Dr. BJ Miller, MD, is a hospice and palliative care physician and the co-founder of Mettle Health, a telehealth platform that provides holistic support for patients and caregivers navigating serious illness. He is internationally recognized for his work in humanizing healthcare and shifting the cultural narrative around death and dying.
Dr. Miller previously served as the Executive Director of the Zen Hospice Project in San Francisco and as an Assistant Clinical Professor at UCSF. His 2015 TED Talk, “What Really Matters at the End of Life,” has garnered over 15 million views, and he is the co-author of the acclaimed book, A Beginner’s Guide to the End. He was also a featured subject in the Academy Award-nominated Netflix documentary, End Game.
Listen to the podcast here, or wherever you get your podcasts.
Kenny Primrose:
Dr. BJ Miller, it is such a pleasure to have you on the Examined Life. Thank you for joining me today. So the kind of theme of the podcast is to use questions as a kind of tool to shine a light on things we might not think of or be paying proper attention to. I know you’ve got a lot of questions that you’ve kind of explored in your work and your life. What is the question that’s kind of bubbling up for you at the moment as something that we should be paying attention to?
BJ Miller:
Yeah, there are a lot of ways we could go with this prompt. But one question that comes up for me again and again and again these days, as though it’s like screaming at me, is to ask myself and others, you know, how or where are you grieving these days? And I like that question for a number of reasons, including it kind of presupposes that you are. That you know you ought to be, you know, yeah boy, should the language of should is really uh generally unwelcome, especially around grief. But I guess I would pose this question to all of us to prompt us to look more closely. You know, for one, I think a lot of us have misbegotten notions of grief, that it’s only relevant if someone close to you died, for example. Um, and so I’ve asked a lot of people, you know, their relationship to grief, and they say, Oh, well, I’ve never, you know, no one I’ve never lost anyone close to me. And it’s an interesting kind of tell that our our notions of grief, if we have them at all, have gotten very kind of narrow, very kind of sort of sense in a sense that that’s kind of optional and only for this big stuff of death. But the truth is, it’s really the wiring is around loss, and we have losses, experience losses all the time, and just some are bigger than others or more dramatic. You know, so one one prompt in this question is democratize the notion of grief that is relevant to if you’ve been on the planet for more than a few moments, you have some access to grief. If an infant were able to communicate, I would imagine that the infant feels a sense of loss of being in the womb. I certainly know that I feel a little bit of grief on you know Sunday nights that the death of the weekend, you know, or certainly have felt grief uh around losing relationships, friendships, romantic relationships. So anyway, I’m going on a little bit, but just to say my question presupposes that we all have some relationship to grief, which I believe we do whether we acknowledge it or not. And and then let’s talk about why I think that’s so important. But first to start us, let’s get in the ballpark. Everyone, every human being, whether they know it or not, knows something about grief.
Kenny Primrose: 05:60
We just have to impoverish the notion of what grief is. If we’re not grieving, it’s not because there’s nothing to grieve, it’s there there’s a blockage somewhere in the system.
BJ Miller: 06:11
That would be my take for sure. Very strongly so.
Kenny Primrose: 06:16
I wonder, BJ, if you could tell us a bit about your your personal story with
Kenny Primrose: 06:20
grief, if we’ve all got a kind of grief narrative, when did when and how did you become acquainted with it as a as a part of the human experience?
BJ Miller: 06:31
Well, uh, you know, and one answer to that question, Kenny, would be very early on, I just didn’t know what to call it. You know, I just felt I was a m you know, I remember kind of being referred to and kind of not and not minding the language of being kind of a melancholy kid. You know, I had real access to sadness early on. My own, just others’ empathic sorrows. So I think for me it goes way, way back. It’s an early experience of being alive, but I didn’t know it wasn’t no one, it wasn’t called grief. I did I didn’t have a name for it. And then at times I kind of wondered if I was sort of depressive, and I’ve treated myself for depression on occasions, and that may have been true. Then, you know, when I was 19, I had a big accident where I lost some limbs. I came close to death myself and lost both legs below the knee and one arm below the elbow. And that certainly came with a big sense of loss. But even then, the the G word wasn’t coming up. If someone was talking to me about grief at the time, I don’t recall it. Um, so there too, I probably would have thought, well, I didn’t die, you know, no one died. So, you know, so I greeted. So that’s you know, it takes me to my early 20s, and I watched myself increasingly be kind of whipped around by my emotional state and surprised by it. Um, I kept trying to apply logic to my emotions and that I should feel this way, or now that I’m so far out from this experience, I should I should feel that way. And I was doing that all the time. Um and then um there’s some other, you know, all sorts of big examples in my 20s of very of loss of various kinds, still no g word in sight. Then I lost my sister when I was 27 or so. And that finally, you know, finally the g word appeared uh because I had lost someone close to me, I died. So that narrow definition now worked. But there too, didn’t we didn’t have any, there was no catchment for grief, there was no holding it. My parents and I certainly talked. My parents are, it’s not as though the family’s closed off emotionally, we just didn’t have really uh language for it and hadn’t really dug into it. So we were all grieving, but I I intended I wasn’t, I I thought I could kind of beeline, I needed to get to acceptance because this had happened. Lisa wasn’t coming back, so okay, I know it. So I just wanted to try to like use my brain, like a lot of us do, to intellectually kind of beeline to acceptance, convince myself to accept the situation, and my emotions should follow suit, was the thinking you know I mean it’s a tremendously, tremendously hard thing to happen.
Kenny Primrose: 09:27
Do you say in your book that you wish you could go back to that kind of gut-wrenching grief of your sister that you passed over too quickly? You said you left your kind of emotions in a pile. I mean, we think of those gut-wrenching times as a valley that we want to move through the really quickly and move on. So tell me a bit more about that, BJ.
