CHAPTER FOURTEEN
Behind Two Hearts: Grief and Vulnerability
JENNA BUSCH AND JANINA SCARLET
“He was different once, a long time ago. Kind, yes. A hero, even. A saver of worlds. But he suffered losses which hurt him. Now he prefers isolation to the possibility of pain’s return.”
—Madame Vastra1
“Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable, but they’re never weakness.”
—social work researcher Brené Brown2
It is a sad fact that most people experience numerous losses throughout their lives.3 After experiencing losses, some people shut down and avoid interacting with others,4 while others might thrive and demonstrate extreme resilience.5 Since the Doctor has lived for over two thousand years, he has arguably experienced more losses than most, his hearts undoubtedly broken by the many deaths he had endured. Between the deaths of his many companions and the people and aliens whose lives he has touched in some way, he’s had more than his share of grief and guilt. After devastating losses, such as those the Doctor endures, some people cope by committing to their work, others by communicating with others, and still others by trying to avoid feeling anything at all.6 What, then, is the most effective way of coping with loss and past heartache?
Grief
Grief is the typical reaction one may experience after a painful loss due to death, a breakup, a job change, or a change in one’s health status.7 In turn, grief that results from a sudden traumatic loss, called traumatic grief, can negatively affect the person’s psychological and physiological health. For example, after Clara’s death, the Doctor spends two billion years in a energy loop, dealing with his grief.8
When a group of researchers interviewed people whose spouses were diagnosed with terminal illness, they found that even the impending eventuality of such a traumatic loss had significant health effects on the partners. Specifically, spouses of people diagnosed with life-threatening illnesses were more likely to develop high blood pressure and heart problems, demonstrate poorer eating habits, consider committing suicide, and eventually develop cancer, compared to people whose spouses did not have life-threatening illnesses.9 After learning the Brigadier died,10 losing Amy and Rory,11 and saying good-bye to River Song,12 the Doctor’s personality changes and he becomes more withdrawn.
Experiential Avoidance
One of the common ways people try to deal with grief is to suppress any painful thoughts or emotions that arise after the loss.13 Avoiding or suppressing painful experiences is called experiential avoidance.14 Experiential avoidance may sometimes provide brief relief because the individual is temporarily able to escape his or her painful emotions. However, in the long run, experiential avoidance may lead to worsening symptoms.15
The consequences of experiential avoidance vary. Overall, experiential avoidance after a traumatic loss is likely to result in prolonged grief, depression, and painful catastrophic thoughts about the loss. The Doctor often throws himself into his travels to distract himself from his sadness at the loss of his companions. For instance, after the Eleventh Doctor loses Donna,16 he doesn’t take on a regular companion until he regenerates into the Twelfth Doctor.
Social Isolation
In addition to worsening psychological symptoms, experiential avoidance can bring on potentially serious health conditions. Specifically, avoidance in the form of social isolation can lead to inflammation, which in turn can trigger a number of physiological and psychological conditions, including chronic pain and depression.17 Chronic social isolation can also cause neurological changes, such as a reduction in the brain’s white matter. White matter consists of specific structures responsible for sending and delivering messages between the different structures of the brain and the rest of the nervous system. If the white matter is reduced, then the brain and the body might not function properly.18 For example, multiple sclerosis (MS) is a disease caused by inflammation that destroys white matter and affects the person’s ability to regulate his or her functions.19
Sometimes people might blame themselves for a traumatic loss, even when they had nothing to do with the tragedy. When the Doctor loses Amy and Rory, he is devastated. He retreats to the Paternoster Gang and retires for a long time.20 Though his friends, the Paternoster Gang (Madam Vastra, Jenny Flint, and Strax), try to entice him with mysteries to solve, he avoids participating.21
Shame and Guilt
When people blame themselves for a tragic loss, they might experience guilt or shame. Guilt is regret for a specific action, whereas shame refers to feeling bad about oneself as a whole. Overall, people who experience shame are more likely to struggle with grief than individuals who experience guilt, and men are more likely to be affected by shame than women.22 Thoughts that might arise from shame or guilt after losing a loved one are likely to prompt people to struggle with prolonged grief and depression.23
There are numerous instances where the Doctor expresses regret, guilt, and shame about having been the only survivor of the Time War, which destroyed his entire race as well as a large proportion of the Daleks.24 It affects him throughout his Ninth, Tenth, and Eleventh incarnations. Only after he realizes that Gallifrey still exists in a pocket universe can he begin to let go of his guilt.25
Vulnerability
The opposite of experiential avoidance is vulnerability. Vulnerability refers to the willingness to face uncertainty, risk, and emotional exposure. Instead of avoiding situations that might result in heartache, vulnerability refers to taking chances even in the face of uncertainty. Some examples of vulnerability include love, trust, creativity, and joy.35 The Doctor knows that his wife, River Song, is going to die because their time lines are running in opposite directions. When he meets her,36 he learns that they’ve known and trusted each other for many years and then he watches her perish.37 Even knowing the tragic end she’ll face, he continues to meet her throughout time and space and pursue a relationship with her.38
Vulnerability researcher Brené Brown has found that people who reported living the most fulfilling lives were ones who were open to vulnerability. She refers to these individuals as wholehearted. Wholehearted individuals embrace vulnerability by being open to both success and failure, love and heartbreak, as well as creativity, play, and laughter.26 Wholehearted individuals seem to possess qualities like these:
• Authenticity—being true to oneself, rather than responding to other people’s expectations. After living for so many years, the Doctor does not do what others think he should do. He follows his own directions, his own rules, and his own moral values.
