Daf Ditty Moed Katan 24: The Loss of Children

Functional Neuroanatomy of Grief

§ The mishna taught: Rabbi Eliezer says: Since the Temple was destroyed, Shavuot is like
Shabbat with regard to mourning. Rabban Gamliel says: Even Rosh HaShana and Yom Kippur
are considered like Festivals. The Gemara comments that Rav Giddel bar Menashya said that
Shmuel said: The halakha is in accordance with the opinion of Rabban Gamliel.

And some teach this ruling of Rav Giddel bar Menashya as referring to the following case: It
is taught in a baraita: Within the first thirty days after birth, an infant that dies is taken out for
burial in one’s bosom, that is to say, he is carried to his grave in one’s arms, not in a coffin. And
he is buried by one woman and two men, there being no need for a quorum of ten men. But he

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should not be taken out by one man and two women, because it is prohibited for one man to
seclude himself with two women.

Abba Shaul says: The infant may be taken out even by one man and two women, for there is no
concern with regard to seclusion in a time of mourning. And for such an infant, people do not
stand in a line to offer their condolences to the mourners, as is ordinarily done after a burial; nor
do others recite over him the mourners’ blessing, which is recited in the courtyard of the
graveyard after the burial; nor is the usual formula for the consolation of mourners recited during
the seven days of mourning.

A thirty-day-old infant that dies is taken out for burial in a coffin [deluskema]. Rabbi Yehuda
says: Not in a small coffin that is carried on one’s shoulder, but rather in a coffin that is carried
in the arms of two people. And for such an infant, people stand in a line to offer their condolences
to the mourners. And others recite the mourners’ blessing at the cemetery. And people recite
the consolation of mourners during the week of mourning.

Jastrow

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A twelve-month-old infant is taken out for burial on a bier, just as an adult is. Rabbi Akiva
says: This halakha applies if the infant that dies is one year old and his limbs are like those of a
two year old, so that he looks older, or if he is two years old and his limbs are like those of a
one-year-old. Only then he is taken out on a bier.

Rabbi Shimon ben Elazar says: For one that is taken out on a bier, the public should grieve
[matzhivin]. For one that is not taken out on a bier, the public need not grieve. Rabbi Elazar
ben Azarya says: The halakha is as follows: If the infant was known to the public, because he
regularly left the house and many people knew him, the public must occupy themselves with
him and participate in his burial. If he was not known to the public, the public need not occupy
themselves with him.

Jastrow

And what is the status of deceased infants with regard to eulogy? Rabbi Meir said in the name
of Rabbi Yishmael: The children of the poor are eulogized from the age of three, whereas the
children of the wealthy are eulogized from the age of five. This is because a child is the sole
source of joy for the poor, and so the pain and grief of the poor over the death of a child is greater
than that of the wealthy. Rabbi Yehuda said in the name of Rabbi Yishmael: The children of the

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poor are eulogized from the age of five, whereas the children of the wealthy are eulogized from
the age of six. And the children of the elderly are treated like the children of the poor, for the
death of a child is particularly painful for an older person.

Summary

More Mourning on Shabbat: Wealthy vs. Poor Families and their Babies1

We learn the rituals of mourning on Shabbat. Generally speaking, we do not display any signs of
mourning when we are in public. But alone, we are encouraged to practice any mourning ritual
that feels right. There are some restrictions, however. A mnemonic is used: Peh (periat rosh,
uncovering the head), chet (chazarat kera, reversing the torn garment), and zayin (zekifat hamitta,
standing the bed upright) MUST be performed. Nun(ne'ilat hasandal, wearing shoes), tav
(tashmish hamitta, marital relations), and reish (rechitsat yadayim, hand washing) are optional
mourning practices on Shabbat.

The Gemara discusses types of head coverings, sexual relations and mending rent garments with
greater specificity.

Our daf includes a conversation about how to mourn infants. Before 30 days, the infant not
considered 'viable', and a less formal mourning process is suggested. After 30 days, however, we
are instructed to incorporate more - but not all - of the mourning rituals that are in place for adults.

From this conversation, the rabbis discuss the meaning of lost infant. They agree that losing a
child is more tragic for poor families for a number of reasons. The rabbis suggest that a lost child
represents a loss of future income and support; the loss of the only joy in in a poor person's
life. They note that eulogies are performed for children at different ages then the child is from a
wealthy or poor family.

The rabbis consider how the thirty days of mourning are counted when the Festivals (including the
High Holy Days) interrupt the mourning.

Our daf ends with a new Mishna: During intermediate days of Festivals, mourners do not rend

1 http://dafyomibeginner.blogspot.com/2014/09/moed-katan-24-more-mourning-on-shabbat.html

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their clothing, remove clothing from their shoulders, eat a donated meal (unless given by a close
relative of the person who died). While the mourner sits on an upright (not overturned) bed,
comforters are obligated to provide the first meal after the burial.

Again I note the fascination between what is public and what is private; what others see of our
behaviour and what we keep behind closed doors. It seems that there is at least one reason for this
focus. We do not want others to break their halachot because they are watching us break our
halachot; this contagion is kept to a minimum when we keep our practice private. This may not
only represent a push toward conformity. Instead it may be a way to continually create a society
where the needs of the group are considered to be as important as the needs of the individual.

Rav Avrohom Adler writes:2

Rabbi Yochanan inquired of Shmuel: Is there (the requirement) the observance of mourning on
Shabbos, or not? He replied: There is no mourning on Shabbos.

The students were sitting in front of Rav Pappa and they said over in the name of Shmuel: A
mourner who engages in marital relations during the period of mourning is liable to death (through
the hands of Heaven). Rav Pappa said: It is forbidden (but he will not be liable to death), and it
was said over in the name of Rabbi Yochanan. Rav Pappa continued: If you heard a law regarding
mourning in the name of Shmuel, perhaps this is what you heard: A mourner who does not let his
hair grow or does not rend his garments is liable to death. Rafram bar Pappa said: It was taught in
Eivel Rabbasi (one of the minor tractates; one that deals with laws concerning death, burial and
mourning): A mourner is forbidden to engage in marital relations during the period of mourning;
and there was an incident with a person who engaged in marital relations during the period of
mourning and swine snatched his corpse.

Shmuel issued various rulings regarding a mourner on Shabbos: The laws, referred to by the
acronym ‘PeChaZ’ are obligatory; the laws, referred to by the acronym ‘NeTaR’ are optional. A
mourner is obligated to uncover (Peri’as ha-rosh) the wrappings from his head on Shabbos; he
must turn (Chazarah) his torn garments to the back; he should turn (Zekifah) his bed the right side
up on Shabbos (otherwise, these activities would be considered displaying mourning in public and
that is prohibited on Shabbos). It is optional for a mourner to adhere to the following prohibitions
on Shabbos: wearing (Ne’ilas ha-sandel) leather shoes, engaging (Tashmish) in marital relations
and washing (Rechitzah) his hands and feet with hot water (that was heated prior to Shabbos) on
Shabbos. Rav said: Uncovering the wrappings from his head is also optional (since others appear
in that manner, as well).

The Gemora asks: Why does Shmuel make a distinction between wearing shoes and uncovering
their head? They both should be optional, for not all people uncover their heads on Shabbos, in the
same way that not all people wear shoes on Shabbos!? The Gemora answers: Shmuel maintains

2 http://dafnotes.com/wp-content/uploads/2015/10/Moed_Katan_24.pdf

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that a mourner must rent his garments at the time of intense grief and he must cover his head in
the same manner that the Ishmaelites cover their head (and therefore it would be recognizable that
he is a mourner).

Rav Nachman demonstrated this by wrapping himself in his garment up to the hollow of his
cheeks.

Shmuel said: In order to fulfill the obligation of rending his garments, it must be done on the day
of the relative’s death. The Gemora asks on Shmuel by citing certain incidents where we see that
an Amora rent his garments many days after the death of his teacher. The Gemora answers: The
death of a teacher is different since every day their teachings are mentioned (the loss is felt every
day) and it is considered like the day of the death.

