Crackpots #16: Grieving Under Capitalism (Patreon)

This edition of Crackpots comes from Jayinee Basu. Jayinee is a resident physician in psychiatry and the author of the science fiction novella The City of Folding Faces. She is currently working on a sci fi novel tentatively entitled Interior Design. She is on Instagram at @yumpopink.

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God it’s freaking depressing out here. 

First let me acknowledge the everyday joys: light entering and leaving a crystal, my excellent cat Attorney General’s big purrs, and the Ethiopian dish gored gored — big raw cubes of steak slathered in spicy butter. I don’t want to take anything for granted. But in-between these ordinary delights, reality has been taking any opportunity it can to rip my heart out and stomp on it. An unending genocide, overnight climate refugees, and the inauguration of another enemy regime form the backdrop of my personal tragedies. Perhaps yours too? And as we are all being tossed around in this terrible salad of sadness, we find ourselves more and more needing to console each other. It turns out that there is a right and a wrong way to do this. 

It’s old news now but still funny, I think, that video of the two leads of Wicked being asked about their response to people “holding space” for the lyrics of a song in the movie. Ariana Grande grasps Cynthia Erivo’s talon who is gasping and saying “I didn’t know that was happening” several times (what was happening???), while the interviewer looks regretful that she oversold the whole thing. In later interviews, all three acknowledge that no one in the room knew what the hell was going on, and that all three were producing emotional reactions they assumed were expected of them. 

I, like many haters, do not like the term holding space. I genuinely do not know what it’s meant to signify. I particularly resent it being described as nonsense therapy-speak, as therapy jargon tends to be specific in meaning. As a resident doctor in my last year of psychiatry training I am by no means an expert in psychotherapy per se. But I have been learning about and practicing psychotherapy for the past four years in a program that emphasizes psychotherapy training, and I’ve never heard this term used in a clinical setting. 

Around the time that the Wicked clip went viral, I was sitting in my obstetrician’s office waiting for her to do a scan and tell me if I was having a miscarriage. To distract myself, I posted an Instagram story asking whether anyone knows where the term holding space comes from. 

Some responded with laugh reacts. Someone thought it meant to reserve physical space at meetings for marginalized groups. Someone else thought it meant rumination. Another person thought it meant regarding someone else’s trauma over your own processing of it, which is probably the closest to how I normally see it used. One friend said they had done their own research and came up with intriguing but fruitless leads.

One friend who uses it a lot (I guess?) was pissed at me for implying the term is abnormal and stopped short of calling me a dumbass for not knowing its meaning. 

I mean I kinda knew. In the same way the Wicked interviewer kinda knew, though probably she kinda knew even less than me judging by her misapplication of it (I feel pretty certain you categorically cannot hold space for a recorded song). But is kinda knowing really knowing? 

I for example did not immediately connect the term to psychoanalyst Donald Winnicott’s concept of a holding environment in object relations theory. An occupational therapist friend on Instagram had to make that connection for me. The reason I didn’t make that connection is because a holding environment as it’s used in psychotherapy is more than just being present and aware and nonjudgmental. Holding environment originally referred to a mother’s complete tolerance, responsiveness to, and literal holding of her crying infant, and her gradual retreat in order to allow the developing child to come to terms with his physical and conceptual separation from her. In psychoanalysis, this image is figuratively used to refer to “any therapeutic space that allows an emotionally fragile or insecure person to deal with affects that might potentially be overwhelming.” Winnicott wrote: “A correct and well-timed interpretation in an analytic treatment gives a sense of being held physically that is more real...than if a real holding or nursing had taken place. Understanding goes deeper”. 

Are people making psychoanalytic interpretations out there in casual conversation? Insane, if true. More likely it’s the case that when someone says they’re holding space, they are extending an invitation to process difficult things with the offerer as witness, similar to a therapist. But is “therapeutic” a reasonable or even desirable quality to expect of a conversation between friends? 

Importantly, a holding environment in therapy implies boundaries that delineate it from some other, less supportive environment. Therapists typically practice in offices or hospital rooms or other clinical spaces. In addition to the physical space, the boundaries of the therapeutic context—the agreed upon time, the rules of the clinic, the therapist’s and patient’s role, the cost, the legally enforced confidentiality, etc. — is called “the therapeutic frame”. Paying attention to the way this frame is maintained or manipulated is one of the most important aspects of a psychodynamic practice. Removing boundaries from a holding space removes the structural underpinnings that make psychotherapy a safe and effective treatment. Seemingly an offer to hold space would involve specifying these boundaries, which I’m not sure is happening (what for the love of god is happening???) 

If Winnicott’s concept did birth the term (dubious), it has since moved on from its psychoanalytic meaning toward something else that is somehow equally professionalized. The author of the blog post that popularized the term in 2015 is facilitator Heather Plett who references Malcolm Gladwell, mandalas, and miscarriage in her personal bio. In it she mentions that she did not come up with the term holding space but learned it from multiple sources during the course of her own facilitator training. One of these sources is The Circle Way, a system created by two nice-seeming white ladies in the early 90s, which now offers $1700 retreats where you can immerse yourself deeply in the ancient art of talking while sitting in a circle. Riding the wave of popularity of the 2015 blog post, Plett herself has started a center where you can become certified in space holding for $7K CAD — about $4860 USD — plus a yearly maintenance fee. The certification provides a license to use the content of the course and Plett’s book in one’s own work. So maybe the confusion around the meaning of the term can at least partially be explained by its proprietary nature. 

