WP_20141022_003Pamela Yew Schwartz

What does it take to comfort someone deeply afflicted by sadness—a family member unable to express his grief over a recent death, say, or a friendless patient warehoused in a public hospital’s long-term-care ward? Mental Health Clinician Pamela Yew Schwartz has spent more than three decades offering comfort to mourning strangers.

Emulating her physician father (who spent half of every day running a free clinic) and her teacher mother (always active doing volunteer work in school, church, and community), Pamela Yew aimed for a life of service. “My parents believed that service and friendship are more important than money,” she says. “I wasn’t conscious of this influence growing up, but it was a great legacy.”

Yew Family

Pamela Yew grew up in Hong Kong. Her mother, who was from Shanghai, was so successful and happy in her profession that she did not choose to marry until she was 40—a life of unusual independence for a woman in 1940s China. Her father, plucked out of poverty and educated by missionaries, was 57 when Pamela was born. “When I was a teenager in Hong Kong, they didn’t have therapy per se,” she says. “My friends and I wanted to share problems, to talk to someone, but we didn’t want to go to our parents. I thought it would be a wonderful idea to talk to somebody who was sort of like a third person, and more objective. So when I came to this country I majored in psychology, sociology. As I did field work, I got more and more interested in psychiatric problems.”

And so, while earning her Ph.D. in Counseling Psychology at New York University, Pamela Yew (now Schwartz) was working with people who were truly in need and largely abandoned—patients in the locked wards of the Manhattan Psychiatric Center, a public hospital on Ward’s Island in New York City’s East River. “It seemed so natural,” she says, “to spend time with people who need help and who can’t get it.”

40-wards_Manhattan Psychiatric Center

What Dr. Schwartz provided was not only counseling but something these isolated patients desperately needed: “implicit social support”— the companionship she could supply simply by being there. “In these locked wards, many patients had the same day, over and over again, year after year,” she says. “Even sitting with them in silence made them feel recognized.”

Asked whether she thought she could do much to help those long-term patients, Dr. Schwartz gives a long sigh. “It’s very difficult,” she says. “ Every day you try to make life a little better for those who have been abandoned by society . . . but actually turning life around, I would say it’s limited. Nobody hears them. Their families have tossed them aside. They have lots of problems . . . substance abuse, maybe cognitive deficits, legal entanglements, behavioral issues, multiple problems in their lives. It’s a great problem.”

Was it draining to be their psychologist? “Yes,” she acknowledges, “but somebody had to make these people’s lives a little different every day.” And, she further acknowledges, she is lucky because she followed her mother’s counsel to “find a profession you like so much that it feels like a hobby.” In 27 years at the hospital, Dr. Schwartz says, “I don’t think I looked at my watch more than five times.”

Seven years ago, Dr. Schwartz retired from her Ward’s Island post. Now, in her private practice ([email protected]) and as a bereavement counselor on the staff of the New York Hospice and Palliative Care Program of the Visiting Nurse Service of New York (VNSNY), she is using her training and experience as the only Chinese-speaking bereavement counselor on the program’s New York City staff.

While she works with all bereaved clients, her understanding of the culture of the Chinese families she counsels and her ability to speak their language (Cantonese, Mandarin, and Shanghainese dialects) are great advantages. “Asians have certain customs about bereavement, especially the older people,” she says. “Outward presentation is important to them; it is important not to cry, because crying means you’re weak. The family members could be crying in the privacy of their home, but they won’t cry where they can be seen.”

She smiles, picturing the dramatic scenes in old Chinese movies where the widow attempts to leap into her husband’s coffin. “Of course, at the funeral, you must cry,” she says. “If you don’t cry, you don’t care enough. But elsewhere, the family members hide their grief. I call it a ‘dance of caring.’ The children don’t want the parents to know they are worried, and the parents don’t want the kids to know they’re upset. It’s mutual protective helping.

“This is where I feel it’s a great opportunity for me to come in and say, ‘I understand. You can talk to me about it, if you want,’” she says. “It’s amazing how many people will talk to me.

“Everybody grieves differently. Some have intense feelings they’d like to share in a group; some people don’t like to be with other people, but want to talk individually; some don’t want to talk but will consider mindfulness, meditation, that kind of thing, or visit the grave. We bereavement counselors can’t take the pain away; we can just help the bereaved, support them on this road; they are the drivers, we are in the car with them.”

Visiting Nurse Service of New York bereavement counselors make contact with the “primary bereaved” family members some two or three weeks after the patient dies. They then follow the bereaved for 13 months after the death, as much and as little as is desired. Usually their counseling is conducted over the phone, but Dr. Schwartz sometimes visits a client’s home (anywhere in the five boroughs) in person. “I visit those who are especially vulnerable, like a child losing a parent, or when the mourner is older and has trouble hearing on the phone.”

She has learned to approach her Chinese and Asian clients’ pain obliquely. “When I call them, I sometimes spend just five minutes on the phone, asking, ‘Are you eating? Are you sleeping? Who’s coming to see you?’ I ask about physical, practical things. If they’re not ready to talk about their feelings, then I back off. They know that at least someone remembers and cares about them.”