BJ Miller: 09:50
Yeah. And you’re right, Kenny. I mean, these are not very savory feelings, or some of them, but you know, it’s not it’s not a zone, especially if you’re uninitiated, that you it doesn’t seem like a place you want to hang out. And also the cues I would get from the public was, you know, pull yourself up from the bootstraps, kind of get back on the horse language, and you know, that was cast as sort of a sympathetic supportive talk, which is basically, yeah, yeah, get keep moving, get going, and you know, just kind of keep keep keep moving, don’t before the feelings set in, you know, essentially. And I tried to do that for a number of reasons, for my own sake, because I thought that that’s what uh my parents would be good for them, because the cues I was getting from around me some seemed to suggest that’s what I should do. That’s what a strong person would do. So I had some identity hangups there that, you know, if I looked really closely, that, you know, if I interrogate my my my feelings about my feelings, it was as though sorrow was for chumps, you know, or for weak folks who were weak or something like that. I mean, somewhere in my nervous system bought into that. So for all these reasons, I was trying to just leapfrog over the hard stuff, go right to acceptance. I was rewarded. People would say, Oh gosh, you’re back at school already, or God, I didn’t expect to see, you know, I got some sense of welcome surprise that I was doing, quote, so well. And the so well was measured by my lack of tears or by some sense of normalcy in my expression and my behavior. But I was, of course, just faking it. It was all performative. So, but it took me a while to realize that. But sorry, Kenny, you were gonna say something there.
Kenny Primrose: 11:39
Well, I was gonna ask,
Kenny Primrose: 11:40
who were you performing for? You point out that people are kind of allergic, are afraid of grief like it’s contagious, like they are with you know, death. Do you think it was a performance to make other people feel less awkward or yourself? For sure, for sure.
BJ Miller: 11:56
In a in a loving way, you know. I I I really it was I thought I was doing myself a favor by not getting bogged down or not getting lost. You know, the feeling was like if I if I give in to these feelings, I’ll never get out. You know, and it’s like this abyss that you fall into and you’re screwed, you know. So I I I thought I was doing myself a favor, certainly, but you bring up a really important one, Kenny, that we all kind of conspire in our culture and society for these things. Friends don’t know what to say, it’s awkward, you know. So, you know, and so me as the as the bereft, anything I can do to let them off the hook. So, oh, you know, it’s okay, or change the subject. So we’re conspiring to avoid the subject for their purposes, for my purposes. Everyone’s it just seems like it’s better off if we just smile and keep going, you know, essentially. This is all shorthand, of course. At the time, it wasn’t so coherent. I couldn’t explain this to you, but in retrospect, this is what I was doing. But but to your question, a big driver was what I thought I was doing other people a favor, sparing their awkward feelings. But that’s not the whole story, of course. But then I and I realized some things um along the way is you know, friends sometimes friends of my sisters would tell me they had dreams about her, or she visited them, you know, and I felt so sad. I couldn’t, I could, I couldn’t even really think about my sister by trying to wall myself off from these harder feelings. I came to realize I was walling myself off from her memory because thinking about her, conjuring her, feeling her, came with some hard feelings. I tried to avoid them, and therefore I avoided my sister by accidentally. So I couldn’t even like I would talk about, I couldn’t, I could mention her name, but as though it was like there was nothing, I couldn’t, there was no purchase. I couldn’t feel her in ways that some people were telling me they could feel, and I felt really left out and I felt cut off from my sister in ways that I in retrospect didn’t need to be. And it was um working with my patients as a physician who taught me about the lessons I’m getting to here. But let me just pause there, Kenny. Was there a question or see your face? Was there something to jump into on that point?
Kenny Primrose: 14:24
So many questions. Yeah, I I can relate to lots of it too. I think I grew up with a kind of script message from childhood that my my sadness or my fear or or whatever it was not welcome. We needed to just like get distracted. That was your medicine, yeah. And and everybody just kind of functioned on. Maybe we can come back to the kind of societal pathology behind that. But this this idea that you you you numbed yourself from those memories, I I did that for my mum passed when I was you know 21, and I find it still quite hard to access those kind of visceral memories. Um and I think it’s cause like there have been moments they get kind of charmed out by a talented therapist or the right piece of music. But did you manage to did it did it resurface for you? Did you manage to reconnect to to that?
BJ Miller: 15:20
Yeah, yeah. And thank you for that example, Kenny, and such great language. Recharmed by yeah, something exactly it’s like uh something like conjured or something needs to be pulled up and out of this sort of a vague, abyssy stew of feelings. And yeah, so so with time, I watched myself, I could see myself because I if we were talking back then, you would recognize me back then. It’s not like I I was very interested in the hum full human experience, including the emotional one. I I just was laboring under the sense that this is what I should be doing, and I didn’t know how to do it otherwise. There was no, I had access to a therapist, and that was helpful, but that was in the language of pathology and psychology, and there was no there wasn’t, it was a little bit threatbare in terms of the visceral experience. But anyway, to your point, and so I I would have held up my hand saying, hey, I’m one of those guys that’s interested in feelings. I I, you know, and of course sadness isn’t an enemy. I would say all those things, but if you watch my behavior to myself with myself and others, I was in shades of gray of playing into this sort of sidestep of feelings for all the reasons we’ve said. So, and I got so I could see how by my late 20s, this may be an amalgam of experiences of loss and practicing medicine certainly didn’t help. I was going farther and farther into a numbed-out state where I couldn’t access uh feelings about my sister or memories of her. I couldn’t access all sorts of things. I was starting to see, I was really I was starting to get the clue that I was pretty blocked and and against my will at this point. It’s not like I could just say, go home, take a deep breath, realize I’m safe, and turn on the emotions. They just I couldn’t find them. And even I had them, I was so at the receiving end of them in some undifferentiated. See, I was just being whipped around in a way that I couldn’t even experience what I was experiencing consciously. I was just moody, kind of cut off. And I knew that’s how I didn’t want to be. So then I engaged in more performance. I knew I wanted to be a warm person, a nice person. So I would do those things out of memory, muscle memory, and habit, but I was increasingly not present in my own experience. And um, and that has fallout fallout for me, of course, personally, but also your relationships begin to feel it. If you’re not relationship is an active, dynamic thing, whether you’re relating to a dog or a best friend or a stranger or yourself, it is a dynamic, engaged process inherently, if you’re if if you want to really be there. So, anyway, all these cues and clues are coming in. And meanwhile, I’m functioning as a hospice and palliative care physician, you know, talking to people about things like grief in a cancer center, you know, all the time. But so it tells you one thing about the sort of the medical model and how it makes space or doesn’t for this stuff, even if you’re sensitive and want to be dealing with it, it’s just not much there. Sort of a desert. So and then so I’m sitting with patient after patient, one way or another for months and years. And I, you know, as it goes, of course, you know, I’m supposed to be doctoring them. But as it happens, they’re doctoring me, of course. And that’s that’s good, that’s nothing but good news. And one of the ways I got doctored by my patients was seeing people grieve, people wail,