The Gemora cites a braisa: A mourner displays his rent garment in the front during the shiva period
and if he wishes to change his garments, he may do so, but he is required to rend the new garment,
as well. On Shabbos, the rent garment should show in the back and if he wants to wear a new
garment, he may do so, but he should not rend the new garments. This braisa is seemingly
inconsistent with Shmuel who maintains that the rending must be done on the day of the relative’s
death. The Gemora answers: The braisa is referring to the death of a parent, where Shmuel agrees
that one can rend his garments even on days after the death. The Gemora presents a dispute if the
garments which were rent to honor his parent (the first day, there is an obligation; afterwards, it is
done to honor them) may be sewn together afterwards or not.

The Mishna had stated: Rabbi Eliezer says: Once the Beis Hamikdosh was destroyed, the festival
of Shavuos (which is only one day) has the same halachos as Shabbos (in regard to the days of
mourning). Rabban Gamliel says: Rosh Hashanah and Yom Kippur (even though they are both
only for one day) have the same halachos as the other festivals. The Chachamim maintain that
Shavuos has the halachos of a festival (since one can offer the festival korbanos for seven days
after Shavuos) and Rosh Hashanah and Yom Kippur have the same halachos as Shabbos. Rav
Gidel the son of Menashye said in the name of Shmuel: The halachah follows the opinion of
Rabban Gamliel.

The Gemora cites another version of Rav Gidel the son of Menashye’s statement. The Gemora
presents a dispute among the Tannaim in regard to death of a child. A baby under 30 days old is
carried out for burial in someone's arms (without a bier or coffin). The burial does not require ten
men present; it is sufficient with one woman and two men. One man and two women should not
bury him (the cemetery was generally outside the city and would be regarded as a forbidden
seclusion). Abba Shaul does permit this (they are preoccupied with the mourning and it will not
result in sin – Tosfos). They do not form a row to console the mourners; they do not recite the
mourners’ blessing and they do not comfort the mourners.

If the child was over thirty days old, he is carried out for burial in a coffin. Rabbi Yehudah says:
It should not be a coffin that is carried on the shoulders, but rather, one that is carried in their arms.
They form a row to console the mourners; they recite the mourners’ blessing and they comfort the
mourners. If the child was over twelve months old, he is carried out for burial in a bier.

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Rabbi Akiva maintains that he is carried out for burial with a bier only if he is either actually two
years old or developed like a two-year old. Rabbi Shimon ben Elozar says: If the child is carried
out for burial in a bier, the people grieve over him; otherwise, they are not required to grieve. Rabbi
Elozar ben Azarya says: If the child was known to people in his lifetime, they are required to come
to the burial and comfort the father; otherwise, they are not required to get involved. The braisa
continues: When do we eulogize a child? Rabbi Meir said in the name of Rabbi Yishmael: If the
deceased child came from a poor family, he is eulogized if he was over three years old. If the
deceased child came from a rich family, he is eulogized if he was over five years old.

Rabbi Yehudah said in the name of Rabbi Yishmael: If the deceased child came from a poor family,
he is eulogized if he was over five years old. If the deceased child came from a rich family, he is
eulogized if he was over six years old. The children of the elderly are regarded as children from a
poor family. Rav Gidel the son of Menashye said in the name of Rav: The halacha follows the
opinion of Rabbi Yehudah who said in the name of Rabbi Yishmael.

Rabbi Anani bar Sasson expounded in front of the house of the Nasi: If one day of mourning was
observed prior to Shavuos and then Shavuos passes, it is considered that mourning has been
observed for fourteen days. Rabbi Ami heard of this and he became angry. He said: Is this his
own? This was stated by Rabbi Elozar in the name of Rabbi Oshaya. A similar incident occurred
when Rabbi Yitzchak Nafcha expounded in front of the house of the Exilarch and Rav Sheishes
heard of this and he became angry. He said: Is this his own? This was stated by Rabbi Elozar in
the name of Rabbi Oshaya.

Rabbi Elozar said in the name of Rabbi Oshaya: One is obligated to bring a shelamim offering on
the first day of Shavuos (similar to the other festivals). He cites a Scriptural verse that there is a
seven day compensation period for anyone that didn’t bring the korban.

Rav Pappa accompanied Rav Avia the elder and expounded: If one day of mourning was observed
prior to Rosh Hashanah and then Rosh Hashanah passes, it is considered that mourning has been
observed for fourteen days. Ravina said: Accordingly, one day prior to Sukkos, and then Sukkos
and Shmini Atzeres passes, it is considered that mourning has been observed for twenty-one days.

"ATIFAS HA'ROSH" OF AN AVEL ON SHABBOS

Rav Mordechai Kornfeld writes:3

Shmuel maintains that in order to fulfill the obligation of Atifas ha'Rosh, an Avel must wrap his
head in the manner that Yishmaelim do ("Atifas Yishmaelim"). The Gemara says that according
to Shmuel, on Shabbos an Avel is not permitted to walk around with Atifas ha'Rosh because it
constitutes an explicit act of Aveilus (which may not be observed on Shabbos), as no one else
walks around with his head completely enwrapped. Rebbi Yochanan says that if the Avel wears
shoes when he walks around with his head enwrapped, the shoes give the impression that he is not
an Avel and thus he is permitted to walk around with Atifas ha'Rosh.

3 https://www.dafyomi.co.il/mkatan/insites/mo-dt-024.htm

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RASHI (DH Ela) writes that if the Avel is wearing shoes, he may wrap his head in private if he
wants to, even in the manner of Atifas Yishmaelim.

The words of Rashi are difficult to understand. It is Rebbi Yochanan who permits an Avel to wrap
his head if he wears shoes. However, Rebbi Yochanan is also the one who rules that an Avel must
observe private aspects of Aveilus on Shabbos, and thus he should require an Avel to wrap his
head when he is in private. Why, then, does Rashi say that if the Avel wants, he may wrap his head
in private, implying that he is not required to do so? According to Rebbi Yochanan, the Avel is
required to wrap his head in private on Shabbos! Moreover, Rashi implies that when the Avel does
not wear shoes, he may not wrap his head even in private. Rebbi Yochanan, however, requires an
Avel to wrap his head in private regardless of whether or not he wears shoes! (MAHARSHA)

Even if the statement that an Avel may wrap his head if he wears shoes would have been made by
an Amora other than Rebbi Yochanan, what indication in the Gemara implies that an Avel may
wrap his head on Shabbos only in private if he wears shoes? The Gemara implies, to the contrary,
that even in public one may wrap his head as long as he wears shoes.

In the PERUSH RABEINU GERSHOM ME'OR HA'GOLAH (on which the commentary of
Rashi in Moed Katan is based), these words do not appear in the body of the commentary, but they
appear as an addition in the margin. Further examination shows that these words are actually a
verbatim quote from RABEINU CHANANEL (from the words "Aval l'Galos" until the end of
Rashi's comment). The beginning of the quote from Rabeinu Chananel actually begins in the
preceding comment of Rashi (DH Lo Shanu) from the words "b'Shabbos Tzarich l'Galos Chotmo,"
and the quote continues into the next comment of Rashi (DH Ela).

From the words as they appear in the commentary of Rabeinu Chananel, it is clear that Rabeinu
Chananel does not refer to an Avel who wears shoes, and, moreover, he does not refer to the
opinion of Shmuel altogether. Rather, these words are part of Rabeinu Chananel's Halachic
summary of the Gemara, and they express the opinion of Rav, not Shmuel. (See also the text of
Rabeinu Chananel as printed from manuscript by Rav David Metzger.)

Rabeinu Chananel rules that although Rav does not require that an Avel perform Atifas ha'Rosh
in the manner of Atifas Yishmaelim, l'Chatchilah he should perform it that way. With regard to an
Avel on Shabbos, Rabeinu Chananel understands that according to Shmuel, who requires an Avel
to perform Atifas Yishmaelim, the Chachamim suspended the requirement for Atifah (and required
the Avel to uncover his head) on Shabbos so that the Avel not have the appearance of an Avel on
Shabbos. Since the Chachamim made it mandatory for the Avel to uncover his head on Shabbos,
they did not differentiate between an Avel in private and an Avel in public. Therefore, even in
private an Avel may not wrap his head.

