bedford Playhouse for inviting me to speak this evening. You know, one of the things that I don't know Dan, if we were able to catch up on what I grew up, just in Elkisco. So to me, this is very special to give back to the community up in Northern Westchester. You know, I was involved at the time with the Boys and Girls Club in Northwestchester. And so, to me, this is really a big treat. So what I'd like to do, you know, in the interest of, you know, not having you guys take a look at me throughout the entire talk, but to kind of refer to some, some diagrams that might help to inform everyone about the different concepts and ideas around this this evening's topic. But tonight we're introducing the very large topic of grief and loss during the pandemic. Dan really nicely introduced what Singular Institute is in just to reiterate we're a 501c3 organization we are transforming lives of individuals suffering from anxiety and depression we want to individualize diagnostics and treatments and we're doing this through an innovative learning health system that's going to create and deliver precision medicine leveraging technology and our clinical research. We envision a world in which no individual endures needless suffering due to anxiety and depression. And this is the impetus for us to create this organization. This evening, I wanted to provide you with a little bit of the landscape, we're going to start off describing the universal mental impact of the COVID pandemic. I'd like to define some terms, just so that we can talk a little bit more in depth about the grieving process. And within the grieving process I'm going to detail out the different ways that we can breathe, whether it's the loss of life, the loss of life in the pandemic, which is suddenly different, especially during the last several months, you know, has been very tragic for many people have lost lives. And also we're going to talk a bit about the loss of the way of life. And that really covers just universally everyone. And this evening talking about the difference between grief, which is a normal process and depression, which is a mental illness and other related illnesses as well. So, you know, we're all impacted by the COVID pandemic. And the way that I conceptualized it when, when it was happening, you know, right at the start was I really started to conceptualize and internalize it we were having three simultaneous dialogues. You know, all at the same time, and it was quite confusing. And the way that I categorized that was through the first which is what has happened to me. And that really refers to the grieving process where we were grieving the loss of life for some and of a past life for all of us. Again, a question or dialogue that we were having was what is happening to me. We were taking inventory of what we call our hierarchical needs, and we were using this sort of organization to try to parse out what when we do what can we solve in order to maintain those needs. The last dialogue that we were really having was what will happen to me. And that was related to answering our uncertainties and related fears. So let's define some terms. Emotional loss. Emotional loss is a disconnection from an emotional attachment or a removal of emotional needs. It can be concrete, like it could be a person, an object. It could be a place. It could even be a situation. In all contexts, emotional loss is abstract. It is hard to see. It is hard to sometimes feel. And it's certainly hard to touch, if not impossible. And so when I refer to loss, I'm going to refer really to emotional loss. Grief or otherwise known as bereavement is a process. And really it's a very complex process. It's a cognitive emotional and spiritual process in response to loss. Many of you are familiar with the Kugler Ross brief cycle. For those of you who are not familiar with the Kugler Ross cycle. It was a five stage model that was introduced and coined by a Swiss American psychiatrist by the name of Elizabeth Kugler Ross. She detailed out this process in her book called on death and dying. And this was a detail of her work with patients who were on their deathbed. And what she found was that this brief cycle was really consistent throughout all individuals either who were dying or their loved ones. What I'd like to do here at this point is go a little bit more in detail about the brief cycle in order to start talking about how we grieve the loss of life. Death of a loved one creates really a concrete and emotional void. Our perception. That is the way that we see things are our beliefs in particular. They tend to lag behind the reality of the loss. So in other words, we might have lost something or someone. We just don't believe it yet. This creates what is called a cognitive dissonance. And that's really a situation in which there are two opposing beliefs or attitudes that are presented and causes conflict. This characterizes the stage which we call denial. The person in denial will avoid things that remind them of that reality. There might be some confusion as they go through the process of that cognitive dissonance. And they might even be elated. In a sense be lifted somehow, almost warding off some of the really negative emotions that are really just waiting to be emerged. But really among all people, I think the one part that seems to be consistent throughout is a sense of shock. And that shock really makes things very difficult to move on. As we go from the denial stage to the other two stages, which kind of introduce a little bit together is anger depression. And we're not talking about clinical depression per se. We're talking about is a sadness and utter sadness or even sometimes despair. Anger and depression seem to kind of go to and fro. For anger, people as they go through this back and forth to and fro incognito dissonance will perceive that loss as injustice, or maybe there was a wrongdoing. And so when they maintain that wrongdoing, they direct their anger in different ways. And sometimes at different people. This creates a lot