If they are ready to talk, they let Dr. Schwartz in on their sadness, depression, lack of energy, regret. A husband ruminates that he wasn’t nice to his wife. A widow is upset because she wasn’t there when her husband passed on: “I didn’t think he was going to die, and I needed a break at the moment, so I went out. And I wasn’t there!” Family members agonize about what they could have done or shouldn’t have done. And very often they mourn, “I wish we could have kept him alive longer.”

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Sometimes Dr. Schwartz comes to see the family when the patient is alive because of the language component. When she’s there, she sometimes finds herself acting as emotional broker. “The children often feel that if they don’t try everything to prolong the parent’s life, they are lacking in filial piety. And the parent says, ‘I’m ready, but I don’t want to go because I don’t want my children to be upset. I’m doing it for them.’

In such a situation, Dr. Schwartz will ask the patient (let’s say it’s the mother) what she wants (e.g., “I am ready to go”) and what she wants to say to the family and finds hard to express (e.g., “I love you and appreciate all you have done.”) “The more traditional Chinese generation finds it difficult to express affectionate emotions directly.” Dr. Schwartz says. “Then I ask the family/children what they want to let their mother know. Often it’s that they are grateful for all the sacrifices she has made. But they are afraid that if they say it, she will die. Often I say that it will allow their mother to go in peace if they tell her that they will manage and will be OK, even though they will miss her. Basically I try to help them say goodbye to each other and exchange gratitude and thankfulness.”

Putting their regrets into words does give some ease to the bereaved, Dr. Schwartz has found. “First you have to build trust, so the survivors know you’re not going to tear them down and make them feel bad or weak. But regret slows recovery. I always say, ‘You don’t get over it you get through it.’ It helps them to get it out.”

Like other VNSNY bereavement counselors, Dr. Schwartz runs support groups for bereaved family members. Her twice-a-month male and female Chinese groups are very different:

“The men are slower to express emotion. They’ve been together for a year. They’ll talk about sports—the U.S. Open, or the World Cup . . . sports is a lifesaver. They’ll talk about playing mahjongg (they actually don’t play mahjongg in the group). Then someone will ask, ‘How do you make the rice for one person?’ Then someone mentions that the most lonely time is before he goes to sleep at night, and do you sleep in the middle of the bed? Supposedly they don’t like to talk about their feelings, but they do, they do.

“The women tend to be more overtly supportive of each other: I can get them to go to senior centers and to do volunteer work. They share a lot about the illness and their caretaking time, and how difficult it was. And now what? If they have devoted their lives to taking care of the house and family, what are they going to do now? How are they going to spend their time?” One of Dr. Schwartz’s clients is a sixtyish woman who has been a housewife all her life, speaks no English, and feels like a failure now that her husband is dead and her children are grown. She had a panic attack and ended in the emergency room. Dr. Schwartz persuaded her to venture out to a senior center. “But senior centers are very cliquish, so I had to find one that was more open to her.”

Dr. Schwartz did indeed find one. “Not only is she going there on a daily basis,” she notes with pleasure, “she has also brought two new members from our women’s group to the center!”

All our lives we are called upon to find words of comfort for someone who is grieving—and all too often we find ourselves speechless. Dr. Schwartz acknowledges that there is not much to say . . . but there are things we should try not to say.

“To witness someone else’s grief is so uncomfortable. You want to do something. Your helplessness is so great that you say, ‘Oh, you’ll feel better in time. I’ve been through that.’ But the grieving person thinks, ‘But you’re not me!’

“Don’t be dismissive about their pain. Just say, ‘I’m so sorry; I’m just here for you; tell me what I can do.’  Give them a hug, if they want you to. But be careful not to minimize their feelings. Mostly acknowledge, validate, and witness their loss for what it is.”

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  • Claudia Harkins October 26, 2014 at 2:47 pm

    Dr. Schwartz is a gem of a person. I can’t think of a more needed and necessary career than a counselor of patients who have been abandoned or are grieving a loss. Deborah captured the behavior of most people when it comes to saying the right things or giving support to someone who has lost a loved one. Also, Dr. Schwartz’ thoughtfulness and sensitivity to those in hospitals or homes who have no social involvement. I remember how lonely and cutoff I felt when I lost my beloved husband. And retirement can also make you feel alone when you no longer have work or the friendship of your fellow co-worker. There is great need for a Dr. Schwartz at sometime for everyone.

    Reply
  • Liz Robbins October 25, 2014 at 11:25 am

    Wonderful and important piece Deb about an inspirational woman. Thanks for this.

    Reply
  • Susanna Gaertner October 23, 2014 at 6:47 pm

    Shining through Deb’s thoughtful profile is the heart of this empathetic woman…wonderful job, both of you!

    Reply
  • Toni Myers October 23, 2014 at 3:29 pm

    Dr. Schwartz does wonderful work. I think we forget about the importance of consulting a grief counselor when we’re in pain over the loss of a loved one. I hope there are many more as empathetic as is she. Thanks!

    Reply
  • Roz Warren October 23, 2014 at 8:48 am

    What a terrific profile! Sharing this one to FB. Thanks!

    Reply