“Healthy, honest, and healing.” An interview with Joe Primo

Posted on May 30, 2012 by


Joe Primo is the Associate Executive Director at the Good Grief Center for grieving children and teens in New Jersey and a board member of the National Alliance of Grieving Children. He earned his master’s of divinity degree at Yale University.

Primo’s essay, “The Business of Grief,” which draws from his personal experiences as a hospice minister and bereaved grandson, examines the economic and ethical concerns surrounding death, burial, and grief. Interview conducted by Robyn Jodlowski.


In your essay, you detail washing your grandfather and preparing his body after his death. This clearly gave you some comfort in terms of his passing, but I wonder if it also affected your relationship with your father and your cousin, who were also present. Can you talk about that?

 The act of washing my grandfather was an important one. My father, cousin, and I have each washed the dead before because of our professions. I believe the care, intimacy, and tenderness that went into this decision was an act of love. I would encourage everyone to consider it when a loved one dies if the circumstances permit. We cared for my grandfather for several weeks leading up to his death so it would have seemed foreign to me if we did not extend that same care after he died.

Last year a good friend and neighbor died from cancer. I helped his wife with his care during the last week of his life. I was present when he died just before dawn. His wife filled the wash basin and together we washed and dressed him in clothes that no longer fit his withered body. It was her last act of love before the funeral home picked him up and took him to the crematorium.

In both these instances—acts of love for people I cared about—I don’t feel that it brought me closer to the people in the room who were also participating in this act. Instead, it brought me closer to the people who died. I did something for them that they couldn’t do for themselves, and I did it with reverence and compassion. I’d say that it was transformative for me and it ultimately contributed to my healing as I grieved their deaths. To this day, I’ve never spoken to my dad, cousin, or friend about those few minutes when we prepared the dead.

You’re fairly critical of common contemporary grieving and burial practices in your essay. Is there anything you’d say we’re doing right?

Yeah, I totally have issues with the funeral industry even though I know some great people in the profession who stand behind it. I think my issues are pretty simple: funeral rituals should have environmentally sound practices, they should be affordable, and they should provide an opportunity for healing and expression.

I don’t think that any of this is about “doing it right.” I believe there are many ways to go about caring for and “disposing” of our dead. Instead, I’m more interested in what is healthy, honest, and healing.

Propping up the dead to make them look like they’re sleeping, doing wakes days after a death, and then creating a hyper-intense and anti-intimate space for mourning, doesn’t seem healthy to me. I don’t mean to insist that everyone should wash their dead, do a home funeral, and bury grandma in the backyard while singing her favorite hymns. But I do believe these decisions should be intentional and that we, the consumer and bereaved, should be well-informed about our options and what might be most helpful to us. Sometimes, depending on the circumstances of the death and our relationship to the person who died, a funeral is just the disposition of a worn out and tired body. Most always, it is so much more than that, and we need to pay attention to the process.

I think the questions we need to ask ourselves are simple: what’s going to help us remember, express our feelings, honor the person’s life and our grief, and set us on a path towards healing?

If grief is a unique experience for everyone so too should funerals be, because they are, at their core, both an expression of love and an act of mourning. Funeral rituals can have cookie-cutter elements, but the content and process should be personal.

I believe the way in which people are navigating through this—that is, trying to find our way or a new norm—is through cremation. A family can get mom’s ashes back in a couple of days and then plan a personalized memorial service quickly or at a future time. It’s just logistically easier.

Cremation is fine. I might go that route myself. However, here are a few things to understand. I generally operate under the notion that grief consists of three processes: 1. Thinking; 2. Feeling; 3. Go on living. The thinking process is simply our ability to comprehend the death—that is, to truly digest what has happened to someone we love.

One of the challenges with cremation is how it is done and how it aids or prevents our thinking process. Generally, the person dies, gets cremated, and everyone comes together and looks at the box placed in the center of the room during the memorial service. That can be hard for people to process. The lack of ritual around the body (in its full state), our lack of interaction with the dead or the visibility of the dead (before cremation), makes the “thinking” part of our grief more difficult.

So, back to the question of what are we doing well. I think if we keep heading in the direction of personalizing rituals, interacting with the dead as they naturally are, and making funerals more affordable—even if that requires family and friends to have a more active role in the process—then we can arrive at a new norm; a new culture around death that pauses, acknowledges, supports the bereaved, and moves forward in a healthy and healing direction because our rituals have set-up that process.

How did your divinity school training instruct you to deal with death?

It didn’t. I love my alma mater. It’s one of the top in the world. Although it’s training some of the best theologians, ministers, and activists out there, it glazed right over that one thing that has a 100% participation rate. I think it’s telling that a major institution, such as Yale, doesn’t spend time on death and grief. What do ministers spend a lot of their time doing? Ministering to the dying and bereaved. What do theologians spend their time talking about? Why humans exist and why we suffer. It seems blatantly obvious that institutions charged with educating people should teach bereavement, death, and dying.

I don’t dislike my alma mater because it didn’t invest in what should have been a key characteristic of my training. Oddly enough, many social workers, psychologists, and medical professionals have no training in death and bereavement. Of course the subject matter is all around these professionals, but most are not equipped with good information or tangible tools to be effective.

I learned about death through hands-on experience at hospice. I was able to get my educational and emotional needs met only because I sought out solutions, mostly through independent studies with faculty. If I had been trained, however, I would have had a more solid foundation to begin my career.

There’s talk of including grief in the DSM-5, the newest edition of the psychological diagnostics manual. If grieving is medicalized, how do you think it will affect its public expressions?

The DSM-5 has red flags all over it. From what I understand the entire process is a quagmire, and including grief in the manual is the least of its problems.

