European Stars and Stripes (Newspaper) - July 7, 1990, Darmstadt, Hesse                                By Victor Cohn Washington Post it s known As a the pariah syndrome Quot a the tendency Many of us have to suddenly shun even old friends who have a fatal or disabling illness. It can equally be applied to those who have suffered some tragic loss. All of us who at some time experienced such a loss know the pain we Felt when we never heard from treasured friends in contrast to the warmth and support we received from others. A a 1 a a a. 1 a a William Rubin is editor of a group of National medical newspapers a internal Medicine news family practice news and others a published in Rockville my As a medical journalist he was familiar with the pariah syndrome As applied to the seriously ill or dying. But i april 1989, his 33-year-old daughter Joan committed suicide and a Surprise to me Quot he says a a Many people treated me the  a year later he has written of this experience in his sometime column Quot notes of a sometime  his words can instruct All of us who have put off or avoided a painful encounter because we did no to know what to say Rubin writes Quot 1 did t know what to say so ended up saying nothing is How too Many people react when a Friend patient or business associate loses a loved one. Quot the death of someone a aged Parent usually in t that difficult to Deal with. She had a full  at least he a relieved of his  people Are supposed to die when they re old that a the natural course of events. Quot it s the untimely death of a loved one especially the death of a child that makes people uncomfortable around the  and Quot suicide in particular scares friends away. It makes them worry about their own children and they Don t want to think about things like  Rubin is of course aware that Quot i did no to know what to say is not the real culprit Quot we survivors know that manifestations of grief can be upsetting to others. We Are embarrassed by our own sobbing and wailing. That a Why we cry in the Shower so frequently that turning on the faucet seems to set off the  even More Basic Quot anyone a death is an unwelcome reminder of our own mortality Quot the effect of this shunning on survivors Quot those of us who lose a loved one begin to feel As though we have some loathsome contagious disease. After the Emily Post proprieties a and the Flowers cakes and fruit baskets of the official mourning period a the friends disappear. Quot if i had a broken leg or were recuperating from hepatitis friends would Call occasionally and ask How Are you doing a Quot not so with grief. I did t know what to say or a i thought head rather be alone Are too often the rationalization for not saying anything. Whether we be lost a Mother on whose guidance we depended or a lifelong spouse Quot a or in Rubin s Case Quot a child s suicide the ultimate rejection Quot a a we feel lonely or  the answer a avoidance by our friends in t what we need. We know about the support groups and therapy to help us with grief. That Isnit what we re asking from friends. Quot perhaps we need the reassurance of continuing Contact with the non grieving world. Some of us might want to talk about the decedent others might not. And different situations and relationships would evoke different reactions. But that in t really what i m talking about a simple How Are you holding up or Are you doing Okay would serve As the reaching  another report on the pariah syndrome in june 1979, David Rabin a professor of Medicine at Vanderbilt University in Nashville began developing Amy trophic lateral sclerosis a als or Lou Gehrig s disease a progressive paralysis of All the Muscles of the body. He would almost certainly die and would in the meantime deteriorate. By october 1980, he was limping badly and walking with a Cane to maintain balance. Still he had been invited to participate in a european medical conference and said to his wife Pauline a professor of psychiatry a this is Likely to be the last conference i will be Able to attend most of the speakers Are Good friends and i think id enjoy being with these people one More time Quot in his Book Safe passage the humanistic aspects of Medicine philosophical Library 1985 written with his wife he tells what happened a the speakers were All housed in the same hotel had their meals in the same dining room arid spent their Leisure time in the same Smalt lounge. A despite the physical proximity my wife and i. Might have been on a desert Island. People walked past us with eyes averted or were suddenly mesmerized by the floor. If Eye Contact was unavoidable there would be a hurried a hello David a and off the person would go almost  Quot though Many friends remained steadfast and close the experience was repeated again and again As Over time Rabin lost the use of All his limbs and began having trouble speaking and swallowing. Quot the message was Clear a my illness had resulted in the irrevocable cancellation of what Susan Sontag has called the passport of the healthy we had been reclassified As pariahs social  the rabins finally decided that Quot if we Felt this Wayt so too have others Quot so in 1982 they wrote about their experience for the new England journal of Medicine. Quot the response was electric. Hundreds of letters poured in from physicians and Lay people from sick people and their families. The letters were Heartbreak Gly alike. Over and Over again people wrote this is precisely what happened to us. We thought we were to blame in some unknown Way. What a Relief to know that we were not treated in a uniquely cruel  Quot can our Modem society meet the Challenge of dealing compassionately with chronically ill persons Quot the Rabid is ked. Quot we have struggled with other forms of discrimination and Are learning to overcome racism sexism and age ism. Awareness of our prejudice and fear could form the basis of a humanistic approach to the disabled and chronically  in october 1984, David Rabin died. Pauline Rabin. Moved to Washington where she is now a psychiatrist with group health association. When David died she says Quot there were still some people who had great difficulty talking to me. But i think i had changed a great Deal and i was Able to Cope with it. I saw these people As having a very serious Handicap in not being Able to Deal with  those Ivhon say Quot i did no to know what to say Quot i have to confess that i have said it myself i Hope this was Only in the Distant past for i have Learned something. In part i Learned it when my wife of Many years died suddenly and unexpectedly in 1980.1 Learned that what you say is not very important. In fact you done to have to say anything. The mos important thing is just to be there. It it w to of 3 01 0 it abandoned lonely with grief saturday july 7, 1990 the stars and stripes Page 13