This is an edited interview with Gary Reiss (LCSW) a licensed clinical social worker with a diploma in Process Oriented Psychology living in Oregon. The interview is about the processwork approach to working with coma and issues of death and dying. Gary teaches aspects of processwork worldwide, including; comawork, conflict resolution, family and relationship work, and the general skills and theory. Tapes and transcripts of this interview (full version) can be ordered through Gary Reiss at greiss@igc.org .

MARK: What recommendations might you have for professionals working with death and dying? What do you feel is important if you are working with people who are dying?

GARY: I think it is to work on your own death a lot first. Lie down sometimes and imagine you are dying. And then see what happens next. And get familiar with death as a transition point in yourself, so that you are not against it. And also to really work on your own inner views of valuing only healing, and being so one plus, as opposed to valuing each moment and each state.

MARK: Right, so you say lie down and imagine your own death. That might be scary for some people, to even think of doing that. Some people don’t even choose to think about death. What kind of experiences do people have when they do this kind of work?

GARY: They almost always have a huge sense of relief. That something which needs to die dies, and then the next thing comes, like maybe… say you are very anxious person, you lie down, and then maybe you find that what has died is your anxiety. And then maybe the next thing you find yourself is jumping up and down. I know I’ve done that exercise so many times that I’ve had wonderful experiences becoming rivers and stars. And it’s a way to find something bigger, the Big You, something that is beyond your ordinary identity.

MARK: So we are in a sense needing to die in order to live

GARY: That’s really right, so that to live more fully you have to die, and learn to die to each moment. And learn that at certain times of your life big processes are dying. For example, in the mid-life crisis a lot of old identities from the family you come from, and all your old patterns, like maybe you consider yourself a victim of this or that.. All those old patterns start to want to fall away like the skin on a snake. And people often feel like they are dying, and they are, one part is dying but not the physical body, a certain form of your identity. So that’s a different form of life, viewing life as a constant shedding of skins, at different times of your life, and then you’re reborn again. It can have great effects on your physical body and on your energy levels

MARK: Do you know of particular people that have worked really effectively with their own dying process. Like you have worked with dying people and you’ve met shamans from different cultures. I am curious about what your observations are around how people have dealt with their own death.

GARY: I think of some of the people I have worked with who have made huge leaps in their personal history cleaning things up and also leaps into their spirituality. Like I am thinking of one woman who had almost no psychology, and she was on dialysis, she had kidney failure, and eventually she chose to not get anymore dialysis. But in the times just before she died she cleared up all the relationship stuff with her family, she even cleared up the relationship stuff with her pastor who had made her feel really bad about things. She had an incredible death; she became more and more lucid and clear, and spiritual and loving. And the last thing that happened was that I called her from another town where I was teaching. And they said she had been in a coma for six days. And I asked them to put the phone up to her head, and let’s say she was called Sally. I said “Sally how are you doing it’s Gary”, and she said “GARY!, I’m doing good”. I said, “I thought you were supposed to be in a coma?” She said “Yeah!” And I said, “What’s happening”. She said, “All life is beautiful, everything is clear, and I love everybody, and I am in a state of love. I am ready to travel and I am free.” And I said “Sally have a great time, I love you alot”. And she said “Oh I love you a lot”. And she said “See you later”. And when I got back to town I discovered that about 12 minutes later she had died. So that’s a woman with very little pre-psychological training who used her death to, in a way, become enlightened. In my view she died something like an enlightened being.

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MARK: Also we are going to talk today about Coma Work. And one of thing that often comes up around coma which is a big ethical issue is about when to let someone die or when to keep someone alive on a life support system? And I wondered whether you could talk a bit about that issue in terms of Process Work and your work with people in comas?