According to Rav, however, since an ordinary act of Atifah (as opposed to Atifas Yishmaelim)
also qualifies as Atifah for an Avel, and that type of Atifah can be done inconspicuously on
Shabbos even in public, the Chachamim did not require that the Avel uncover his head on Shabbos.
Therefore, in private an Avel may wrap his head even with Atifas Yishmaelim. In public, even

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Rav agrees that an Avel should not wrap his head with Atifas Yishmaelim, because then he will
stand out as an Avel.

This is the meaning of the words of Rashi here, which were erringly printed as part of the
explanation of the Gemara when they are actually a Halachic summary (taken from the words of
Rabeinu Chananel).

WHY DOES SHAVUOS COUNT FOR SEVEN DAYS OF THE

SHELOSHIM?

The Gemara teaches that if a person becomes an Avel one day before the Yom Tov of Shavuos,
with the passage of Shavuos it is considered as though fourteen days of Aveilus have passed, and
the Avel counts only sixteen more days to complete his Sheloshim. This is because the Yom Tov
of Shavuos annuls the Shiv'ah (as the Mishnah says on 19a), and thus the seven days of the Shiv'ah
are considered as though they have already passed. When Shavuos passes, it is considered as
though another seven days have passed, for Shavuos is a Yom Tov with the same status as Pesach
and Sukos (see RITVA), which last for seven days.

What is the basis for the second part of the Gemara's ruling, that one day of Shavuos is considered
like seven days? If Shavuos is considered like seven days because it has six days of Tashlumin for
its Korbanos (Chagigah 17a), then why does the day of Shavuos itself count as seven days, and
the following six days count towards the Sheloshim? Those days are being counted twice!

Furthermore, if, for some reason, a Yom Tov is considered like seven days, then Sukos should
count as 27 days (the first seven days of the Shiv'ah are annulled by the Yom Tov, the first day of
Yom Tov counts as seven days, there are six days of Chol ha'Mo'ed, and, finally, the Yom Tov of
Shemini Atzeres counts as seven days, for a total of 27), and not as 21 days as the Gemara says!
Why do the six days of Chol ha'Mo'ed not count towards the thirty days of the Sheloshim by
themselves, like the six days of Tashlumin which follow Shavuos? The Gemara says explicitly
(20a) that the entire festival, including Chol ha'Mo'ed, is included in the count of thirty days of
Sheloshim!

The TIFERES L'MOSHE (YD 399) suggests an ingenious solution. He explains that during the
times of the Beis ha'Mikdash, Shavuos was considered a seven-day festival because of the six days
of Tashlumin that followed the Yom Tov. Those six days counted towards the thirty days of
Aveilus (as the Gemara says on 20a with regard to Chol ha'Mo'ed). On the other hand, during those
days of Tashlumin, an Avel would not observe any of the laws of Sheloshim because the laws are
suspended during the festival. (This is based on the words of the TUR (YD 399) in the name of
the ROSH, who writes that an Avel is not allowed to cut his hair or iron his clothes during Chol
ha'Mo'ed -- not because of the laws of Sheloshim but because of the laws of the festival, as the
Gemara says at the end of 19b. The other laws of Sheloshim, such as wearing freshly pressed
clothes, do not apply on Chol ha'Mo'ed at all.

The RAMBAN (in Toras ha'Adam), however, writes that all of the laws of Sheloshim apply during
the festival, and one may not wear newly-ironed clothes on Chol ha'Mo'ed. The Tiferes l'Moshe
suggests that even the Ramban applies this ruling only in a case in which the death occurred on

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the festival itself, in which case the festival does not annul the Shiv'ah. In such a case, the
restrictions of Sheloshim apply not because those days are part of the Sheloshim, but because they
are part of the Shiv'ah. If, however, the death occurred before the festival, and thus the festival
annulled the Shiv'ah, then even the Ramban agrees that the laws of Sheloshim are not observed
during the festival.)

Accordingly, during the times of the Beis ha'Mikdash an Avel gained seven days during which he
did not have to observe the laws of Sheloshim, and yet those days still counted towards the thirty
days. The seven days that counted towards his Sheloshim comprised the one day of Shavuos and
the six days of Tashlumin that followed. When the Beis ha'Mikdash was destroyed, the
Chachamim did not want the Avel to lose those days because of the Churban of the Beis
ha'Mikdash, and therefore they decreed that nowadays, too, the Avel subtracts seven days from
the count of thirty when Shavuos passes, and he observes seven days less of Sheloshim. This is
the intention of the Gemara here when it says that Shavuos counts as seven days.

The Tiferes l'Moshe points out that this also explains why the days of Chol ha'Mo'ed of Sukos and
Pesach do not count towards Sheloshim by themselves. Only the first day of Yom Tov counts as
seven days, because the only reason why a festival day should count as seven days is because it
has six days of Chol ha'Mo'ed that follow it. Thus, only when a Yom Tov does not actually have
any days of Chol ha'Mo'ed that follow it (such as Shavuos) did the Chachamim give it a status of
seven days by itself.

Why, though, do each of the other single days of Yom Tov, such as Shemini Atzeres, Rosh
Hashanah, and Yom Kippur, count as seven days towards the Sheloshim according to Raban
Gamliel (whose opinion is the Halachah)? Those days are not seven-day festivals, and during the
times of the Beis ha'Mikdash they were not followed by another six days of Tashlumin.

The RAMBAN explains that they nevertheless count as seven days because the Torah compares
all of the festivals to each other (Shevuos 10a). Hence, since Shavuos counts as seven days even
though it is only a one-day festival, the other one-day festivals also count as seven days even
though they are not followed by days of Tashlumin.

ROSH HASHANAH COUNTS AS FOURTEEN DAYS

The Gemara concludes in accordance with the opinion of Raban Gamliel (19a) that the day of Yom
Tov annuls the Shiv'ah and removes seven days from the Avel's observance of Sheloshim. The
Yom Tov itself counts as another seven days. Accordingly, Rav Papa states that if the Aveilus
begins one day before Rosh Hashanah, with the passage of Rosh Hashanah it is considered as
though fourteen days have passed: seven days of the Shiv'ah which Rosh Hashanah annulled, and
another seven days towards the Sheloshim which the Yom Tov of Rosh Hashanah constitutes.

Ravina states that if the Aveilus begins a day before Sukos, with the passage of Shemini Atzeres
it is considered as though 21 days have passed: the seven days of Shiv'ah which the first day of
Yom Tov annuls, the first day of Yom Tov itself which is counted as seven days towards the
Sheloshim, and Shemini Atzeres which is counted as another seven days towards the Sheloshim.

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Rav Papa emphasizes that Rosh Hashanah not only stops the Shiv'ah but also counts as an
additional seven days, and thus it counts as fourteen days towards the Sheloshim. What, though,
is Rav Papa's point? What difference does it make that Rosh Hashanah counts as fourteen days
towards the Shiv'ah? In any case, Yom Kippur will arrive seven days after Rosh Hashanah and
annul the Sheloshim altogether! It does not matter how many days of Sheloshim are left after Rosh
Hashanah. (TOSFOS, DH d'Rebbi Elazar)

(According to the opinion (on 19a) which maintains that Yom Kippur does not annul the
Sheloshim when the Avel does not shave before Yom Kippur, the answer to this question is
obvious: Rav Papa's statement that Rosh Hashanah counts as fourteen days is relevant in a case in
which the Avel does not shave on Erev Yom Kippur and, consequently, he needs to continue
observing Sheloshim after Yom Kippur. In such a case, Rosh Hashanah counts as fourteen days of
the Sheloshim. However, the Gemara there (19b) concludes that, contrary to this opinion, even if
the Avel did not shave before the festival, the festival nevertheless annuls the Sheloshim. What,
then, is the relevance of Rav Papa's statement that Rosh Hashanah counts as fourteen days?)