of tension, obviously for people around them. But for them, they're just trying to dispel out what they believe has been unfairly taken away. When a person reaches a period of sadness. It's sort of like people described as being overwhelming. And I think I've mentioned that the sadness and depression and the anger, they're kind of merged at times because really we think theoretically that the sadness and the depression or at least non clinical depression is underneath the anger. So the anger, in a way, is a warding off again of protecting against this really deep, deep pain. When the person starts to go through their period of sadness, and the anger starts to subside, the person is starting to move closer to the reality that the loss might actually be reversible. And to them, they start to really feel the gravity of what they have lost. The good news is that most people tend to move beyond that period of sadness. And into a period of bargaining. And this is sort of an interesting one because this more about our, I don't know, maybe what ifs, what if, or if I only did. And this really is kind of the last stepping stone towards acceptance, which is really what we're trying to get to. But when a person is in a period of bargaining, what they're really wondering is whether or not the reality is actually irreversible or not. And so the bargaining comes into play when we start to believe that maybe this loss can be reversed. Over time, and as a person moves through to the next stage, we start to see people reemerge. And so when a person is sort of home or taking time away, which, you know, a lot of jobs allow people to do, which they have bereavement time. What we start to see is that life can move forward and that person starts to reemerge and find different ways to transition and adjust to a new normal, feeling much of that void. What you'll start to see is that person starts to explore options. They might have a new plan. And ultimately, they can adjust to that new normal without that person, or without that thing that they lost with them. Now, acceptance or another word of another term is closure. People I think maybe misunderstand is that it doesn't mean that the cycle doesn't get triggered again. But the good news is that when we get through this very big stage, which is nonlinear, meaning that you can cycle through different stages at different levels, that when we get out of that stage and we get to a new acceptance, we get to a new place, that we are now able to adjust, which is in line with the reality of loss. The added complexity of a loss of a person is that there's also a loss of a relationship and in that relationship is a person's identity. The nature of the relationship is complex. We have interacted with them, how we thought and felt about them when we were there with them, how we believe they thought and felt about us. We have shared memories, memories of things and situations and places that maybe some of us have forgotten. And that is not just of a person, but of some of those shared experiences. There might actually be a loss of other relationships, relationships that that person had in common with the people who are left behind. So this poses as an additional challenge. Beyond just the grieving process. To actually reform and heal by modifying a little bit parts of our identity. So I'd like to turn to the next part, which is a bit about beliefs attitudes and traditions about death. Now I can't claim that I'm a sociologist or a cultural anthropologist. But I'd like to just briefly comment on the fact that spiritual religious and cultural beliefs are the foundations of the mourning and grieving process. Core beliefs about death can help us understand how best to breathe. The first core belief that really needs to be understood and honored is the existence of an afterlife. Or in some cases in some cultures and religions, there might be an existence of a universal bond or spiritual tie. If we move to the right, we see pictures of different ways that people are grieving. And this was a means of presenting you different attitudes that might be portrayed for some cultures. It might be necessary to mourn loss with sadness with pain. For other cultures, it might be celebratory. The picture to the right. And for some, it might be an attitude of honor. For all beliefs, attitudes and traditions, it is really important to really note and respect that even within larger religions and cultures, there might be ways that families might grieve loss or groups of people might grieve the loss. Either way, what we do know is that community distributes that emotional burden. Human touch, it soothes physical presence, emotional presence. It allows us to not be the one carrying all the weight, but rather distributing that across an entire group of people. And then it comes to bureaucracy of death. We have the estates, we have the burial, the pre-nation, the ceremonies. All of them cost money. All of them require invitations, halls. They need help. The bureaucracy of death is really understated but is quite a task and a burden. And so this also poses as a challenge as people grieve the loss. I wanted to highlight at this stage in tonight's talk about what it has been for people to die during the pandemic. You know, I don't know another word to use other than tragic. But during this pandemic, it has limited so many different things that we have cherished as as a people about death, death of the individual, death with integrity, death with loved ones. And I wanted to give a little bit of control. Because of the pandemic, we've also lost the predictability or control and maybe the belief that we can protect our children in our elderly loved ones. During the pandemic, if it was due to COVID, it could be sudden and maybe even medically unexplained. In many cases, the shock or the denial and even the despair tends to be quite high. And so what we have to understand if we know of anybody who has lost a loved one due to COVID, that for them, this process has been much, much harder. I wanted