• Self-compassion—letting go of perfectionism and practicing self-acceptance and self-support.
• Resilience—letting go of numbing through connection: Connecting to others helps him avoid growing numb to experience and emotions. Even though he knows that he might lose them, the Doctor continues to bring new companions in to travel with him.
• Practicing gratitude for what one already has. For instance, when the Doctor meets a “human” incarnation of the TARDIS, Idris, he celebrates her life and expresses gratitude to her.27
• Trust—letting go of the need for certainty. The Doctor trusts his companions, even allowing them to occasionally operate the TARDIS.
• Creativity—letting go of comparison and instead following one’s own creative process. The Doctor often uses his creative mind to solve problems, defying what he’s supposed to do and coming up with solutions no one would expect. For instance, he sends a message to Sally Sparrow from 1969 to warn her about the Weeping Angels,28 or he uses a hologram of himself to confuse a ghost.29
• Playing and resting, rather than striving for achievement to raise one’s self-worth. On many of his adventures, the Doctor finds the time to laugh and enjoy his experiences. For example, when he and Rose find out about encountering potential werewolves, they are both excited about this venture.30
• Practicing mindfulness—slowing down enough to notice the present moment. The Doctor, knowing this is going to be the last outing with his wife River Song, takes her to the Singing Towers of Darillium and spends time with her, allowing himself to weep and take in every moment.31
• Meaningful work—letting go of self-doubt and doing what matters, rather than what one is “supposed to.” Despite knowing the havoc his longtime enemy Davros will cause him and the universe, the Doctor goes back to save him, stating that it doesn’t matter what side one is on, as long as there is mercy.32
• Laughter and dance—letting go of being in control.33 Instead of retreating into himself when the Doctor believes he’s facing his final day of existence, he travels to the Middle Ages and puts on a show, playing guitar for the crowd.34
Hence, connecting with his core values and engaging in meaningful activities may reflect vulnerability, but it also seems to be helpful. Connecting with companions and activities may have profound effects on psychological resilience. In fact, research on this topic suggests that when people who struggle with depression connect with their core values and perform meaningful deeds, their depression symptoms abate.39
Connecting with others can also increase positive emotions, extend life span, and prompt the release of oxytocin, the body’s own stress-protection hormone.40 In addition, the willingness and the ability to experience and focus on positive emotions boost human resilience. For example, people who are more likely to practice vulnerability in terms of connecting with positive emotions are more likely to recover from stress quickly, as well as have improved cardiovascular (heart) recovery after being exposed to a stressful situation. Such recovery could lead to improved heart health and serve to protect the individual against the potentially damaging effects of stress.41
Healing Broken Hearts
As counterintuitive as it may seem, embracing their vulnerability allows people to be more resilient. In some ways, vulnerability can be a strength; for the Doctor, it could be his best asset. Though he experiences some of the negative reactions to grief, like guilt and isolation, he moves through them. His choice to travel with companions who will eventually leave him and die shows his willingness to experience grief and move through it.
Barr, P. (2004). Guilt- and shame-proneness and the grief of perinatal bereavement. Psychology and Psychotherapy: Theory, Research and Practice, 77(4), 493–510.
Boelen, P. A., van den Bout, J., & van den Hout, M. A. (2006). Negative cognitions and avoidance in emotional problems after bereavement: A prospective study. Behaviour Research & Therapy, 44(11), 1657–1672.
Boelen, P. A., van den Bout, J., & van den Hout, M. A. (2010). A prospective examination of catastrophic misinterpretations and experiential avoidance in emotional distress following loss. Journal of Nervous & Mental Disease, 198(4), 252–257.
Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–28.