(a) Some Rishonim answer that Rav Papa's teaching is relevant in a case of a Shemu'ah Rechokah
-- when one hears about the passing of a close relative more than thirty days after the time of death
(20a). If Rosh Hashanah arrives between the time of death and the day on which one hears about
it, the festival counts as fourteen days. Accordingly, it is able to transform a potential Shemu'ah
Kerovah into a Shemu'ah Rechokah (since one day is considered fourteen days).

TOSFOS and other Rishonim reject this explanation. As the RITVA writes, there is no reason for
why the festival should affect the amount of time with regard to a Shemu'ah Rechokah; the festival
reduces only the amount of time which an Avel has already begun to observe. In the case of a
Shemu'ah Rechokah, the Avel did not yet begin to observe Aveilus (because he did not hear about
the death before the festival arrived).

(b) The Rishonim quote RABEINU SHIMSHON and the RI who answer that Rav Papa's
statement that Rosh Hashanah counts as fourteen days of the Sheloshim has practical relevance.
The Gemara earlier (23a) quotes a Beraisa which details the different stages of Aveilus. During
the first week, the Avel must stay in his home. During the second week, he may leave his home
but he must sit in a different seat in the synagogue and not in his regular seat. During the third
week, he may sit in his regular seat but he may not speak, and so on. Rav Papa teaches that the
week after Rosh Hashanah is not considered the second week of Aveilus; rather, once Rosh
Hashanah passes it is considered as though fourteen days have passed, and it is the beginning of
the third week. Consequently, the Avel may sit in his regular seat in the synagogue, but he may
not speak.

(c) The BEHAG and the BA'AL HA'ME'OR (16a of the pages of the Rif) assert that Yom
Kippur does not annul the Sheloshim in this case, but counts only as seven days towards the
Sheloshim. As a result, the Avel needs to observe an additional two days of Sheloshim after Yom
Kippur. (He already observed 28 days: the seven days annulled by Rosh Hashanah, the seven days
that Rosh Hashanah itself constitutes, the seven days between Rosh Hashanah and Yom Kippur,
and the seven days that Yom Kippur itself constitutes.)

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The reason for why Yom Kippur does not annul the Sheloshim is that a festival cannot annul the
Sheloshim when another festival already annulled the Shiv'ah. Only one part of the Aveilus can be
annulled by a festival. Since Rosh Hashanah already annulled the Shiv'ah, Yom Kippur cannot
annul the Sheloshim.

Their proof for this assertion is from the next statement in the Gemara. The Gemara says that Sukos
counts as 21 days of the Sheloshim. Why, though, does it not annul the Sheloshim entirely? The
first day of Sukos annuls the Shiv'ah and the following Yom Tov of Shemini Atzeres should
completely annul the Sheloshim. Why does Shemini Atzeres count only as seven days towards the
Sheloshim? It is evident that once a festival already annulled part of the Aveilus, another festival
cannot annul the Sheloshim.

The RAMBAN and ROSH disagree. They refute the proof from the Gemara's statement about
Sukos by pointing out that a festival can annul part of the Aveilus (Shiv'ah or Sheloshim) only if
the Avel had already begun to observe some of that part of the Aveilus before the festival. The
first day of Sukos annuls the Shiv'ah because the Avel observed some of the Shiv'ah before the
festival. Shemini Atzeres, however, cannot annul the Sheloshim because the Avel never observed
any of the Sheloshim (since the laws of Sheloshim are not observed during the festival).

(d) The RITVA suggests that this question is addressed by the Amora'im themselves. When
Ravina was asked, "Did you say that Rosh Hashanah counts as fourteen days?" he answered
cryptically, "I said only that it makes sense that the Halachah follows Raban Gamliel." What was
he protesting? Why did he not want to admit openly that he said that Rosh Hashanah counts as
fourteen days, especially since that is what Raban Gamliel maintains?

The Ritva explains that Ravina was protesting the irrelevance of saying that Rosh Hashanah counts
as fourteen days. Since it is irrelevant to say that Rosh Hashanah counts as fourteen days (as
explained above in the question), a statement to that effect is inaccurate. It is true, however, that
the Halachah follows Raban Gamliel, who says that a Yom Tov counts as seven days.

Rav Papa, who explicitly states that Rosh Hashanah counts as fourteen days, does not intend to
make a relevant Halachic statement. Rather, his point is to teach that the Halachah is that Rosh
Hashanah annuls the Shiv'ah. When he says that it counts as fourteen days, he means that had this
fact been relevant, Rosh Hashanah would have annulled both the Shiv'ah and counted as seven
days (thus constituting a total of fourteen days).

HALACHAH: The SHULCHAN ARUCH (YD 399:9) records the ruling of Rav Papa as the
Halachah, but he changes the wording to reflect the explanation of the Ritva (in (d) above). He
writes that Rosh Hashanah "annuls the Shiv'ah," but he does not say how many days of the
Sheloshim Rosh Hashanah constitutes, because, as the Ritva explains, it is irrelevant -- the
Sheloshim anyway becomes annulled by Yom Kippur, as the Shulchan Aruch himself writes later.
In this respect, the Shulchan Aruch rules like the Ramban and the Rosh, and not like the Behag (in
(c) above), since he follows their view that it is possible for two festivals to annul both the Shiv'ah
and the Sheloshim of one Aveilus.

12
The SHULCHAN ARUCH later (YD 399:12) records the view of Rabeinu Shimshon and the Ri
(in (b) above) who maintain that since Rosh Hashanah counts as fourteen days, the week after
Rosh Hashanah is considered the third week of Aveilus and not the second week, and thus the
Avel may sit in his regular place silently.

The MISHNAH BERURAH (OC 548:4, based on the RI MI'GASH #185) writes that the
Gemara's statement that a Yom Tov always counts as seven days (even when it does not annul the
Shiv'ah, such as Shemini Atzeres) applies only when the death occurred before the festival and the
Avel started to observe the Shiv'ah. If the death occurred during the festival (and thus the Shiv'ah
did not start at all), the festival does not count as seven days, and the Avel observes all of the
Shiv'ah after the festival passes. (The Sheloshim, however, is counted from the day of death,
because the days of the festival do count towards the Sheloshim.)

Mourning a Baby

Steinzaltz (OBM) writes:4

The traditions associated with the burial and mourning of a baby who died less than 30 days after
birth differ from normal customs. Specifically, the Gemara teaches that such a child is carried to
the cemetery in a woman’s arms, rather than in a coffin, and the statements of consolation are not
uttered, neither in the cemetery nor in the home.

These differences stem from the possibility that a child who perishes after less than one month is
considered a stillborn. Although it is clear from here that there are no public eulogies on such a
child, the Gemara is not clear about the possibility of mourning within the family circle. Here we
find one of the differences between the Diaspora and Israel; the accepted practice in Israel is to
mourn for a baby who dies, even if it was just one day old, while in the Diaspora, no mourning
takes place.

The normal rules of mourning apply to a deceased child who is more than one month old, and he
is carried out and buried in a deluskema – a sarcophagus. During the Talmudic period, burial
coffins were made of stone. These boxes came in different sizes, based on the size of the deceased.
Obviously, children were buried in boxes that were relatively small and could be carried on one’s
shoulder, while adults were buried in boxes that had to be carried by two people.

Public eulogies are done only over a child who is a little older. Rabbi Meir quotes Rabbi Yishmael
as suggesting age three for poor people and age five for rich people; Rabbi Yehuda quotes him as
ruling age five for the poor and age six for the rich. Several explanations are given for the
distinction made between rich and poor. Rashi suggests that poor people have no pleasure in life
aside from their children, so their mourning over a lost child is greater; alternatively, they rely on
their children for sustenance and support more than rich people do. According to the Ran there is
a unique closeness that develops between parent and child when the parent saves his last crumbs

4 https://steinsaltz.org/daf/moed24/

13
to feed his child. Another approach is that we are concerned for the feelings of the poor person
who will suspect that it is because of his low status in society that his child did not receive a proper
eulogy.