to note that people are dying through the pandemic that may not be not be sick with the COVID syndrome. And so what I wanted to highlight there in the picture is that there have been many people who we have lost that could not say goodbye in an ample or appropriate way. Because of limitations that were really there for the public health good customs and traditions have been disrupted. You see a picture on the left of looks like a couple who are videotaping or virtually recording a memorial service. Likewise, looks like pastor or religious leader who is doing the same thing, but this time in the church, and we're seeing a video recording on the bottom of a freedom of service. This has impacted greatly the ability for people to be able to go through that process with the burdens, as we mentioned of the community being distributed. And the ability to, to express a lot of the intense emotions that comes with the process of grief. So for those people and I hopefully will be able to answer their questions as best as I can during our Q&A. But for them, I feel sad, and I feel the tragedy that they have had to feel and go through. So I'd like to switch gears a little bit and talk about our loss of the way of life during the pandemic. So here we see a picture of Times Square New York City Times Square. And it looks like a ghost town and for many people, many New Yorkers at least. This was a very big loss to them. There was a lot of identity really connected to the vibrancy and the connectedness and the people that create New York City. And so I wanted to just show this picture here. Obviously this is people here in the New York area, mostly, but, but also just a way of showing how much for contrast. There was when the pandemic hit. The process of this brief that we did and still are going through was a little bit milder, but still present. Persistently. Attachment theory suggests that all losses, big or small, are simply recapitulations of the earliest losses. And throughout our lifetimes, we accumulate those losses, and we feel them, and we go through them throughout our lifetime. And so what this pandemic has done is it has given us this longer runway of the brief process, and it's still going on, whether businesses can reopen. And some were seen have to reclose these losses are still going on. What I'd like to do is address a little bit of what I mentioned with the hierarchical needs. Abraham Maslow, who was a psychologist who coined the term of, you know, hierarchy and needs, or the source schema that describes that all people have a set of physical and emotional needs that start from the bottom with the physiologically sleep and in eating sustenance to safety like a home or house safety from danger and the things that provide us with safety like money. As we go up higher, we start to see a little bit more of the needs that can get met after we've reached the lower runs of love and belonging, and even higher than that as we create our identity, we create a purpose for our lives we are in essence creating self esteem. We have the highest self actualization which talks about the ability to reflect and be able to use that process of reflection in order to make choices in life that allow people to conquer goals to reach new heights and to be what they have envisioned themselves to be. If we take a look at Maslow's hierarchy of needs and we apply the impact of the pandemic and what has done. What has really shipped away from the bottom runs, all the way to the top. And so when I talk about taking an inventory of these needs what I'm speaking about is, which one of these needs are being impacted the most, and how can we fortify this structure how can we make sure that we get our basic foundational needs like eating and sleeping, making sure that if we lose our jobs we're able to afford home protection, and within all of the public health. The expectations and and responses to the pandemic. It has impacted our ability to connect with one another and I'm not saying, obviously that the public health measures were not right or appropriate they really are. But it also has been this struggle between our emotional needs to connect to touch one another to be with one another. And our public health needs to decrease the incidence and rate of infection for people have lost jobs or are struggling to keep their jobs. There are many caretakers who have to tend to the needs of their children, or their elderly loved ones. And also, trying to forge their own career trajectories it's been very harrowing for these people self esteem has decreased. And so a lot of us are, in essence, trying to survive. And so this has been an individualized process, and the pandemic is really impacted. In just different ways. I want to turn a little bit to fear. The reason why I want to turn to fear is fear and anxiety are pretty much one in the same fear is a normal biological response to threats. But the behaviors how we respond to fear can either be adaptive or maladaptive. And one of those on the bottom portion of the slide is that this is biology, this is survival, this is how we as animals have been able to survive. But the key word here is maladaptive. If we respond to threats, whether it's real or perceived in ways that are reactive. Sometimes do more harm than good. Want to detail out some of those universal fears, because I think it's important for us to be able to identify them when they happen. There's clearly a fear of death. We just talked about how the COVID pandemic is killing people. And we're losing people because of this virus. It has stirred up lots of fear and all of us. The fear of abandonment is our loved one going to get it. What will we do if our loved one gets it. The next fear, fear of abandonment or separation. We talked about the social distancing or the public health limitations that have caused this separation, but also in losing someone who is sick and dies. The fear of abandonment too strikes the fear. The fear that turns into reality of abandonment and separation. The fear of punishment