BJ Miller: 18:55
the tears flying out of their face, and them not corking it, you know, one way or another, letting themselves emote, and even in this deep heaving cries and not didn’t look comfortable, but you could see also the relief in their eye, the you could feel how they were touching this person that they still loved and had access to. And I just got really curious and even a little jealous of my patients. Like, how are you doing this? I couldn’t, I couldn’t, I couldn’t cry if I wanted to. I couldn’t even get to so the my patients were the ones who were showing me, like, a that you can have these feelings and let them out, be with them. And what it said that it’s some sort of package deal that with those feelings, first of all, the feeling, the hard stuff doesn’t stick around forever. These are not permanent states, big, big important point. And secondly, I got to see, like I say, I’m repeating myself, but I got to feel how connected they were to themselves and to this thing or person that they lost. And I was like, okay, I’m I gotta I gotta revisit that, I gotta learn some new tricks here. So that that’s in my 30s, and then ever since then has begun began an apprenticeship with grief one way and another, my own and other people’s. And I have come to see it, well, see grief everywhere. What I really think I see is unrecognized grief, unacknowledged grief, and then it does, then it starts creating other problems, and we can talk about that. But let me shut up for a second.
Kenny Primrose: 20:25
Please don’t, it’s absolutely fascinating. This this kind of portal you get into your own grief through watching other people grieve. You bring to mind a line from C.S. Lewis, and I might badly paraphrase it, but he said, I sat with my anger long enough until she told me her real name was grief. And I think you which I think is a beautifully astute line, and he he says something similar to what you said in your book, the grief masquerades.
BJ Miller: 20:55
Yeah.
Kenny Primrose: 20:55
And presumably there are some masks that feel authentic and helpful, and other masks which are not doing anyone any favors. Can you speak into that?
BJ Miller: 21:06
For sure. Yeah, can you? It’s such a good point. Well, and also want to make sure I circle back to your last question, to and we can talk about it more, but I want to make sure that the listeners know that grief is not on this sort of linear time horizon. We talk about six months or a year of grief. Don’t be too seduced by that. It’s not on a timeline. And many, many years after my sister’s death, when I finally came around to the wisdom of grief and actually daring to feel the stuff, I did get to feel reconnected to my sister in new ways. So it in some ways I want to make it make the message it’s it’s never too late. The connections are subtle. I don’t make too much of them, but I feel connected to Lisa in ways I did not have access to before. And that was many years down the road that I was able to circle back. So I I definitely want to make that point here. We can talk more about it. To your uh uh other question. So yeah, grief is you know, what’s the difference between grief, sorrow, depression? Ah, you know, they all smell a lot alike, and depending on what lens you’re pulling, looking through a medical one, psychopathology one, or spiritual one, etc. So um I I I can’t tell you really, there are not a lot of really very firm lines between these emotional states. That’s one point. But grief is not like you know, it’s like an altered state, essentially. Like as I say in my book, when we were lowering Lisa’s casket into the ground, I started like I was such a odd experience and so surreal that I started like sort of laughing, like a cackling laugh came out of my face, and it was so I was so freaked out by my own, like, what the hell was that? What was it even laugh? It was just a weird, laughy kind of sound at the absurdity of everything. And and and I was very embarrassed by it, but I’ve come to realize that was grief. You know, I it it it it’s an inherently subjective state, and how any one of us experiences grief, anyone else saying you should feel this way and not that way, just throw me out the window and everything. It just it’s really you’ve got to just go with the feeling itself in your version of it. And there are moments where sure you can follow Elizabeth Kuber-Ross’s teachings around sort of the stages of grief, you know, bargaining, anger, etc. Those those those are in there. You could you can identify those. You can identify a zillion other ones too. So to your point, like the uh it has a lot of proxies, it doesn’t always show up as recognizable as just plain sorrow. It can be laughter at weird moments, lightness when everything else feels heavy, or just a strange heaviness where everyone else is light, altered the force that moves through you and morphs. And and I think to T. S. Elliott’s wisdom there is not just interesting, grief has all these proxies like anger, for example. It’s not just a note of intrigue. If we don’t really get to know these feelings, then you’re at the receiving end of something else. So if you if you mistake your grief for your your for anger, if you are just acting on that intense anger feeling, well, you might lash out at others, you might blame people for something, you might look for cause and effect, you might make meaning around that anger that is actually just totally wrong. You know, our feelings, our thoughts, they’re not necessarily so linked up with the truth in any one moment. They just think, you know, you have to interpret them. So if you’re not really acutely aware of how grief can work, and if you’re not interested to look at the nature of your own feeling, not in some eggheady intellectual way, intellectualizing your feelings, I don’t recommend it. It’s a great way to not feel your feelings again. But I do think knowing these feelings helps you see what’s actually
BJ Miller: 25:25
happening. And then this is the public service thing of why I think re these days would be so helpful. Like I think a lot of our politics right now, um, and in the sort of foul divisive nature of it, I would bet all my money that if you could unwind all of this and get to some core place that that out of which all this our current time sprung, I think you would find a lot of sad, mostly boys, little boys who lost something and didn’t have the space or the language to grieve it. And did that again and again and again, got scarred down, misread their feelings. Anger, for example, lights up and they have it’s such an intense feeling. Well, they gotta have be anger at something, so they start scapegoating, and away we go. So, anyway, let me pause there.