Earlier (20b), the Gemara taught that if a person does not have a shirt which to tear when he hears
about the death of a relative, if he later acquires a shirt within seven days (‫ )שבעה‬he must tear that
shirt.

Tosafos (‫ )וכל ה ד‬notes that our Gemara, which invalidates a tear which is made not ‫חימום בשעת‬
,seems to contradict the earlier statement which that a person is obligated to tear his shirt anytime
during the seven days if he has not done so yet, although it is no longer ‫ חימום שעת‬. Tosafos offers
several solutions to this problem.

The halacha is as stated in our Gemara, that the only time when it is appropriate to tear due to grief
is at the intense moment of distress. The Gemara earlier which stipulates that tearing can be done
throughout shiva is speaking about a case where a person did, in fact, originally tear his shirt when
he first heard about the death. He later changed shirts during shiva. Although he already tore the
first shirt, we are taught that this next shirt must be torn, as well.

Maharsha questions this interpretation of the Gemara because it seems to say clearly that it is
dealing in a case where the person was just now obtaining a shirt, and not that he had one from
before. Maharsha suggests, therefore, that Tosafos might have had a different reading of the text
in the earlier Gemara.

A second answer of Tosafos is that the lesson of the earlier Gemara is that if someone has a shirt
at the moment he hears about a death, the only valid expression of tearing is at that moment. If he
waits to tear that shirt, the ‫ קרע‬is not proper. If, however, he does not have a shirt to tear at that
moment, then he certainly can tear a shirt any time during shiva, as our Gemara says.

Finally, Tosafos suggests that the earlier Gemara which requires that ‫ קריעה‬be done at “‫”חימום שעת‬
does not limit this moment to the one initial hour when one hears tragic news. If a person can
reignite the grief-stricken moment within himself, the ‫ קריעה‬can be done throughout shiva, as our
Gemara reports

A Beraisa taught: A mourner should wear his rent garment with the rent in front and if he
chooses to change garments he may change and rend [the second garment].

Tosafos (1) writes in the name of Rashi that the Beraisa refers to one who wishes to change his
garment during shiva to a garment that was laundered before shiva began.

14
According to this understanding of the Beraisa, although it is prohibited for a mourner to launder
his garments during shiva, it is permitted for a mourner to wear a freshly laundered garment.

Rambam (2) also rules that a mourner is permitted to wear freshly laundered garments during
shiva. Tosafos (3), on the other hand, explains that the Beraisa refers to a case where the mourner
is changing into a garment that is not freshly laundered because it is, in fact, prohibited for a
mourner to wear a freshly laundered garment even if it was not laundered during shiva.

Tosafos adds that the common custom in his time was that another person wore the freshly
laundered garment for a day or half a day before the mourner would wear it and it was thus no
longer a freshly laundered garment.

The ruling in Shulchan Aruch (4) is like the strict approach of Tosafos and he prohibits a mourner
to wear freshly laundered garments even if they were laundered before shiva. Rema (5) mentions
the lenient custom noted by Tosafos, i.e. to have another person wear the garment before the
mourner, but he mentions it in the context of the restriction against wearing freshly laundered
garments during shloshim rather than in the context of shiva.

Pischei Teshuvah (6) , however, cites the comment of Teshuvas Lachmei Todah who explains that
when the Rema applied this custom to shloshim he was referring to a case where the mourner
wanted to change clothing for pleasure .

If the mourner is changing his clothing because the clothing he was wearing was dirty it is
permitted to have another person wear it even during shiva.

In our Gemara we find two Amoraim who taught that if a person sits shivah from the day
before Shavuos, the interposition of the festival makes it as if seven days passed on Erev Shavuos,
and Shavuos itself then counts as another seven. According to this, by the day following the
festival, the mourner is considered fourteen days into his shloshim. After the halachah is first

15
mentioned, we find that Rav Ami became upset with Rav Anani because the law was originally
taught by Rav Elazar in the name of Rebbi Oshiya.

The following story about the Yismach Yisroel, zt”l, should shed light on why Rav Ami was so
incensed. A scholar once came to the Yismach Yisroel and asked for an approbation for a book he
had written. After the Rebbe went through it, he found something that didn’t meet with his
approval.

Although the work was filled with good material, it was really only an anthology. The writer hadn’t
innovated any of the concepts—they were all taken from other Chachomim whom the man had
failed to acknowledge.

Worse, the ‘author’ neglected to mention that the ideas weren’t his own! The Rebbe handed the
manuscript back to the man and said, “It is now possible to understand the verse in Koheles 12:12:
‘Make books without end…’

The Gemara in Megillah 15a tells us that a person who transmits a Torah concept in the name of
the originator brings redemption to the world. This works in reverse as well. Now that people write
books without mentioning the names of the actual authors of their contents, the redemption is held
back.

This is one way to read the verse: Make books (where the real authors are not named), and there
will be no end to the exile, ‫ושלום חס‬.

Rabbi Joshua Mikutis writes:5

Rituals can act as a balm because they give us structure at moments that feel chaotic and uncertain.
Through most of this tractate, we’ve been discussing the laws of labor on the intermediate days
of Passover and Sukkot. In recent pages, however, we’ve focused largely on rituals of mourning.
These seemingly disparate topics are united by a shared dilemma: How should our practice change
during periods of “in-betweenness,” of liminality?

Mourning plunges the individual into a profound period of liminality — a time when they must
negotiate between the world they knew with their loved one, and the new world without; and a
time when they must balance their unique obligations as mourners and their other commitments.
Today’s daf today brings this theme to the fore in a discussion of kriah, the ritual in which a
mourner tears one of their outer garments as a physical sign of their bereavement.

To help define the parameters of this new and uncertain time, Shmuel states that the tearing should
happen at the moment of peak grief. In this way, it is a ritual to mark a turning point. He says that
if the garment is not torn at that moment, it does not fulfill the mourner’s obligation.

5
Mytalmudiclearning.com

16
But how can we know when the peak of grief has hit? Indeed, the Gemara then leads into a curious
story about Shmuel’s own experience of mourning that seems to contradict his teaching:

But when they said to Shmuel that Rav had passed away, he rent twelve garments on account
of him, and said: The man of whom I was in fear, owing to his great learning, has gone and
died.

Similarly, when they told Rabbi Yohanan that Rabbi Hanina had passed away, he rent thirteen
expensive wool garments on account of him, and said: The man of whom I was in fear has gone.

Whereas traditionally one rends a single garment, Shmuel and Rabbi Yohanan tear multiple and,
in Yohanan’s example, expensive garments. Why? The Gemara’s answer is profound:

The sages are different. Since their teachings are mentioned all the time, every time they are
mentioned is like the time of most intense grief, as the pain over their death is once again
renewed.

Though the text refers specifically to the sages, it shows keen insight into a common experience
of mourning. Mourning can be a lasting experience with no clear time boundaries — grief does
not necessarily hit a single peak moment and then decline, but can linger, wax and wane, and
return, unexpected and uninvited. We might think we know when the moment of peak mourning
has hit. And we might very well be wrong — a dozen times or more.

Rabbi Johnny Solomon writes:6

The Mishna (Moed Katan 3:7) at the end of our daf (Moed Katan 24b) states that only the seven
closest relatives (father, mother, sister, brother, son, daughter, spouse) of someone who has died
on Chol HaMoed tear their clothes, wear non-leather shoes, and eat a mourner’s meal.

As we shall see in the upcoming daf (Moed Katan 25a), some exceptions do exist to this rule -
such as if a great Torah Sage or a particularly righteous person dies. Nevertheless, what this Mishna
seemingly brings into focus is the difference between the formal mourning rituals required by the
seven closest relatives, and those permitted to other more distant relatives or friends.