and pain. We all fear whether or not something is going to actually hurt us physically hurt us. And what we've seen with the pandemic and what we've seen with people who really get severely ill. It's a painful process. We fear that pain. We fear that imminent process, or at least we experienced or proceeded as we might fear failure, familiarization. In this case, we might be talking about a loss of a job, loss of the ability to maintain our survival. If we are the person who is in charge of the finances of family. And lastly, which is really kind of the catch all fear is our fear of loss of control. We tend to experience this as uncertainty, or really secondary to the other four fears. For each one of these fears, we need to address them. I just wanted to show here the kind of the image of what's been happening with social distancing and how this has been impacting social connectedness. And you know what is striking to me when I was looking up pictures for this evening's talk. I saw, you know, this image of this child who's trying to do his, his learning online with his mom, you know, kind of iron and watching her and, and making sure that he, he does office homework. It's really been so wrong that we have basically taken the complexities of society and, in a way, we force everybody to be more simple, which in and of itself is very complex. This evening we are on this talk and, of course, we don't have to the screen to get everybody on it but there have been articles about zoom fatigue what is zoom fatigue. And that is that are ways that we're being creative and thankfully we have these ways but in these creative ways that we connect with one another, even that can be confusing and fatiguing and trying. So this sort of is the second part to the fear and anxiety portion is what do we do when we experience these intense anxieties. So I wrote here a list of questions that we can ask ourselves what that allows us to process those fears. What are my emotions, what are my feelings. And, you know, I do want to just make a note that when I work with patients, especially the young ones, and they say, I'm feeling that I kind of stop in there and I say, wait, that's not feeling. That's an opinion. I'm talking about emotion. I'm talking about what do we feel physically. When we think about these things. The question is, is why am I feeling this way. Am I experiencing fear. Am I experiencing anxiety, and it's fear what am I fearful of. If it's anxiety what are my worries what am I worried about. Now common answer would be nothing I'm fine. We're not all fine. We don't have to be all fine all the time. We have all had these fears come up. Arguably they're present and kind of going through us throughout our entire lifetimes but but specific to the pandemic we are going through these anxieties and we are going through these fears. When we think about anxiety we want to ask ourselves whether or not there's evidence for or against our fears worries becoming true. You know for people who are fearful of catching the virus and getting infected. This is particularly true for people and patients that I've worked with I say to them well, there's a cost benefit analysis right you have to go get groceries you have to go pick up gas and be able to do all the things that you need to do in order to survive. And so if you stay isolated at home, you're not going to get your survival needs met. And so there's this constant struggle between beers and worries and survival needs. Another question asked is what are my fears and worries urging me to do what what is it telling me to do is that thing that it's telling me to do. Is that right for me. Is that a good solution for me. Is that a solution to a problem that I can actually solve and will acting on those urges results in effective or ineffective outcomes. Being able to reflect on our fears and anxieties help us navigate the world. And be able to meet our survival needs, but also maintaining some of those nasal higher needs. I want to switch gears here to talk about to disorders. One called persistent complex bereavement disorder, or in short complex grief. And the other is major depression disorder and short depression. These two disorders are ones that you might see in a small subset of people who are going through the brief process for the complex grief. What I wanted to just kind of note is that the grief is typically longer. And it's kind of persistent longing and sadness for the deceased is usually a sense of disbelief or kind of like a reluctance or inability to accept the loss risk factors might include social isolation. The emotional attachment, the emotional attachment insecurities, anxiety, and in some cases experience in loss that's sudden and inexplicable like the COVID pandemic. Although I have not done studies on this, I would not be surprised if we start seeing more people who are going through this complex bereavement disorder. Now studies have shown that for these people. It's actually psychotherapy and not medications that are the most useful for depression or major depressive disorder. What I want to be able to do is sort of separate these two, because when we think of major depressive disorder or depression. I mentioned this earlier on when I said there's a non clinical depression that we're all experiencing this depression is acute. It is what what we mean by that is immediate, almost immediate onset. And what you'll start to see is a sudden change to a person's mental function. A sudden change does not lift the book say we experienced those symptoms the five or more of the night symptoms that are listed there. If we have them for more than two weeks then we have the diagnosis major depressive disorder. But I think what's more useful to look at is is the picture below that, which talks about the time for us to treatment. This graph here it's on the y axis is is the severity or intensity of symptoms. So actually to go down there. There's a higher intensity. And from the left to the right is time. What we see in a person who is