GARY: I think Arny Mindell said it so well, he called it the ‘Thanatos Ethic’. And what he means by that is that you don’t just take any one state of consciousness in any part of your life to make a huge life decision. In other words lets say you were deciding to stay in a relationship, then you don’t just make a list of the pluses and minuses of the person and add them up and make a decision. You ask another level of consciousness, like you ask for a dream or something like that. And so that is really what you do with coma patients. Let’s say that someone signs a living will. That’s one level but that was the pre-coma level of awareness. And what we do is to ask them in the coma, through signals, to indicate to us, their position now on dying. One of the big reasons for that, is that a number of people who we have asked, who have come out of coma, who had living wills, and yet because of the Coma Work they weren’t disconnected from the plug, have said that in the coma state itself they were in a different place and didn’t want to die. So you have to ask both states, and you have to ask many many times of someone in a coma. And it’s amazing to me that people show in coma states, when you do Coma Work, they can make really clear choices in those states. Like somebody may stop breathing or something like that, and they choose in that way to die. Or you’ll see them go in a certain direction. On the other hand people who I have been told have no chance of living, where the hospital wants to unplug the person, we have had experiences of people getting up and walking and talking. So the ethic is to ask the person and not to impose a medical or legal view on the person.

MARK: A comatose state as I understand it is a state of a very different type of consciousness, so what do you mean when you say asking someone or communicating?

GARY: Well there are two major ways I do it: One is, that I look at the trends. Like if you try a lot of interventions with somebody and you get no minimal feedback at all, there’s no verbal sounds, no movement, the person is not interested in anything. Then I look at the trends, and if the person has been going further and further away from consciousness that’s a strong signal for me. And then another way of doing it though is to create a binary signal hook-up, which means you find a way of asking the person ‘yes’ or ‘no’ where they clearly signal you back and you test that signal over and over again. Like I’ve used a bunch of them. One is somebody taking a deep breath meaning ‘yes’; another is often working with someone putting their finger or their thumb up.

MARK: So you can actually get a yes or no answer? So there is some sort of definite consciousness, and a communication loop happening between you and the person in coma?

GARY: That’s right. And I will also ask them many times about dying, but I will also ask them many other questions about how they are doing, what their experience is like. And I may ask them if they would like to come-out of the coma. And if they have a sense, I may ask them times, “Do you imagine coming-out in a month? ..or in two months? ..or six months? Or..”

MARK: That must be an incredible experience for a family. I presume that a lot of the families you are working with, people who’s relative is in a coma, are not familiar with the chance of communicating with them from the start?

GARY: Well I think that is the most relieving thing. I think it’s very important when you do Coma Work with a family, to let them know you are coming from a slightly different place than a western approach. Because in a western approach they hire you and you are supposed to bring the person out of the coma. But the clear thing for me is that, no my job is to follow nature. Which means I am not against death. And so I am there to follow the person and to ease them into dying if that is their process. Or just to clarify the process, if it’s to come back or if it’s to take a long time. And every family I have ever worked with has said that the main benefit they found, whether or not the person “gets better” is that the communication improves greatly. And families love being able to communicate with the person.

MARK: So do people pick up those skills while you are working and they start to interact in the same way?

GARY: If people are interested I almost always try to train the family in how to do at least do the basics of it, which is the communication style, and maybe making a binary hook-up, and following some of the movement processes and stuff like that.

MARK: We are talking about families. What happens in a family around coma? I know Process Work has some ideas around the importance of family work around people with comas, and I’m curious about what kind of dynamics are happening?

GARY: Well there are so many important things to address in a family, one is the idea that it is possible that the family itself mirrors what is going on a lot in the person in the coma. That they are like receivers for the signal. So one thing I look at is, in terms of the recovery of the person, how much energy there is in the family. And you find a huge diversity, from people who say “we are ready to let go of the person” to people who have huge extended families organised, and they are working on the person almost around the clock, and you have to tell them to give the person a rest. And so one possibility is the family is a reflection of it. A second thing, which is important to address, is the well being of the people you are working with, also. Because a lot of times the family itself burns out and other people start having a lot of physical symptoms. And it’s a huge thing if somebody is identified as the sick one, or especially in an extreme situation like a coma, that the other people may have physical problems and symptoms which they feel free to bring-up. I talk to families a lot about “how are you taking care of yourselves?”