However, there are situations when a more distant relative or friend has died and a person feels so
overcome with grief that they sense that they need to channel their emotions through practicing
some measure of mourning customs. And when this occurs, they can often be advised by friends
or perhaps even by rabbis that this is only appropriate if one of their seven closest relatives has
died.

Yet as the Rambam makes clear in his commentary to this Mishna, while this difference does exist,
and is emphasized, in terms of mourning rituals on Chol HaMoed, significantly more latitude exists
when a death has occurred outside of a festival at which time, ‫כל הרוצה לקרוע בגדו ולחלוץ מנעלו אין‬

6
www.rabbijohnnysolomon.com

17
‫‘ – מונעין אותו‬whoever wishes to tear their clothes or remove their shoes are not inhibited from
doing so’.

In fact, basing himself on the Ramban’s reading of Brachot 16b, Rabbi Shmuel Baruch Werner
(1911-1993) explains in his ‘Mishpetei Shmuel’ (Responsa no. 3) that even a non-relative can
nevertheless experience ‫ – צער של קרובים‬meaning ‘the pain of one who has lost someone close to
them’, at which time flexibility should be shown in giving them the opportunity to mourn as well.
Of course, each situation should be treated individually.

However, my key point is that there are times when you are not ‘one of the seven’ but you feel
that you are, at which time – especially when a death does not occur on Chol HaMoed – if someone
feels the need to practice at least some mourning customs, they may do so.

Jewish Ritual Practice Following the Death of an Infant who lives

less than 31 days

Rabbi Stephanie Dickstein writes:7

7 https://www.rabbinicalassembly.org/sites/default/files/public/halakhah/teshuvot/19912000/dickstein_infant.pdf

18
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21
22
23
24
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27
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 ‫ת‬

The Infant Mortality Rate

Berachot 5

Jeremy Brown writes:8

Rabbi Yochanan bar Napcha (c.180–279 CE) is cited many hundreds of times in the Talmud. But
it was his tragic family story that perhaps most defined who he was. He was a father who had lost
ten children.

8 http://www.talmudology.com/jeremybrownmdgmailcom/2020/1/4/berachot-5b-nt-mortality

30
CHILDHOOD MORTALITY IN RABBINIC SOURCES

Rabbi Yochanan’s tragedy might have been extreme in its severity, but his was not a unique
situation. In fact the Talmud and the Midrash are replete with stories that reflect the high rate of
both infant and child mortality at the time. Rabbi Yishmael lost at least two sons, (Moed Katan
28b) as did Rabbi Akiva (Moed Katan 21b). Rabban Gamiel cried in sympathy with a neighbor
who lost her child (Sanhedrin 104b), whereas when Rav Yossi of Zippori lost a son, he chose not
to cry, but to expound all day long in the Bet Midrash (Moed Katan 21a). The Midrash recounts
that both sons of Rabbi Meir died on a Shabbat (Midrash Mishlei 31:10), and when the sons of
Rabbi Yossi ben Chaninah died, he refused to wash with warm water (Taanit 13b). Children were
eaten by wolves (Taanit 22b) murdered by brigands (Semahoth 12:13) and buried in earthquakes
(Semachot 11:4). In some hemophiliac families, infants bled to death after being circumcised
(Yevamot 64b), while other children committed suicide rather than face either physical abuse from
their father (Semahoth 2:4-5), or an unwanted arranged marriage (Seder Eliyyahu Rabbah 19).

Professor Meir Bar Ilan (from the university that bears his family name… and my cousin!)
identified over two dozen other cases. Professor Bar Ilan adds that an additional factor should not
be overlooked.

…almost all the cases indicate deaths of sons, not daughters. Apparently it reflects the nature
of a patriarchal society, where one's importance depends merely on his sex (as in more than few
societies even today). Furthermore, since there is no reason to believe that boys were prone to
death more than girls (except in the case of circumcision), it reveals that, actually, the cases are
all 'males' while ignoring the females. Because of this 'male' factor, one that wishes to know
the exact number of deaths in the above sources, should multiply his data with (almost)
2.25 That is to say, that usually the deaths of girls were ignored, though they, apparently,
happened at the same rate.

CALCULATING THE INFANT MORTALITY RATE IN THE

TALMUDIC ERA

Professor Bar Ilan counted about nine cases of infant or child death among the fifety or so tannaim
mentioned by name in the Talmud. After considering the “ignored” factor of deaths of girls, he
suggested that infant mortality rate among the families of the tannaim approached 30%.

To put this number into context, the infant mortality rate in Great Britain around 1880 was about
135 per thousand live births, or about 13%.

Among the Jews of Italy, about 40% of children under the age of three died. It is harder to calculate
the mortality rate in ancient Rome, but other scholars have estimated it to be 25-30%.

31
THE SHAMEFUL INFANT MORTALITY RATE IN THE US

In 2017 the infant mortality rate in the US was 579 per 100,000 or just under 0.6%. That rate is
fifty times lower than the rate during the centuries over which the Talmud was compiled. The
leading cause of death is congenital malformations, but accidental injury remains a major cause of
mortality in children. Just like it did in ancient Israel.

— More infants are dying in US states that rejected expanded Medicaid. Quartz, Feb 1, 2018.

But take a look at the chart below and you will see that the rate in the US is over two or three times
higher than it is in other western countries.

It is shameful that the country with the highest per capita rate of health care spending finds itself
so low down on this list.

32
 Infant mortality per 1,000 births, 2010-2015. Date from the United Nations.

“Comparative studies show different data from various cultures and times, and together with
the texts themselves, suggest that some 30% of all children born in the Land of Israel at the
beginning of this era would not reach their maturity.

Meir Bar Ilan. Infant Mortality in The Land of Israel in Late Antiquity.

“NEITHER THE SUFFERING NOR THE REWARD”

Because infant and childhood deaths were so common it is not surprising that the rabbis of the
Talmud tried to inject a glimmer of metaphysical hope into this most tragic of tragedies.

Rabbi Yochanan had lost no fewer than ten children, and his colleagues attempted to console him
with the promise of a reward to come:

“If one engages in Torah and acts of charity and buries his sons, all his transgressions are
forgiven.” That might have consoled Yochanan the Rabbi, but it did not console Yochanan the
grieving father.

Rabbi Yochanan rejected the very notion that suffering -of any sort-was worth a reward. “I
want neither this suffering nor its reward - ‫ל ֹא ֵהן ְול ֹא ְשָׂכ ָרן‬.”

33
 New Jewish guidelines for coping with the loss of a child.

Dr. Ron Wolfson writes:9

It’s every parent’s worst nightmare. A stillborn, a premature infant who can’t make it, a baby born
without a chance to live. No one ever talks about the possible complications of birth that can
threaten the life of a baby. Not in childbirth classes. Not in the doctor’s office. Not in the excited
conversation of expectant parents. So when the unimaginable happens and a baby dies at or shortly
after birth, the parents, their families and the community are totally unprepared.

One reason we are so shocked by a neonatal death is that the medical technology to monitor
pregnancy is so advanced. We know so much about the baby, even in utero, that the failure to
prevent this loss seems nearly unbelievable. It didn’t used to be that way at all. Until quite recently,
the rate of neonatal death was quite high. In the Middle Ages, parents anticipated many
pregnancies, fully aware that a high percentage of the babies would not survive. As sad as

9 https://www.myjewishlearning.com/article/stillbirth-and-neonatal-death/

34
miscarriages and stillbirths were, the family and the community knew of the risks and expected a
certain amount of loss.

The rabbis were aware of this as well. Although there are some dissenting opinions that allow
mourning even a one-day-old newborn, the predominant position of Jewish law was that if a baby
did not survive for 30 days, it was as if the baby had not lived. The two major halachic (legal)
statements on which this custom is based are these:

“We do not mourn for fetuses (nefalim), and anything which does not live for 30 days, we do not
mourn for it.” — Maimonides, Mishneh Torah, Hilkhot Aveilut 1:6

“The infant, for 30 days, even including the full 30th day (if it dies), we do not mourn for it.” –
Shulchan Aruch Yoreh De’ah 374:8

The reason for the limit of 30 days appears to derive from the fact that 30 days is the age at which
we are commanded to redeem the firstborn (pidyon ha-ben). For the rabbis, this marked the point
at which a fetus became fully viable.