going through a depression is that a normal mood, meaning that all the highs and lows and in between are present, and people can kind of go through them with ease. When they get stuck in more negative mood state, then we're starting to see that person progress to a disorder, the severity of the symptoms are related to the degree in which that person's impacted in their responsibilities obligations can they still get things done get things accomplished. And still be able to lift their mood back up just above that dotted line. If a person is going into an acute depression. You'll start to see that drop and it happens very quickly. It's sort of like you'll see it progress progress progress, and then very quickly you'll see that drop. The good news is that there is treatment medications do work. For most people. It works one third of the time. You know, very effectively one third, it might work a little bit. And the unfortunate truth is that for one third, it may not work. Psychotherapy can help in all cases. And so psychotherapy and medications combined are the most effective in treating depression. And so thankfully, and I've had the opportunity to see many patients go through this process is when they start to respond to treat. You start to see their symptoms lift. And their mood can be more even healed. And when we get to that point of remission, we're on a good track. And so person then who's then been able to be without symptoms. For almost a year would then be considered in full recovery. In these cases, the cases that I've been talking about the persistent complex treatment disorder with major depressive disorder. It is really important for you to know that number one, most people don't go into these disorders, but two, when you start to see them progress. And at the moment, as a loved one, that you can actually intervene, and you can talk to the person about what you're observing. Some people are very afraid to be perceived as being judging or opinionated or controlling. But in these instances, if we look at this graph, if you can actually intervene at a point, just before they hit that bottom. You can get them out. And so the suggestion would be, then if you start to see that one slipping down, bring them to a psychiatrist, bring them to a mental health provider. Have them evaluate it. If a person is grieving. And it's just taking a long time. And by a long time we're saying over six months, encourage them to see a bereavement council encourage them to see a psychotherapist. But again, I just want to caution, you know, beyond mental health providers that, you know, teaching you here just to be able to identify what might be going on. And of course, you would have to bring that loved one to see a mental health provider. So I want to start to finish up and wrap up, at least for the part that I'm giving information here. Illustrate the key points for this evening one is allow yourself to agree the loss of what has happened, and give yourself time to go through that process. The loss of life of a loved one, work with your friends family and community to align with personal cultural values beliefs and attitudes to carry out a modified form of custom or tradition. The good news is that in most cases of brief brief psychotherapy or bereavement counseling is quite effective. You experience a loss of survival needs. Speak with supervisors at work partners, family, friends, financial advisors, in order to come up with a three to six month strategy. Combat your fear and anxiety through understanding what's in your control. And what is not. Have a plan for the things that are in your control process and accept the things that are not in your control. If your ability to carry out day to day activity and responsibilities are being impacted. You're probably moving to a point of distress, maybe that you can't read down from and police contact one of us mental health professional. So I'm going to wrap up and just say, you know, it's been a pleasure to, to present this information to you I hope that this has helped to understand the process. For more information, you can contact myself and my colleague, Patricia demeaning at the email here and if you go to the website below www dot singular Institute.org. You'll be able to see we have a link to some resources that we've compiled to help people understand what to do and in some of these cases where we're questioning whether someone's going through a mental health crisis. Please check us out on social media, Facebook LinkedIn and Instagram. So I want to maybe turn it over to Dan. Okay. Mark, thank you very much. That was really fascinating presentation and we invite you now, please, if you have any questions to submit them through the q amp a form on your screen. Mark, I'm going to start off with one that was actually sent to us in advance via email this afternoon. And I think you've touched on I think the basic gist of this question, but it deal it basically it suggests that, as you've said grief and loss applies to things that are not only physical death relationship loss or job loss. You feel that the sense of the community that everybody is experiencing this together is your assessment that people who were already say, may not have been diagnosed with depression, but had been on maybe on the verge of it have been, like an increase in numbers of people who are directly because of the effects of the pandemic, who are being diagnosed now versus they may not have been had things remain the same. So that that's a very good question. I'd like to thank the person who you know who asked that. So, the question of the rates of depression and there was a study that was put out by the CDC. That showed that over the course of about two and a half months from April, June, the rates of depression, or at least depressive symptoms have have increased during this time, about three fold. So, from a population based study, we are starting to see that that symptoms of depression are going up. It's not clear from that because it's designed using a