Kenny Primrose: 26:25
It’s such a good point, a really important one to pause on. I read an essay called the Grief to Grievance Pipeline, and it was talking about exactly this. So, an example could be where I live in the northeast of England, you’ve got all these closed coal mines, and when they close, you know, environmentalists were dancing on top of the closures think this is wonderful. There was no space to grieve the livelihoods and the communities that were kind of gutted through it, and those same communities are where you’ll find quite a lot of scapegoating and xenophobia and like grievance pointed towards outsiders as if that’s like the reason that this all happened, and it feels like uh a good example of unprocessed grief. Amen, Kenny.
BJ Miller: 27:12
Oh, totally. I mean, I you know, I completely believe that. And boy, interesting to note the word grievance. Being in there. Yeah. No, I I think there’s and if this isn’t actually the whole enchilada, it’s certainly a piece of it. But this is where I begin. I think it’s grief and us re-engaging with this ancient force of being alive, for one, will help us actually really feel alive. And for two, will help us sort of unpack some of our wayward meaning-making efforts, the blame, the scapegoating, the externalizing, the otherizing, et cetera. All this is fallout from us trying to keep hard, unpleasant feelings away. Um, and so one way or another, we’ve got to come around to learning how to feel these feelings and pause before acting on them as though they’re some fact, that anger two mentions, et cetera. So yeah, I couldn’t believe this more strongly.
Kenny Primrose: 28:15
You’re listening to The Examined Life with me, Kenny Primrose. Today, in conversation with BJ Miller. Just taking a brief pause from the conversation to say that if you are enjoying this conversation, then you might also enjoy receiving the newsletter and updates from this examined life on Substack and checking out previous episodes. The simplest way of supporting the show is to share the examined life with someone who you think might enjoy it, and to leave a review on Apple, which will help others to find the show. That’s my plug. I’m now going to return you to my conversation with BJ Miller. The words grief I looked
Kenny Primrose: 28:55
up today, I thought I wonder what the etymology is. It comes from gravis the Greek, you know. I guess you get gravity from its like weight, but it feels as if, at least implicitly in what you’re saying, that grief doesn’t only take away. There’s some kind of something generative about it. You know, Rumi said the the wounds are where the light gets in. I think partly we run away from grief because we’re scared of being annihilated by it.
BJ Miller: 29:20
Isn’t it?
Kenny Primrose: 29:22
But there might be something life-giving in moving towards it.
BJ Miller: 29:27
Absolutely. So, Leah, let’s keep going with this. So uh one, so so far we’ve talked about like grief being an important voice force to connect us to people and things we’ve lost and to ourselves with the feelings of loss. So that connecting force, huge. If we live in a world everyone feels disenfranchised, disconnected, lonely, et cetera. Well, this might be a really important sort of conduit to reconnect. So that’s that’s in here. Um, we’ve also talked about it a little bit, touched on it as sort of a harm reduction effort, because if you don’t know you’re grieving and you’re just at the receiving end of your own feelings, and you know, you could follow, you could take your own bait and get yourself really angry at the wrong thing or the wrong person. So, in some ways, there’s the public service here of grieving would be so that we sort of stop the hemorrhage and you know, this phrase hurt people, hurt people. Like, yeah, like okay, if we realize that we’re the source in some level, we are hurt, then tend to that, tend to that wound and before you start externalizing and hurting other people. Um, so there’s a that’s so the sort of harm reduction piece, I think, is really important. Now you’re pointing us to something else, which is this um that grief can be this very beautiful thing, and it kind of touches on the connected aspect of it. So so, yes, there are those hard feelings of loss, but if you really let yourself be with that loss, you begin to see how amazing it is that you’re alive at all to have experienced loving something or someone so much that they’re lost is agon, that the loss of that person or whatever is agonizing. It it’s tricky, but it does tell you how alive you are and how amazing it is that we get to feel these love connections at all, and that they’re so powerful that that they hurt when they end or seem to end. So, so it can, if you let it, if you keep rolling with the feeling, it will tell you that you are very much alive and that that life, by virtue of learning how to lose things, you realize it is precious, it doesn’t stick around forever as such. So it can help as a quickening force, it can kind of wake you up to your aliveness. Um, it can also help you experience hard feelings and build your capacity to be with hard things. And a lot of things in life are hard, including lots of pain of various kinds. So it can build your capacity to have a much richer access to the to feelings of being alive, to be alive. And also when you acknowledge what you’ve lost, you also that’s a way of honoring it. And when others see you honor that loss, they’re more likely to feel okay with it. It sort of builds on itself, they’ll feel okay with their losses. They’ll also, like as a doctor, if I signal to my pay, if if one patient sees how moved I was by the loss of another patient, it sends a signal to them when it’s their turn to go, they know that their doctor actually cares about them so much that he’s not afraid to shed a tear uh about losing, that that person mattered. So it signals this mattering to anyone watching, which is its own powerful course. And then maybe lastly, by showing you you know what you have lost and acknowledging that you’re still here, it has this way of pointing you back to all that you still have. Yes, what you’ve lost, but as a dark and light kind of shadow, sort of form and emptiness, you get to also see all that you still have. And that primes you to appreciate what you still have while you still have it, which is so much of the game of life for me. Like all this work, really, I think, in some ways, for two for two things. One is can I learn to love reality and and and realize my place in generating it? Can I be okay with what actually is? Can I get there? Can I really love life? Not love life if it absent this thing or that thing, or if you know if I can avoid this feeling or that you know no, life becomes much more, much bigger than just avoiding pain. So, and then I’ll just say lastly, Kenny does it and let’s open up Michael’s just to say can I come to appreciate all that I have while I still have it? I’m really good at appreciating things right when I’m about to lose them or I have lost them. That contrast helps me appreciate, but can I, can I, do I need to have the loss to love who I love? Do I need to lose them before I realize how much I love them? And that appreciation, I think, is so much the point of all this. And if you act from that appreciation of life, including its sorrows, then you’re cooking with gas, and you’re in a whole other place, and kindness becomes possible to yourself and others in new ways, and feeling all the connections among us in new ways becomes possible, et cetera, et cetera. There’s a sort of a virtuous circle opens up. So now, anyway, Kenny, thank you.