The result of this ruling was that none of the practices of mourning was to take place if the infant
was born dead or did not survive to the 31st day. Although the child was buried, there was no
funeral per se, the grave was left unmarked, and the parents might never know where the grave
was located. It was undoubtedly considered an act of kindness to the parents and the community,
for without the restriction, families would have been in mourning almost continuously.

Today the opposite is true. The tremendous sense of loss and the overwhelming need to grieve felt
by the parents of an infant who dies before the thirty-day benchmark does not go away just because
the halacha prevents the mourning rituals from taking place. The medical profession has now
recognized that parents experiencing a baby’s death must face the loss, and protocols to enable
them to mourn have been developed within recent years.

Parents are encouraged to see and touch the baby, pictures may be taken, mementos kept. It is
recommended that the parents name the baby; it will be much easier in the future to talk about
“Daniel” than “Baby Boy.” Social workers routinely recommend funerals, and support groups for
bereaved parents experiencing neonatal death can be found in many communities. Yet, most rabbis
and most Jewish laypeople presented with this type of loss would be hard-pressed to know what
to say, except to repeat the painful words, “There is no mourning for this child.”

Jewish law has remained viable and relevant because each generation of interpreters applied
the halacha to its own time. The Committee on Jewish Law and Standards of the Rabbinical
Assembly of the Conservative movement adopted a new position vis-a-vis neonatal death in 1992
by accepting the teshuvah (rabbinic responsum) of Rabbi Stephanie Dickstein to the question,
“What should be Jewish practice following the death of an infant who lives less than 31 days?”

Rabbi Dickstein points out that the commonly held belief that there is no mourning for a child who
does not survive to 31 days is not the only position found in Jewish legal literature.
In Mishnah Niddah 5:3 , we find this statement: “A one-day-old infant, if he dies, is considered
to his father and mother like a full bridegroom,” and therefore the child would be mourned. In the

35
Babylonian Talmud, Tractate Shabbat136a, we read that the sons of Rav Dimi and Rav Kahana
mourned for their newborns who died.

Even Maimonides states: “If a man knows for certain that the child was born after a full nine
months, even if it dies on the day it is born, we mourn it” (Aveilut 1:7). The Shulchan
Aruch concurs (Yoreh De’ah 374:8). Rabbi Dickstein also points to the universally accepted
requirement to bury a newborn infant, stillborn or fetus miscarried after the fifth month.

Rabbi Dickstein has led the Conservative movement to establish new legal responses that carry
with them the full authority of Jewish law. Here are the major points of this new practice:

1. Full Bereavement Practices

In the case of a full-term pregnancy, when an infant dies for any reason, at any time after birth, its
parents and other family members should be obligated for full bereavement practices, just as for
any other child. The parents should recite Kaddish for 30 days and should observe yahrzeit .
Young siblings have no obligation to say Kaddish, and post-bar/bat mitzvah siblings should be
encouraged to use the traditional rituals to work through the many feelings they have.

2. Burial in Accordance with Jewish Law

The body should be buried in accordance with Jewish practice. The funeral should follow standard
practice with appropriate readings of comfort in place of a eulogy. Parents should be encouraged
to attend the funeral, as should family and close friends. The funeral should be held as soon as
possible, although if the mother wants to attend, burial may be delayed until she recovers enough
physical strength following the delivery to attend.

3. Naming

If the infant was not named prior to death, it is usually given a name at the grave. The name may
be the one the parents intended to use for their child (although this might be difficult for the
surviving grandparents whose own parents may have been remembered with this name), or they
might choose a name like Menahem or Nehamah, names that indicate a desire for “comfort.” There
are two reasons for the naming: a) according to Jewish folk tradition, giving a name will enable
parents to “find” their child in the world to come; and b) psychologists consider the practice of
naming to be an important help in healing the parents’ grief.

4. Autopsy

If the information gathered from an autopsy can help determine the advisability of future
pregnancies for the couple or of treatment of diseases to which other children of the couple might
be susceptible, it should be allowed, even encouraged.

5. Shiva

A complete shiva should be observed, beginning with the meal of consolation and including daily
prayer services for the mourners. Communal participation in the shiva makes real this loss and
overcomes the tremendous isolation the parents feel. If things had turned out differently, the

36
community would have been there for visiting the baby and welcoming it with Jewish birth rituals.
The family whose newborn dies should not be denied its community. It is also extremely important,
especially for the father, to allow permission to do nothing else but mourn during the shiva period.

6. Treat Parents Equally

The father and the mother should be treated equally as mourners. Both parents will react differently
to the loss, [but] it is particularly important for the father to recognize his loss, for it is no less real
than the mother’s. When the father is treated as a mourner, he is relieved of the burden of “being
strong” for his wife. He has a specific set of ritual tasks to do that encourage him to confront the
magnitude of his loss in all its dimensions.

7. Viability Debate

In the case of infants born prematurely, there is still debate within the Law Committee on how to
define “viability.” Some, including Rabbi Dickstein, argue that between five months and thirty
weeks the decision concerning mourning might be made by the local rabbi and the parents.

Certainly, there may be those who feel the centuries-old practice of not mourning a neonatal death
could be more comforting than engaging in the whole ritual of Jewish bereavement. But for those
who desperately need a vehicle for grief, this recent ruling allowing for the mourning of newborns
is indeed a welcome development.10

Jewish Guidance on the Loss of a Baby or Fetus

JASON WEINER writes:11

10 from A Time to Mourn, A Time to Comfort (Jewish Lights).

11 https://hakirah.org/Vol23Weiner.pdf

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 When My Son Died, I Felt I Was Mourning Alone

Rhonda Roth writes:12

12 https://www.chabad.org/library/article_cdo/aid/5275706/jewish/When-My-Son-Died-I-Felt-I-Was-Mourning-Alone.htm

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Last year, my dear son, Jacob, unexpectedly passed away at the young age of 24. During the week
of shiva, people were coming to our home saying, “May G-d comfort you among the mourners of
Zion and Jerusalem.”

These are the traditional words of consolation said to Jewish mourners. But I would think,
“Thank G-d, they never lost a child. They can only imagine what it feels like, but they’ll never
really know.”

A father who lost his daughter the same age as my son came to offer words of comfort. Even
though this man shared a similar experience, I still felt as if I was mourning alone.

May G-d comfort you among the mourners of Zion and Jerusalem. Why do we say this short phrase
to comfort those who have lost loved ones?

The basic interpretation of this statement is that the mourner’s emotional pain is also the pain of
the community. Just as Jews are grieved over the loss of the Holy Temple in Jerusalem, all Jews
share the loss of an individual as well. Hence, other Jewish people are grieving with me.

Even though our Holy Temple is physically gone, its soul and the soul of Jerusalem, the Holy City,
still remains. Thus, even though Jacob is not physically here, his soul lives on and is still with me.
And just as G-d promised that Jerusalem will be rebuilt and the Holy Temple restored, He also
promised that Jacob, together with the rest of our people who have passed on, will once again live
in physical bodies, in the time of the Redemption.

I Couldn’t Find Comfort in Comforting Words

But when Jacob passed away, these customary words of consolation seemed to have little meaning.
During shiva, I thought, “These people mean well, but Jacob is gone, and I just don’t feel any
comfort.”

And the phrase, “May G-d comfort you ... ” made even less sense. How is G-d comforting me?
G-d took Jacob away in the first place and now He’s offering solace?

50
I didn’t hear a booming voice from Heaven eliciting words of comfort. I didn’t hear G-d talking
to me. These visitors to my home were the ones trying to offer comfort, and I couldn’t take comfort
from them. I just didn’t see G-d in the picture at all.

G-d Is the Only One

When I began to contemplate the deeper meaning behind these words, the phrase “May G-d
comfort you ... ” started to have more significance.