questionnaire. And so patients are reporting this, you know, it's, it's, it's hard to tell what what is clinical depression or that acute depression that I kind of talked about. You know, when it comes to people who are at risk for depression. It really depends on what the pandemic is doing to them. And it's really quite different for different people. There, there are people who whose jobs actually started to do very well that they actually started to some people gun promoted and, you know, and being at home is actually more comfortable than, than going into the office. To other people, I have a patient of my practice who lost his job, and that caused a significant strain. This was a job that he had been dreaming about and had just started. And it was taken away and, and that was a big loss. And so, you know, it really is about how the specific things that the, the pandemic has offered that person, how it's impacted that person is, is kind of playing out with them. But for sure, the people who are more at risk for depression, if it's negatively impacting them, they're the ones who are attending to kind of fall into the depressed state. Here's another question. This one comes to us from Jessica Ruiz, who I. Yes. She is now a, she is now a mental health counselor in North Carolina and her question is, she would like to know how you recommend that mental health providers address the complications with family and friends with a loved one who was grieving, telling them to move on with their life, the pain, educating them or ignoring them. And also, there's a second part, what treatment options do you recommend for children or adolescents in grief or a loss of a loved one, and also the grief parents are feeling from the pandemic and the ideal parenting life. Yeah. So, it looks like there might be like three questions in this. So you want to break them up. Let's take, let's take them apart. So the first one is, the first one is how do you recommend, how do you recommend providers address the complications with family and friends with a loved one who was grieving. So, you know, it's, it's a very obviously sensitive and delicate situation, regardless of the pandemic, when it comes to being able to communicate and talk with with friends and generally they're in many ways, you know, we, we see the impact of stigma. Even in grieving, I think grieving is one that, you know, is more society accepted but at the same time, it really is about the other people's discomfort, whether they're comfortable with being a person who is that vulnerable. And, you know, for, for many people who are in that camp, it's, it's a very challenging thing for them to confront. So, there are some people who just avoid from contacting the person who lost that loved one. Understanding that loss is impacting people and in all these different varieties of ways. I think the best thing that I would recommend doing is understanding and being a bit flexible with the different needs that people have. And it's a very hard thing if you are the person who's grieving to understand that the person that you care about is maybe avoiding you, it's not that they're avoiding you, they're avoiding from confronting their own fears. In this case, it might be maybe a fear of death and dying, maybe it's a fear of being humiliated, they don't know how to socially handle that. So, I think that the best thing that I can kind of advise people is, is understand when people are quote unquote awkward. It's because they're dealing in large part with these fears. The best thing to do in some cases, if there's a relationship that is stronger for some people, then being able to approach that and say, hey, you know, I need some support. I need to be with someone today. You know, can we need for coffee, massage? You know, can I talk to you? Can we set up a Zoom call? Can we, you know, those things really do help. If you're the person who doesn't know what to do or what to say, and you don't have those fears that are impacting you, try to go on the side of contacting that person because they really are in need of support. I think the second part is, is if people, it seems like if people are in some way invalidating of the person's grief process, what do you do? You know, it's a very difficult thing to teach someone out of some sort of insensitivity. Now there are some cases where it is a mistake and, you know, the person's up to learning. But then there are other cases, there could be like opinionated and strong beliefs in the opposite way. What's very hard to do, especially during this time period that there's a lot of unrest in society is to start a fight. And so in those cases, unless you have a strong relationship with that person and you've confronted that person before with things and been able to kind of get through, I would say leave that maybe alone. In terms of children and adolescents, absolutely therapy. The person really has to be able to, the small child or the process of grief is more confusing for the child. And it's seen in a subtle way. Usually it's denial in many ways, but also it comes out oddly in kind of concrete things that a child says, you know, Daddy no longer is living or, you know, and it's a kind of an absolute statement. You'll see this sort of subtle on this to to this and it's because the child is really trying to process this and, you know, seeing a therapist is the best thing for children or adolescents that have lost a loved one during that period of time. Looks like there's another question. Yeah, sorry, Mark, the minute up here. Yeah, this one is an anonymous question that speaks to a sort of longer term grief. What if after 10 years of losing your beloved spouse, you still can't move on in some respects. It was a wonderful real happy marriage. You know, this kind of maybe speaks to some of that complex grief that we've, that I sort of discussed this is work that was done by Dr Catherine Trier at Columbia, and they, her and her colleagues were able to get on the books on the DSM or diagnosis, excuse me, statistical