Kenny Primrose: 35:00
Thank you. That was so beautifully poo. And my experience is very much that when you deny the hard stuff, all the other stuff is denied as well. You get that, yeah. And it makes you very present, right? Grief seems like but partly because you’re not running away, I suppose. And a lot of the time you’re not grieving, it’s because you’re running away looking for distraction and you know the next thing. Yeah, I remember oh, sorry, carry on.
BJ Miller: 35:28
No, I was just gonna say that’s such a huge point. When do you realize how much work each of us is doing every day to keep all this hard stuff at bay? It’s a lot of work. Like another thing that happens is life just you can ease into it. Life doesn’t like it, it’s not that life gets easy, but you learn how to hold life and easy with more ease. And so things can feel lighter, and you’re not this burdened, and you’re not so adding to save a lot of energy by putting it elsewhere besides resisting reality.
Kenny Primrose: 35:58
So it’s a huge point, and it’s something that you can be trained into, right? Once I’ve been through some of those oscillations of grief, I’ve moved into it, I can feel the feels, move through it. I’ll laugh
Kenny Primrose: 36:10
again, you know, that will happen, but I’m crying right now. Yes. I mean, I think of this a long time ago, I was very young when Princess Diana died. Do you remember? Did that that make waves over in the States? Yeah, it did. It did. I mean, she was she was much beloved in the UK. She was a symbol, like a totem of various things, and it was interesting because there was a real kind of collective mourning. And I don’t think it was just for Diana. It was like the the cork was off, and people unplugged from their headphones and they spoke to each other in the underground. And you know, there was something kind of special that happened there. And what was quite clear is that we are in desperate need of those rituals that allowed us to have that. You know, I think of the you know the acronym weird, like Western educated, industrialized, rich and democratic. So like 12% of the globe do life so differently. Education, child rearing, and things like that. I’ve not read anything on death, but it seems that we do that too. So we’re we’re atomized and hyper-individualized, and we’ve instrumentalized our time for some future gain. There’s all sorts of stuff, and this came out in a really pronounced way. So my my brother was married to a Kenyan woman, and there’s a Kenyan funeral and a Scottish funeral, and the morning was so different. And I think that us Scottish people didn’t really know how to do it, and the Kenyans were kind of leading the way, and there was something about their culture that that had remembered how to do this, I think. So I mean, yeah, when you look at our fairly secularized culture, do you notice an illiteracy, if I can say that way?
BJ Miller: 37:56
It’s great, it’s very well put, Kenny. I I absolutely do. Like, you know, my it’s been my own experience. It’s a lot of people I work with, people I talk to. And then again, you once you get an eye for spotting sort of unrequited or unaddressed grief, you start seeing it all over the place. And of course, there’s our weird times, you know, 150 years ago, whatever, and for most of human history, your community would be only so big, and you would only need to be in touch with so many people, the loss of that might have befall so many people. Now, with all our connectivity, hijack that word, it’s connected and it’s not, right? So, you know, I can be aware of all sorts of death and destruction all over the planet. Any one day, my eyeball, my body might is receiving news of so much loss, so much just so much sorrow. Like we we have not figured out how to deal with sort of this grief at scale. And each of us, if you’re online, you are experiencing this scaled version all the time. And so you’ve got this double whammy, this sort of much more fodder potentially to feel about. And then, you know, it’s all happening through a screen, and at a time where our sort of weird society has been secularized and cut off from ancient rituals around grief, where society would shut down for a period, or you’d hang crepe in the window and nothing would be expected of you for months, you know, because you they’re honoring this altered state you’re in. So now, you know, you could be in intense grief and be surrounded by people who you work with, and they would might have no idea that you’re grieving. They would have no, you know. So anyway, so back to your point. It’s just we are living in a really hard time where there’s never been more need for grieving rituals, and have we, and we’ve never been more cut off from them. So we need to reconnect, re-create new rituals or or reinvest in old ones. But something needs to hold what we’re talking about. It’s very diffuse and vague, and it needs a container and needs some habits so that you don’t have to think that people can acknowledge what’s happening. Um so yeah, we need this is a call to arms for uh re-ritualizing grief in our society in ways that we can all participate in. Yeah.
Kenny Primrose: 40:24
Yeah, I sometimes think of the Jewish Shiva mourning rituals. I’m kind of jealous of just such a handrail, isn’t it?
BJ Miller: 40:30
Exactly. And you know, you don’t have to think, you know what to do. People have been doing for millennia, just you this is ancient, it tells you what you’re going through is not new. You don’t you don’t have to you you you you’ve got a sort of an autopilot for your body to engage in and to s to see and be seen. So anyway, yeah.
Kenny Primrose: 40:49
In your book, you mentioned the previous rituals where you were black or an armband or whatever, and it was this external sign of your internal state that made me think about what you’ve said previously of your injuries that so that you suddenly had a body that reflected uh kind of inner hurt or turmoil, and the that consonance this you know put aside the the pain, the anguish and the sadness. There was something helpful about that. And uh yeah, I felt like there’s a there’s an an analogue to you’re a great point, Kenny.