I’ve been quite vocal about this effort, including the submission of testimonials to the committee working on the inclusion of grief.

Here’s the positive: if grief is included then educational institutions will finally educate their students about grief. It will help psychologists bill for it, and bereaved people will presumably have more access to support. Otherwise, I think including grief is foolish and just another example of how we pathologize many aspects of the human experience.

Grief is a universal, natural, normal, and productive characteristic of the human experience. It serves a purpose. It is, in fact, helpful despite its messiness. However, because it is messy does not mean that it needs treatment. Grief needs support systems, caring friends, and the ability to get expressed as needed. However, the sadness that accompanies grief is often labeled as depression and then drugs are prescribed. Studies are beginning to show that such treatment can actually get in the way of grief, forcing the bereaved to revisit their grief at a later date when they aren’t medicated.

In my opinion, the only thing that is pathological about grief is our culture. Because death and grief are taboos, in that the bereaved have to compose themselves and act differently than how they feel, people are directly affected by the culture that inhibits the process. The culture, which is one of judgment and isolation, enables substance abuse and other forms of dysfunction as a way to cope. Any culture that ignores its suffering members until they can carry on like everyone else is dysfunctional, and that type of dysfunction only leads to more dysfunction.

The inclusion of grief in the DSM-5 pathologizes grief. It implies treatment is necessary and that those complex characteristics of grief can’t be handled alone or in a context outside of a professional context. If the DSM-5 includes grief, I’m confident that kids and families who attend Good Grief (the center where I work) will be up in arms. This will be yet another opportunity for us to educate a misinformed public that is consistently confused by one of the simplest components of life. There is nothing wrong with the bereaved kids I work with, nothing broken and nothing that needs fixing. They simply need a consistent and healthy support system as they find their way.

The inclusion of grief in the DSM-5 will lead to an unbalanced and unchecked culture around something as common and natural as birth.

What would you say to people who think green burials are a fad?

I don’t believe green burials are a fad. I believe they are an expression of a growing need and desire. They may evolve into something else, but they are a part of a paradigm shift. I think the days of starch-collared morticians and high-end coffins are coming to an end. I know multiple funeral directors who think of themselves as a concierge service, as an attempt to keep up with the times. Sure, it’s savvy PR, but do we need a funeral home to book our hotels if we are coming from out of town? As far as I can tell, the industry is finding its footing in a culture that doesn’t know what it wants, but can name what it doesn’t. According to what I hear, what people don’t want sounds something like: creepy morticians, over-priced services, stinky flowers, and gigantic tombstones with angels affixed. That’s old school, and people are moving on.

I think cremation became the other obvious option because people think their options are cemetery or cremation, wake or vase for the mantle. Green burial fits in the middle. Not everyone is comfortable with the idea of rapid decomposition (or evaporation) through heat and a bone pulverizer, and not everyone likes the idea of being in the ground. People’s hang-ups about these things are quite interesting.

I believe green burial is a real, practical, and meaningful option. Go out naturally, help conserve some land, and do something meaningful with one’s body in the same way that people feel the need to donate their body to science. This is like donating to the earth, using our nutrient rich body to conserve nature. Not too bad if you ask me. I suspect the pendulum will continue to swing in the direction of cremation and on its way back it will find green burial. My hang-up? Mausoleums. That’s nasty.

Is there a best way to grieve? A vital ritual?

Short answer: no. Grief is an individualistic experience. The important question isn’t what’s best, but what is healthiest. The ritual, in my opinion, is one of the starting points and that’s why we need more public discourse about it. Choosing support systems, friends who listen, taking one’s time with grief, and making healthy choices are all “best practices” in my book.

You currently counsel children through loss at the Good Grief Center. Do kids tend to grieve differently than adults? How so?

Kids are awesome. No, they are amazing. Kids know what they need and they will work very hard to get those needs met. They can teach us a lot because they are quite comfortable with death. In fact, they are fine with it and even enjoy talking about death because conversation about it allows them to process it (remember those three processes above?). If there is anything we need to know about kids’ grief it’s that adults get in the way. Kids recognize and need honesty and authenticity. However, adults try to protect their “innocence.” As a result, kids quickly learn that they can’t always trust adults. A consistently honest, loving, open, and attentive adult works wonders in the life of a grieving kid.

Kids grieve in bursts—they’re fine one moment and sad the next. They can go days without talking about the person who died and then feel blue and miss her terribly. Show up, listen, follow their lead, and be real. I think we could all use that.

How would you define a “good” death?

One that doesn’t require a lot of clean up, I suppose. But I’m sure the nurses in the anthology covered that. When I take my horse-and-pony show on the road to schools, professionals, corporations etc., I try to help people understand that jerks die, too. That catches people by surprise because etiquette says we shouldn’t talk trash about the dead. Guilty.

I think people die “good” deaths when they live “good” lives. We spend a lifetime developing coping skills, relationships, emotional maturity, and intimacy. If we don’t do well with those things in life there is a good chance it isn’t going to go well in death. I think that’s important for people to know. We need to lower our expectations for difficult people because this isn’t Hollywood.

It’s important that someone who has to go on living understand that deathbed conversions are rare, unless the palliative care drugs are really good—like, happy pill good. I encourage a soon-to-be bereaved person to come up with a list of their needs. What do you truly need to hear from the person who is dying? Start at number one and work your way down. If you make it to your third need you’re lucky. If we have real expectations about what someone can give us then we might have a chance of getting our needs met, and that can feel like a “great” death.


Robyn Jodlowski is an editorial assistant at Creative Nonfiction and a recent graduate of the University of Pittsburgh’s nonfiction MFA program. She tweets @RoJoOhNo.