One more thing also, is that helping people process the trauma, the shock and the stress of a loved one being in that state is incredible. Families have to also go through huge transitions. I’ve had families that go so far, that even if the person doesn’t come out (of coma) .. I remember 2 women telling me that the best relationship times they have ever had with their partner was when the person was in a coma. You are helping the family make a shift in consciousness, also, and it’s very difficult. I remember one of the first doctors I encountered who I asked “what do you consider progress”, and he said “When Sadie can sit up and play cards again, then I consider that progress”. Families can get very depressed with that view. And a lot of your job as a coma worker is to help them shift their minds and their perspective to value what’s happening in the person, and to value the coma state as an important state of consciousness in itself.

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MARK: Do you feel there are particular kinds of life processes which go along with a comatose state? Do certain kinds of experiences in people lead them onto comas?

GARY: I can’t generalise too much, but I can say some situations I have seen. But people need to know that this is not causal, that if you have these symptoms you are going to have a coma, because everybody has all of these symptoms. But sometimes before a coma you see some kinds of major depressing things which come up, and which aren’t processed. This might be something you see sometimes. Other things I’ve seen sometime and particularly in older people are people who could never rest much or go into deep more feeling states. So a lot of the time out of the coma you will see people come out with a lot of emotional state, people who weren’t so emotional. I remember working with some people who worked like 90 hours per week and hadn’t taken a vacation for 10 years, and you could look at them in coma and actually guess what their life was like by looking at the posture of their body. I worked with one family where when I went in I said, “It looks like mom is on vacation”. And they said “mom was a farmer” and she had never been on vacation, and she was just about to retire, and then she got in this coma. She was so much on vacation that I had to work with her in the most relaxed way. I’ve also seen people in the midst of fights in comas, and you can see that in their body that the whole coma is about something really aggressive. A lot of comas are also about the need for contact. I know one of the people who lets me talk about her, because now she comes to my classes. A big breakthrough for her was that I had her husband give her a big kiss on her lips because she was moving her lips a lot. And the next morning she came out of the coma. So contact, the need for bringing out your aggression, the need to process different depressing issues, the need to process ‘can I be myself in this life?’ but the one thing is that almost anyone who has come back has much more determination and a sense of what their life is really about. It’s a strong intervention to say to someone “can you be your whole self in this moment”; I sometimes say this to people in coma. And a lot of the research into near death experiences says that people often tend to come back with a renewed determination to living out what is really meaningful about life. And they have asked them about that and it has been about; love; doing something for the world; living out their creativity; and being more in contact with the depths of life.

MARK: Are you talking about spirituality there?

GARY: Yes a sense of spirituality and meaningfulness, and depending on their age it can also be a sense of ‘lets get on with it’. For people in their younger years it may be ‘lets get on with our career or family life. And for people in their senior years it is often more ‘lets get to what’s really real’. I have worked with various successful business people in coma who when they come out seem much more interested in their emotional life and things like that. It’s a kind of stretch. I see coma as a big stretch. Wherever you need stretching, it stretches you.

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MARK: I saw you working yesterday with someone who had been in a coma, and I noticed that you asked them if just before they went into coma had they had any particular experiences. And there was a particularly strong experience. So what is it that is happening just there at the point of entering coma? What are you relating to? Why do you go back to that point?

GARY: Because I wanted to know what was the ‘sentient’ or ‘core’ experience under the coma. And often those experiences are present before something becomes a symptom. Sentient means that it is ‘pre-manifest’. There are other ways of getting to that; one is to ask the person once they come out of the coma if they had a previous near death experience, and then work on that. You can also get to that core thing the person is working on.

MARK: So this ‘core’ experience, would you often find people living closer to that after a coma?

GARY: Yes closer to that core experience. Yes. For example one man had a previous near death experience where he was almost killed by a car accident, and during that time he had a ‘God’ experience, and then his later experiences around dying were all about 20 or 30 years later about picking up his spirituality.

MARK: It’s very interesting I remember hearing about a chap who had very seriously become paralysed through jumping on a children’s bouncy castle. It always struck me that here you are as an adult really letting go and playing, letting your joy and spirit come out, and then you’ve broken your neck and your body is paralysed, what a huge contrast that is. So maybe there might have been something there like a sentient experience of playfulness and fun?