BJ Miller: 41:29
Yeah, that is absolutely true. I think one of the ways we get so life can be so hard as a human being is you know just communicating between two people all that’s happening, you know, and the vagaries of language and and attention, and you know, it’s just it’s really difficult to see and be seen in some faithful way. It’s the sort of gaps, so the gaps can easily open up between people, but intra-personally, gaps can open up so easily, sort of by virtue of like, you know, the way the world treats me versus how sees me versus how I see myself can be so wildly disparate. I mean, just you know, it’s to be so confusing and distracting. So, yeah, I really there’s something about externalizing the internal state. So it sets up at least the potential for a more faithful alignment of what’s actually happening and communication of what’s actually happening. So you’re you yourself know how you’re feeling, and others around you can see that too. And engage on that on that thread. So there’s a it’s uh it’s a way of uh creating alignment that is otherwise so difficult these days, I think. Um Yeah, and you have something else you said that sparked another thought for me, but anyway, back to you.
Kenny Primrose: 42:48
Yeah. Well, tell tell me if it comes back. Yeah, the the the idea of alignment and being seen authentically, it is such a deep, deep need that it’s not being met for so many people. I wonder if you think of BJ as a boy who felt kind of a bit melancholic, as you say, and then you you have your time in in Princeton and the injuries and the loss of your sister. What architecture do you wish was there for you? Or what what would you like to have said to yourself?
BJ Miller: 43:22
Well you know, I this very conversation, Kenny, you know, sanctioning, deputizing, evincing holding my greed and helping me reprogram kind of metabolize all this change, but also you know, I spent so many years in the problems of identity and kind of receiving the programming around sadness was weakness or otherwise unwelcome, you know essentially. The signals that you should be doing this better, that you’re doing it wrong, that you’re not enough. Yeah. Man, we humans, I don’t know, these days, I think a lot of us suffer from feelings like that, that we think that we’re sending ourselves these signals or we think others are sending them to us, and constantly on the hunt to do it better. And if we did it better, then I wouldn’t feel so bad. I wouldn’t really disabusing ourselves of that these hard feelings are themselves what help generate, they’re they’re connected to strength. And and and screw the strength-weakness language anyway. Like, just can you be real? Like, and watching how we just can’t help ourselves but put things in a hierarchy. Something’s got to be better and something’s got to be worse. If you want to be a winner, well, you need a loser. Like, we’re just constantly in this, like in this comparing zone. And it is it’s so back to your question, Kenny. If I’d had more conversation and sort of role modeling, like you’re doing me here, around how to hold these feelings, how to interpret them, what to do with them, what they mean, what they don’t mean, and all the freedom we have within ourselves to work with our the raw material of our feelings and our our life circumstances. Um, I feel like I could have sidestepped many years of walking in the desert cut off from my own feelings, feeling embarrassed to be sad, feeling embarrassed to be, quote, disabled. You know, of course, I learned a lot from walking around in that desert. And it helped me arrive at a new relationship with myself ultimately that was probably pretty durable. I don’t want to make the mistake in answering your question of actually then just slipperily in a slippery way playing into if only we had had this conversation, then I would have sidestepped these harder feelings. Because that’s so so much the mega point is don’t bother trying to sidestep the hard feelings. So I don’t want to accidentally play into that to see how I could have made this better. It’s such a seductive path. I know that’s not why you’re asking, but that’s how I hear myself trying to answer the question. And this is the way it’s so slippery. This self-judgment critical piece were not is wow. So but what’s your the actual nature of your question? I would have longed to have conversations like this where this would have felt just accessible and not exotic. Not necessary to sidestep my feelings, but really to help me be with them. That’s what that would have been really cool. And so I think that’s what I’m kind of trying to do in my work life now is set up structures, places, ways of thinking, languaging, programs, so that we can have safe places to fall apart with each other.
Kenny Primrose: 46:58
I love that line. And you use that to describe metal health, right? Um and the Zen hospice project that you set up. So you’re a reformer and you’d like to see changes in medicine, particularly palliative care. What are the changes you’d like to see that would create spaces to
Kenny Primrose: 47:15
fall apart?
BJ Miller: 47:16
Yeah. Well, so you’re right. I mean, so I’d love to see changes in our sort of in our health in our systems through healthcare, certainly. Healthcare, I really have a lot of antipathy towards it as a system, but it’s also true that that system saved my life. It’s also true that many amazing, devoted, dedicated people work within that system and do beautiful work within that system, but often in spite of the system, not helped by it. You know, since the late 19th century, medicine kind of took the bait that of you know that you call anything a we call illness a problem, and you go to war with that problem and you fix it and live forever. And similarly, so we’re gonna fix death, and therefore then we’ll live happily ever after, which I just couldn’t be more wrong. 150 or so years into this, we’re seeing the insistence of suffering, of death, of mortality, that maybe we’re able to get the signal that death, loss, these are parts of life. This is a meta-theme that we’ve been talking about this whole morning here. That death, loss are parts of life, sacred, therefore, parts of life, part of a whole experience, not at odds with it. Death does not rob life. You will die by because you are alive. It’s not a foreign invader. We are programmed to die. We do this by our nature. It’s in it’s in folded into this thing called life. Same with so that if we really get that signal, then can we stop being at war with reality, at war with ourselves, at war with each other for having these feelings, for getting sick, for dying? So everything we’re talking about now, I want to get that into the DNA of medicine and the healthcare system redesign itself around that fact. Uh, it would be importantly different. But so, but healthcare is one system, society, our political systems, this duality where I really think it’s a dialectic. You know, a dialectic would be so like life is a dialect, like life and death are a dialectic because it’s one thing. You can’t separate death from life, as we just said. It’s not a dual, it’s not duality, it’s a dialectic, and that’s an important distinction. So, you know, I so sorrow and happiness and joy could be a dialectic. You need each of them to have either experience, they’re not two experiences at odds with each other, as it might seem. So driving sort of dialectical thinking deeper into our our politics, the way we think about ourselves in the world, our relationship to nature. Oh my lord. So I won’t be around. I think if we just keep trying to name the mother here, the what’s underneath all of these problems per se, these constructed problems of modern society. I think if we dig deep enough, you will find fear of death at its core. And so I’m really interested in having these conversations going to this stuff, and then watching how what what unfolds as those truths get metabolized into our experience of civic life. I think the structure and systems changes will flow relatively automatically from that. If we can get underneath it all, underneath our roles, if we can touch this core thing that we’re talking about, then I think a lot gets righted automatically. That’s my hope.