(Footnote: While looking into this I was reminded of another certification of questionable value: psychedelics-assisted psychotherapy—i.e. incredibly attentive trip-sitting for compounds of uncertain future regulatory status— available for a heart-stopping $9K at the California Institute of Integral Studies. As a point of comparison, certification in CBT from the Beck Institute and certification in DBT from the DBT-Linehan Board of Certification — both evidence-based psychotherapies— costs under $1K each. At the 2024 American Psychiatric Association conference in Manhattan, a masterclass in psychedelics-assisted psychotherapy made it clear that there are serious kinks to be worked out in its application. To paraphrase a nurse who has participated in psychedelic clinical trials— when a patient having a challenging trip requests physical comfort, what are you supposed to do? There is no clinical equivalent of a cuddle puddle. Spooning is definitely not allowed. Holding the patient’s hand may be one permissible contact. A hand on the shoulder may be another. The nurse then put her palm sideways on her co-presenter’s forehead from 3 feet away to demonstrate a third. To me, the term holding space feels like someone putting their palm sideways on my forehead from 3 feet away as a gesture of care.) 

Back to the question of the right and wrong way to console. 

Happily, I didn’t have a miscarriage the day that I posted the question to Instagram. Things were holding. After crossing into the relative safety of the second-trimester, I finally let my guard down. I dared to buy a single baby item: a fuzzy white hat with teddy bear ears. 

Just a few weeks later, my water broke in the early hours of the morning and I knew it was over. This marked my husband Patrick’s and my fifth miscarriage in the past three years. We put the hat with ears in a cardboard box painted with roses. Our hearts haven’t recovered, and maybe never will. 

After I went back to work, one of the front desk ladies at the clinic gave me a big hug and without a hint of irony advised that now that I’m almost done with residency I take a year off work to reduce my stress levels. I told her that that would be nice but impossible as I had to pay for things like food and shelter and nearly half-a million dollars in student loans. Another front desk lady gave me a big hug, mentioned God, and said “everything happens for a reason.” Then, as if noting the implication, she pulled back and said “um, a bad reason,” which made me laugh. Though these women were clearly not practiced in the art of holding space, I did feel held mostly because of the hugs, but also because they cared enough to acknowledge my miserable situation at all.

The problem with human intimacy has always been our tendency to cause each other pain. At a virtual pregnancy-loss grief support group, I was struck by the way that insensitive responses from friends and family caused severe pain to those grieving, and the way that the pain seemed to intensify inversely with socioeconomic status. To me what sounded like relatively minor acts of thoughtlessness and microaggressions were experienced as intolerable assaults threatening the integrity of the entire relationship. I got the sense that the impact of invalidating communication had more to do with the allostatic load of the person receiving it than the sentiment itself, but I couldn’t be sure. The group was comprised of complete strangers and I never saw them again. 

At Yung Chomsky's New Year’s Eve party I was talking to pain researcher Marianne Reddan who runs a social cognitive neuroscience lab in the Bronx. She advocates for models of pain that take socioeconomic factors into account, hypothesizing that the individual experience of pain is produced not just by the intensity of the painful stimulus, but also by the prior experiences a person has had of resource-related injury and the amount of support they can expect to have in the future. That is, people who have had a more difficult time accessing money, healthcare, housing, education, and community — all things that can ease the burden of injury that pain signifies — will have a higher expectation that pain will cause them harm and subsequently will actually experience more pain in response to the same insult than someone with access to these resources. This idea is reflected in the universal observation that lower socioeconomic status is associated with higher levels of chronic pain, and that pain is a barometer of population health. 

Grief and pain are distinct but related concepts. Unlike pain, grief is not a state, but a process. Acute grief is experienced soon after a loss. Uncomplicated grief is the process of integrating loss into one’s life and forming a new relationship with the object of loss. Complicated grief is an experience of loss that is not able to be integrated, becoming the major focus of a person’s life and is often the result of chronic pain. Maybe I am doing too much with Reddan’s preliminary results, but the model makes sense to me intuitively when I think about my patients’ pain as well as my own. I recognize that part of the intensity of my grief was the way the last three years have eroded my trust in the healthcare system, leading me to question not just my own ability to obtain necessary help in the future, but my ability to help people as a doctor. 

All of this is to say that maybe I’ve been too quick to judge the concept of holding space harshly. Maybe it does have utility for some people or populations whose experience of pain may be inherently sharper, and for whom careless responses to grief may be more damaging. In my experience low-resource people have finely-tuned bullshit detectors and do not respond positively to inauthentic expressions of care, but maybe if I had the special training I’d know how to authentically hold space in my day to day life. 

I still maintain though that what ruins relationships aren’t well-meaning people who offer unsolicited advice or strange supernatural explanations for death. What ruins relationships are nervous systems stretched to their breaking points from the stress of trying to survive in a world where your shelter, relationships, and bodily integrity are held hostage by the whims of capital. That is not to say that one shouldn’t attempt to improve their emotional awareness and communication skills. But I have serious doubts that the knowledge imparted in a $5K training program on effective listening does not already reside somewhere easily accessible within the human heart. 

Incidentally, Plett’s Centre for Holding Space has trademarked the term holding space in the US in the education and entertainment services category with the following description: 

Business education and training services, namely, developing customized leadership and executive development programs, providing executive coaching services, and providing business education programs to employees and executives; Educational services, namely, conducting on-line courses and webinars, in-person retreats and workshops, conferences and keynote speaking in the field of personal, professional, leadership and community development; Providing group coaching and in-person learning forums in the field of leadership development 

God it’s freaking depressing out here.