Bonanno, G. A., & Kaltman, S. (2001). The varieties of grief experience. Clinical Psychology Review, 21(5), 705–734.
Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. New York, NY: Gotham.
Cole, S. W., Hawkley, L. C., Arevalo, J. M., Sung, C. Y., Rose, R. M., & Cacioppo, J. T. (2007). Social regulation of gene expression in human leukocytes. Genome Biology, 8(9), R189.
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56(3), 218–226.
Kanter, J. W., Baruch, D. E., & Gaynor, S. T. (2006). Acceptance and commitment therapy and behavioral activation for the treatment of depression: Description and comparison. The Behavior Analyst, 29(2), 161.
McGonigal, J. (2015). Superbetter: A revolutionary approach to getting stronger, happier, braver, and more resilient. New York, NY: Penguin.
McGonigal, K. (2015). The upside of stress: Why stress is good for you, and how to get good at it. New York, NY: Penguin.
Miller, D. H., Weinshenker, B. G., Filippi, M., … & Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: A consensus approach. Multiple Sclerosis, 14(9), 1157–1174.
Nakagawa, S., Takeuchi, H., Taki, Y., … & Kawashima, R. (2015). White matter structures associated with loneliness in young adults. Scientific Reports, 5. http://www.nature.com/articles/srep17001.
Orcutt, H. K., Pickett, S. M., & Pope, E. B. (2005). Experiential avoidance and forgiveness as mediators in the relation between traumatic interpersonal events and posttraumatic stress disorder symptoms. Journal of Social & Clinical Psychology, 24(7), 1003–1029.
Prigerson, H. G., Bierhals, A. J., Kasl, S. V., … & Jacobs, S. (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154, 616–623.
Shear, M. K. (2010). Exploring the role of experiential avoidance from the perspective of attachment theory and the dual process model. OMEGA: Journal of Death and Dying, 61(4), 357–369.
Shear, M.K., Monk, T., Houck, P., Melhem, N., Frank, E., Reynolds, C., & Sillowash, R. (2007). An attachment-based model of complicated grief including the role of avoidance. European Archives of Psychiatry & Clinical Neuroscience, 257(8), 453–461.
Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality & Social Psychology, 86(2), 320.
1. Christmas special, “The Snowmen” (December 25, 2012).
2. Brown (2012), p. 37.
3. Bonanno (2004).
4. Shear et al. (2007).
5. Bonanno (2004).
6. Shear (2010).
7. Bonanno & Kaltman (2001).
8. Modern episode 9–11, “Heaven Sent” (November 28, 2015).
9. Prigerson et al. (1997).
10. Modern episode 7–13, “The Name of the Doctor” (May 18, 2013).
11. Modern episode 6–13, “The Wedding of River Song” (October 1, 2011).
12. Modern episode 7–5, “The Angels Take Manhattan” (September 29, 2012).
13. Shear et al. (2007).
14. Boelen et al. (2010).
15. Orcutt et al. (2005).
16. Modern episode 4–13, “Journey’s End” (July 5, 2008).
17. Cole et al. (2007); Nakagawa et al. (2015).
18. Nakagawa et al. (2015).
19. Miller et al. (2008).
20. Minisode, The Great Detective (November 16, 2012), https://www.youtube.com/watch?v=G17_B4uACgg.
21. Minisode, The Great Detective (November 16, 2012), https://www.youtube.com/watch?v=G17_B4uACgg.
22. Barr (2004).
23. Boelen et al. (2006).
24. Modern episode 1–2, “The End of the World” (April 2, 2005).
25. Anniversary special, “The Day of the Doctor” (November 23, 2013).
26. Brown (2012).
27. Modern episode 6–4, “The Doctor’s Wife” (May 14, 2011).
28. Modern episode 3–10, “Blink” (June 9, 2007).
29. Modern episode 9–3, “Before the Flood” (October 10, 2015).
30. Modern episode 2–2, “Tooth and Claw” (April 22, 2006).
31. Modern episode 4–9, “Forest of the Dead” (June 7, 2008).
32. Modern episode 9–2, “The Witch’s Familiar” (September 26, 2015).
33. Brown (2012).
34. Modern episode 9–1, “The Magician’s Apprentice” (September 19, 2015).
35. Brown (2012).
36. Modern episode 4–8, “Silence in the Library” (May 31, 2008).
37. Modern episode 4–9, “Forest of the Dead” (June 7, 2008).
38. Beginning with modern episode 4–8, “Silence in the Library” (May 31, 2008).
39. Kanter et al. (2006).
40. J. McGonigal (2015); K. McGonigal (2015).
41. Fredrickson (2001); K. McGonigal (2015); Tugade & Fredrickson (2004).