Kenny Primrose: 50:59
So interesting. It’s so interesting. I was speaking for this series to Stephen Cave, the philosopher, who’s written a book on immortality and the the as you say, the fear of death being the the driving force for so much of culture. I wonder if you see your kind of priorities or your you know the work you want to do within medicine and palliative care as as almost the antithesis of Brian Johnson, you know, the or the the transhumanists who are like, don’t die. That’s the my ambition is to be death.
BJ Miller: 51:28
Yeah. Yeah. Yes. You’re right. I mean, that would be interesting to spar with with those guys. I I can’t help but feel some real sympathy there too. I think it’s probably a scared, really scared little boy who is putting all this effort into avoiding this thing called death. As we’ve talked here today, I think he is setting himself up to avoid life. Um I think it’s it’s it’s going to foment an over-indexing on his on the importance of him versus the importance of life. Part of what death does for us is it puts us in proportion to the world around us and within us. You know, yes, you and I are drops in the ocean, but it would and it would be a different ocean without our little droplets. And one way or another, you and I, as we move through our life, have to come to terms with both the bigness of ourselves. Like I really matter in my experience. Like, you know, I’m a huge in my experience of being alive. And in the grand scheme, I’m a teeny teeny little thing, but I’m part of it still. So you have to be in touch with your bigness and your littless, your littleness, sort of simultaneously, maybe paradoxically. And the Brian Johnsons, not that I know him, but that kind of spastic effort at immortality. Um you know, God bless him. I wish him well. Um, I hope he really the the way through for him is, you know, maybe he advances science, but those guys, I hope they really enjoy what they’re doing along the way because they’re still gonna die. And if they have devoted themselves and hung the hat of their happiness on whether or not they’ve beat death, I’m really scared for them. Um, so but if they are actually just really relishing it, this is them living, then and they happen to maybe advance the science of living a little longer, great, fine. But I worry that the signal that they are sending to themselves and each other and the world is just further playing into this. Do anything you can to avoid this part of reality. We’re talking. That’s just a setup to avoid being really alive. That seems problem.
Kenny Primrose: 53:40
You put it so helpfully, this dialectic idea that you cannot run away from you cannot run away from death. We’ll stop. It’s a futile task, but you can’t run away from death without also running away from life. What have you found helpful
Kenny Primrose: 53:55
personally, DJ, in terms of coming to terms with your own mortality? I don’t know. Is there anything that you you know you work with dying people a lot? How do you help them come to terms with their own affinitude?
BJ Miller: 54:11
Well, uh for one is to just say from the start, lest it’s so slippery, lest I accidentally send signals to people that they should do this or that, that they should feel this or that, if they just follow these steps, then what’s waiting for them is a deathbed filled with joy and laughter and you know kumbaya. So one thing to get super clear from the start before as we answer this question is like let go that death needs to look any which way. I mean, what we’re talking about is feel it all, including the hard stuff. So I want to say for anyone listening and encourage anyone listening, like when I actually am actually at my you know horizon and and actually really finally dying, I reserve the right to freak out. Like I reserve the right to lose my mind and clutch at anything. I mean maybe I will, you know, and I think I don’t want to seduce myself. Oh, I’ve been around death, I almost died, I got this thing. No way, it’s much bigger and more mysterious than that. So, and again, we’re yes, we’re making a pitch to accept a full life, and a full life includes death, but it also includes these hard feelings. So again, success, failure, let those words lose their meaning. You know, free yourself from death as being an achievement of Jesus. We don’t need another one more accomplishment achievement thing to because well, but does that that’s a setup to feel like a failure? Right again, we’re just priming ourselves to feel like we’re failing for dying, but we didn’t do it right. Yet another thing that we didn’t do right. So sorry to go on like that, but your question’s a really good one. And I need to really bury that statement in my answer. So in terms of my own mortality, I see it as a work in progress. I see myself always remembering, forgetting, clutching, uh letting go. Ooh, you know, it’s daily, you know, life is in motion, so nothing stands still. You don’t sound like you find your balance point, you just hold it. It’s constantly trimming your sales emotionally, physically, we’re subtly and obviously you know, in this sort of dynamism all the time. So in this way, nothing’s static. Some things last longer than others, but all of it’s in motion. So therefore, you could imagine like a tight rope walker. You’re constantly making teeny little adjustments here and there, you know, sometimes big ones, to kind of hold this line, to be in your life, to be in the world, to be in your to inhabit your own experience. So every day, all day I’m working on it and letting mortality, you know, letting myself feel attached to oh my god, like this place I’ve been in southern Utah. I love it so much. This landscape is so beautiful. Um, and I can’t clutch, I can’t, I want to freeze it, and so I can experience it forever. But that is, you know, it’s sort of back to Brian Johnson’s and uh immortality, like we have movies and art to show it’s like this is Frankenstein stuff. If you try to like, you know, zombies, like we have this is what happens if you try to live forever or try to fix a moment in time and let it nothing change it. It doesn’t, it doesn’t work well. So back to your question, letting myself remember that death is all over place and it’s in me, and appreciating it as this point, this foil for for life, this reminder of its package deal. And so I’m constantly so getting right with my mortality really means me being right with reality. And do I love reality? Do I even love this sorrow that I’m feeling for telling me that I really miss this thing or this person? Like, can I really can I really live the words that you and I are kind of are playing with today? So, and in answer back to your question, you know, am I making progress? By some measure, probably certainly. I can catch myself with sort of wayward meaning making and interrupt it before I do too much damage. I can catch myself doing that sooner more quickly now. I have a little bit more access to joy, a little bit, you know. And and here’s maybe an important note. When I’ve come to see as something like what I would call well-being or or health, you know, I think a lot of people it’s like if if life is just all good and all happy and no loss, no sorrow, that’s somehow health or something. No, no, no. Like for me, health and well-being would be can I be in a place and I have equal access to sorrow, to joy, to anger, to all my feelings, not just the good stuff, not over-indexing the easy stuff. So I I chart my health as do I have easy access to like, you know, side-splitting laughter and just as much access to my tears. And by the way, I don’t. I still struggle to get to all the way to tears. I’m still working on this. I know I have feelings in me that I just can’t get at still. So it’s a work in progress, and death is part of the sculpting tool that helps sort of unearth reality and lets me feel it again and again and again. I keep practicing it one day after another.