GARY: It’s possible, and also there must have been before paralysis something of the core experience of that before it becomes paralysis, that’s the theory. Like for example we were talking about the person who was fantasising and planning her vacations, and so then some deep relaxation state is way there before the coma. It’s just marginalised, and so you could say that coma is one way to get over huge edges and to get to parts of yourself that are hugely marginalised.

MARK: So those states may not be very easy at all for the person to access even though they are there?

GARY: That’s why doing something like sentient or core work is useful, because there may be such huge edges against the more outward expression of the state. Lets say for example there’s an edge towards retirement, so maybe working on retirement is too difficult for someone, but maybe the sentient essence of retirement is something like ‘letting go’. Maybe you can work with the person and get them to get into some kind of movement process around letting go. So it’s sometimes easier, where there are huge edges in life, to go down to the core sentient experiences of that.

MARK: So do you then think it might be possible that if you could get to those sentient experiences before someone went into coma, possibly it would stop the need or the necessity of going into coma?

GARY: I think so. I work with a lot of people who have hit their heads or have knocked themselves out al little bit. I know one person who told me after one of my classes that she had knocked herself out three or four times recently. So we talked briefly about what was trying to happen in those states. It’s preventative. For example I was gardening recently and I stepped on a gardening tool and hit my head, and then I was gardening a few weeks later and I gave myself another knock, but already I was working on what was that about. I don’t need a bigger knock. Those knocks were enough.

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MARK: Gary if someone wanted to practise Comawork, what could you recommend to someone who is starting out? You have also done Comawork around the world, I know you have worked with Arnold Mindell, and various people know about your work, but someone who is starting out to learn these skills, how do people get started? It’s not like starting a private practice where people will start coming along to you.

GARY: There are a couple of things in that, like first; how does someone train? I think there are a lot of people, myself, Arny and Amy Mindell, and some of the other Processwork teachers teaching Comawork. But I would definitely go to the trainings that mostly happen in Portland Oregon where the main Processwork training centre is. There maybe some training in Zurich I am not sure. I hope to do some work in England in 2001. Then I think the most important thing to do is to get someone to supervise you, or to assist somebody. I had Arnold Mindell supervise me for a long time. The third thing is to get a lot of experience, I have probably had thousands of hours of working with different kinds of patients. I learn so much each time. Working with somebody who was deprived of his oxygen for example, was different from working with someone who had a stroke, somebody who has a head injury, working with people who have had heart attacks, there are so many different kinds of comas, and different ages. Get some training and supervision, and then when you get the basics down, go out and practise and work with as many people as you can in all kinds of situations.

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MARK: Gary do you consider that there is a minimum of skills and experience needed before one begins to work with someone in coma.

GARY: Again a minimum of both skills and what I would call ‘Metaskills’ or feeling attitudes. And Metaskills may be even more important. The key Metaskill for me would be openness to experience and also your sense of concern for somebody. You could hurt somebody in a coma, physically, because you are using your hands on people and they are not able to give you verbal feedback. So I want somebody to have a lot of sensitivity in their being, around following feedback in not pushing someone too far, in not hurting them. And then I want them to have specific training in the various aspects of Comawork including; how to work with verbal issues; how to work with visual things; how to work with body feelings and sensations; how to work with movement; how to work with relationship; and how to work with family therapy. I would like a person to have some basic training in all those things. But that doesn’t mean that if someone calls me from Portugal and says their person is in a coma and they would like someone to work with them, that I am not going to tell the family right away to start. I will, but as a practitioner, I want a practitioner to have some basic skills to know they are not going to hurt somebody.

Books relating to working with coma are; Dr. Arnold Mindell’s ‘Coma – Key to Awakening’; and Dr Amy Mindell ‘Coma – Healing Journey’. Amy’s book has a contact number for people wanting comawork. Gary’s book on Family Therapy that hopefully will be out by 2001 has a chapter on Family Therapy with coma patients. Gary’s forthcoming book ‘Becoming Eagle’ which will deal with the issues around anxiety and death and dying.