manual, the fifth edition, which is really our diagnostic tool. They were able to get on the books as complex grief or the persistent complex bereavement disorder. As I mentioned that the solution there is psychotherapy and really what the therapist is doing is it's, they're helping the person relieve some of the barriers to getting to a point of acceptance. And I think one of the fears and I wanted to address this before, but I'm glad this question came up. It is one of the fears that I think people have early on in the grief process is that if they don't feel the pain. Then their love for them wasn't commiserate to the pain that they're feeling. So in other words, their pain validates their reasons to stay in the grief process. And that really is a tough. It's a tough middle road that people might find themselves in. When we say letting go, which is somewhat of like now a colloquial term, letting go, it doesn't mean to forget. I personally have lost both of my parents, not during COVID pandemic, but you know once during medical school and other during residency. And I still think about them. Not all the time but every once in a while things get triggered in preparing, you know, for this talk I was thinking about them. And so, you know, it is not. There's belief and I think we were talking about beliefs there are certain beliefs that can actually stick people into that place of a continual or perpetual morning process. So for them, as I mentioned psychotherapy helps the person start to see and loosen some of those belief patterns that are making them really stuck. We have one more. Are there any recommended techniques for getting a loved one who is in strong denial themselves into psychotherapy without overstepping any boundaries. Yes, so that that really is also a difficult question but a very good question as well. You know, we in the field as mental health provides we respect autonomy we do understand that for some people and when when a person says well psychotherapy didn't work. I do obviously question, not, not their statement but you know what it is that didn't work. And for for many people who kind of say that when they say well psychotherapy didn't work, or, you know, mental health care is good for everybody but not really for me. There's a form of denial that perhaps is rooted in fear. Right. And so we talked a bit about fear driving the process of doing things that are probably not beneficial to us. So for example fear of a loss of control that perhaps the therapist is controlling them in some way or controlling the narrative or the dialogue or, you know, their lives or their decisions that they make that can cause a conflict with that person because, you know, every time they walk into the office. It's almost like they're losing that control. So, in terms of helping a, you know, in this case a spouse or someone we love who might be in denial. It really takes a village. And so when a person is in extreme forms of denial but needs to really be there, there needs to be kind of a form of intervention in a way. Now, it depends on what the consequences are. So for example, if we're talking about someone who is predisposed to addiction, or someone who is, you know, starting to fall into a state of mental illness. Well then, you know, I would say what you need to be maybe forceful about that. But if it's about, you know, something a little bit more mild but is still consequential to the relationship, then I would ask that person, right, to be able to state that perhaps there needs to be maybe a relationship therapist. To understand why those needs may not be getting met. Now, again, if it's really just to the individual and not in relation to the relationship, then perhaps having some serious conversations with that person confronting them in a way that is when we say I mean what we kind of mean is that we're not saying they're a bad person. What we're saying is that we are concerned that they might be going through something very difficult. And so having that conversation is, is a very tough one to navigate and, you know, happy to talk to that person. You know, or send me an email, because I think it's a particularly hard one and you kind of have to understand the relationship dynamics and a little bit more about what, what the challenges have been. Okay, I should also mention. Please if you have any more questions we have time for a couple more if there are any more. We are recording this session so I think it's important to note that if there's anybody that is tuned in who knows someone who couldn't make it this evening, but might benefit from listening to Dr Leonard's talk, or some of these questions the recording will be on the bed for Playhouse YouTube page in a few days and we will certainly certain we can certainly circulate it to you. If you make any inquiries, the way to reach us is programming at bedforplayhouse.org. I don't see any other questions coming in. Mark, why don't you share your website one more time for anybody. So if we go to www.segulainstitute.org you can see we have a page that's dedicated to mental health resources, and we categorize them based on what that person might need. These are credible sources ranging from the NIH to the Association for depression and anxiety, and also NAMI, which is a terrific organization, a national organization and I think I saw on the Instagram that you attack NAMI Westchester so that was awesome. Thank you so much Dan. Yeah, so thank you again to everybody who tuned in. Thank you, Mark. I hope we can do this again soon on a different topic. And for those again those of you who may be interested we do this as part of a series a larger series that we do called Let's Talk, which you can find more information about on our website, we are going to be doing an event, another one in about two and a half weeks on substance abuse and some other related topics. So thank you again. We really appreciate your joining us. Check out bedforplayoffs.org and have a great night everybody. Thanks again for tuning in. Thank you.