Kenny Primrose: 59:33
It’s so helpful to hear that.
Kenny Primrose: 59:35
I I want to be respectful of your time, BJ, but the what the the one question I might end on, if that’s okay, is we we haven’t discussed the fact that you’re an askete, that you you did art history before doing medicine. And beauty is has got a lot to do with, well, it’s it’s being imbued in the language that you’ve used today. If you could kind of change one thing about the let’s say hospitals in the US thinking with uh an aesthetic eye, what would you what would you change? How would you make beauty more part of the process in in the way that we kind of see does that make sense as a question?
BJ Miller: 01:00:14
Totally does. And you know, uh yeah, you know, beauty why, you know, it’s like a sort of the height of irony that especially if you know places where we’ve had final moments like acute care hospitals, nursing homes, you a place where you might soon lose your body. Like, why do I why is it so exciting to have a body in the first place? It moves around and feels things. It is literally like it’s a sensory, it’s a sack of sensors. And so I can experience my world by virtue of having a body. I don’t, you know, spirit, consciousness, disembodied, you know, states, um, I it’s hard for me to comment on, but while I have a body, I’m glad I have a body so that I can feel things. So why with the higher height of irony, like you know, when you’re at a risk to lose this beautiful sack of sensors, that we in those very environments, we they are the most anesthetic, numbed out, sterile, etc. Uh, it’s it’s it becomes um sort of besides some ironic, it starts getting kind of sad because I think we know that feeling connected to nature, to wonder, to the stars, to a tree. Um, to beauty is a is a way of dying before we have to die. Like it’s a starvation. Beauty is at the base of any uh sort of hierarchy of needs, sort of that feeling alive. I don’t mean beauty as in something really pretty or nice looking, I mean truth incarnate. So Hegelian or philosophical definition of beauty, truth in form. You know, give me that. Like let’s like let’s be there’s an honesty to it, there’s a reverence to it, there’s an embodied piece of it, and therefore a preciousness. Give me that. And I I wholly believe that access to beauty, access to nature, access to truth is inherently therapeutic. So back to Metal Health, a company my partner Sonia and I started a few years ago, back to what we were trying to do at Zen Hospice years ago, which by the way predated me. I think I just want to be clear your comments. I didn’t start Zen Hospice, but I got to work there for a few years. But um, and now to a company called Common Denominator that we’re just beginning to start a little laboratory. We’re gonna be looking to build a place, a respite and end-of-life center to really realize this aesthetic potential as a therapeutic agent and architecture as a therapeutic agent. So we’re gonna be working on the next we are now, and hopefully it’ll be breaking ground in the next year or two.
Kenny Primrose: 01:02:53
So exciting. That’s it so beautifully put, and I couldn’t agree more. I think it was Dostoevsky who said beauty will save us. And yeah, it so much of it goes beyond what we’re able to describe, and that’s why you need it to be incarnate.
BJ Miller: 01:03:06
Exactly. Yeah.
Kenny Primrose: 01:03:08
Yep, right on. Sorry to cut you off. I just couldn’t agree with you more, Kenny. Well, likewise. BJ, it’s been such a pleasure talking to you. There’s so so many things I would have uh loved to unpack more, but what we’ve discussed has felt to me really rich and I think helpful for listeners. I hope it has been for me.
BJ Miller: 01:03:27
Well, I’m so glad, Kenny. It’s a pleasure talking with you, my friend. And and if we ever want to dip into this other stuff anytime, it’d be fun to talk again. So thank you. And thank you out there for folks listening and tuning in. I mean, this is these are shared human states. So we’re all part parse of what we’re talking about today. This is this is stuff for literally for everyone. That’s another reason I love it so much. There’s the most inclusive subject matter.
Kenny Primrose: 01:03:52
It’s so democratic, isn’t it? We’re all we’re all involved. We’re all going to the same
Kenny Primrose: 01:03:56
place. So it’s well, I really hope you enjoyed listening to that conversation with BJ Miller. Having just listened through it myself to do some edits, I’m struck again by BJ’s depth and insight. To me, I feel like he’s pointing us in the direction of growth, depth, wisdom, and becoming more present to our human condition. If you’re anything like me, this is the stuff I instinctively run away from. So here’s my takeaway from BJ’s question on grief and our conversation. Sit with the hard feelings. Allow yourself to feel the feelings, talk about them, let them show you what it is about your life that is beautiful and precious and valuable. We can do such harm to ourselves and those around us by endlessly running away from the hard stuff. The resources are there to help us in ritual and poetry and scripture and communities that remember how to grieve and embrace our human condition. They’re just buried beneath the frantic pace of modern life and its many distractions from reality. If you have enjoyed listening to the episode, if it’s given you a nudge in the right direction, the direction of growth and wisdom, then do please share it with others. Stay up to date with the podcast through the Substack This Examined Life. All relevant links will be in the show notes, as are links to BJ’s work. Thank you once again for tuning in, folks. A big thank you to PJ Miller for being my guest today. Thank you to Moby Gretis for some of the music and my brother for some of the music. Really appreciate it. And anyone who’s given me feedback, encouragement, or practical support, I deeply appreciate it. I’ll be dropping another conversation in a few weeks’ time with the wise, the witty, and the really quite wonderful Dr. Catherine Mannix. Until then, wishing you all well.