In Hebrew, this declaration refers to G-d as Hamakom, translated as “The Place.” Why is He called
“The Place?”

Chassidic philosophy explains that G-d exists within every single creation. For example, when we
say in the Shema prayer that G-d is “One,” we’re not just saying that there’s only one G-d. What
we’re really saying is that G-d is the only existing being; we are all a part of Him, and He fills
every aspect of creation.

We also affirm this concept in the prayer Adon Olam. If G-d and the world were two separate
entities, we would say “Adon HaOlam,” Master of “the world.” Instead, we say Adon Olam, as if
to say, G-d is the Adon (Master), and he is also the Olam (World).

In other words, reality doesn’t consist of G-d and a world. G-d is the world, hence He is “The
Place.”

My Pain Is His Pain

Since all of creation is a part of G-d, it’s easy to understand how He knows what’s happening with
each and every thing He created. For example, I know what’s going on with each part of my body,
and when one part of my body experiences pain, I know it immediately. Similarly, G-d knows
what’s going on with every created being and when one of His creations is in pain, either physically
or emotionally, He feels that pain as well.

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We see this concept described a number of times in our Holy writings:

“ ... In all their sorrows He is saddened ... ” (Isaiah 63:9).

“ ... I am with him in distress ... ” (Psalms 91:15).

“ ... Says the Holy One, Blessed be He, ‘If I punish them, the pain is Mine’ ... ” (The Palm Tree
of Devorah, chapter 1, section 4).

Thus, no one really knows the pain of an individual except G-d Himself.

The father who lost his daughter can relate to my pain at some level, but he still is unable to know
my particular pain and anguish because he’s not me. Just as my grief penetrates to my very essence,
so too, my pain at some spiritual level affects G-d as well because I’m a part of Him.

So I wasn’t really mourning alone. G-d was right there mourning with me. It’s as if G-d is saying
to me, “I know this hurts, and I know you won’t understand. But I had to do it for the good. I feel
sad with you.”

Praying for G-d’s Needs

One of the most well-known Chassidic leaders, Rabbi Levi Yitzchak of Berditchev (1740-1809),
has a novel insight on how to make our prayers more effective.

We normally think of praying to G-d, but we really should be praying for G-d, too. When asking
that G-d fill our needs, we can turn our prayer around to pray for G-d’s needs. For example, if I
ask someone to build a house, I have to supply him with the tools he needs to do the job. What
does G-d want? He wants us to make a dwelling place for Him in this physical world by performing
his mitzvot and doing acts of kindness. Only then can His presence be openly revealed. So, He has
to give us the means to accomplish this task.

So we ask Him for health, livelihood, healthy children and lots of other things so we can do as He
requests. When we pray for health, we’re really asking for the ability to do His will with an

52
energized body and a clear head. We’re praying for the health of the Divine Presence so the world
can function as it should without pain or suffering.

When we pray for a livelihood, we’re asking that He provide us with the money to provide for our
physical and spiritual needs—i.e., so that we can give tzedakah (“charity”), give our children a
good education, to have all we need to celebrate and observe Shabbat and the holidays in a happy
frame of mind, etc. There should be no want or deprivation in the King’s house.

When we pray for healthy children, we’re really praying to bring more children into the world who
will perform G-d’s will. It’s not presumptuous of us to ask G-d to give us the tools we need to do
the job He wants us to do. We can sincerely ask Him to fulfill all our requests for His sake. With
this intent, our prayers can be so much stronger.

We’re Never Alone

I realize now that I wasn’t mourning alone. G-d is intimately involved with all his creations
including me. When we suffer, He suffers. He feels our pain. When we grieve, He grieves with us.

Only after Adam and Eve ate from the forbidden fruit did G-d bring death into the world. Death
was never a part of His original plan for creation. And even after death became a reality in this
physical world, there’s supposed to be some sort of order. Children are supposed to bury their
parents, not the other way around. Parents burying their children is a physical manifestation of a
spiritual abnormality in His world. This is not the way G-d wants it to be.

So when we pray to G-d to end our suffering, we’re praying for G-d to end His own suffering as
well and usher in a time when death will be removed from this world, and we will openly feel
G-d’s presence.

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To Mourn a Child consists of personal accounts written by parents and other family members who
have experienced the death of a child, excerpts from traditional Jewish sources, and essays by
theologians, practicing rabbis, and healthcare professionals.

Many currents flow through this extraordinary book: theological and philosophical quandaries;
psychological and emotional stresses that beset parents, siblings, and friends; halachic analysis
that strives to combine sensitivity with fidelity to tradition; and, ultimately, inspiring expressions
of courage and the indomitable will to accept God’s inscrutable judgment.

Written by ordinary people thrust into extraordinary circumstances, these selections are eloquent
testimony to the strength of the human spirit and the redemptive power of Judaism.

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The Torah has a unique word to describe the death of a child because it is a pain
that never leaves.

A Permanent Tear: On the Loss of a Child

Rabbi Aaron Goldscheider writes:13

What does the Torah teach us about the traumatic and heart wrenching death: the loss of a child?
When Jacob’s children go down to Egypt in search of sustenance they unexpectedly come face to
face with their long-lost brother Joseph. But they don’t recognize him. Joseph, who is now second
in command to Pharaoh, jails one of the brothers, Simeon, and sends the remaining brothers back
to their home in Canaan. When they return to their father Jacob without Simeon, Jacob is beside
himself. Not only has he lost one beloved son, believing Joseph was murdered, but now a second
son’s life in imminent danger. It is in this context that Jacob utters the term that is designated for
parents who have lost a child – shakhul (Genesis 42:36). Jacob says to his sons: I have lived for so
many years as a shakhul, please don’t let this happen to me again.

Thousands of parents experience child loss each year: miscarriages and stillborn births, infant
death, death from sickness and disease, children killed by terrorism or acts of violence, children
killed in accidents, and sometimes there are children who pass away suddenly without warning,
without explanation.

There is no one term in English for a parent who loses a child. Perhaps this is because the culture
does not perceive the loss of a child to be any different than any other death. Shakhul is often
simply translated ahttps://www.aish.com/sp/pg/A-Permanent-Tear-On-the-Loss-of-a-Child.htmls
“bereaved,” which does not capture its true meaning.

13 https://www.aish.com/sp/pg/A-Permanent-Tear-On-the-Loss-of-a-Child.html

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Jacob lives 22 years with the belief that Joseph, then his teenage son, has tragically died. Although
this portion of the Torah is not usually read in this light, we have a snapshot of how a parent
mourns a child’s death.

Jacob tears his garment (Genesis 37:34). This is the first time a Jew rends his garment, a ritual
incorporated into halacha, Jewish law, and we continue to observe it on the death of a parent,
spouse or sibling. According to our sages, the act symbolizes the permanent tear in one’s heart.

Jacob’s family and friends try to comfort him for his loss, says the Torah “…but he refused to be
comforted” (37:35). The classic commentator Rashi explains that Jacob was really saying that he
felt that he would never find comfort for the rest of his life after losing a child (Rashi 37:35, ‘Avel
Sheola’).

The pain is a lingering pain; the tear in one’s heart is permanent.

During the 22 years that Jacob mourns the loss of his son, the commentaries say that Jacob
experiences an absence of God’s presence in his life (Rashi, Genesis 45:27). The Shechina, God’s
warmth and closeness, which once permeated Jacob’s life, now seems to be gone. Apparently, the
Torah is suggesting that the experience of child loss is unique. Remarkably, the descriptions that
we find in these verses reflect the way parents still describe this kind of bereavement – a pain that
never leaves.

In all the years I studied and taught the story of Jacob and Joseph, I never saw it in this light until,
I, tragically, experienced the sudden death of my own four-year-old son, Elisha Chanina z”l. As I
now continuously search the Torah and our holy books for insight and wisdom in confronting my
aching loss, I have found comfort in discovering that the Torah treats child loss in way that is
honest and real. It establishes a word specifically for parents who endure the bitterness and pain
of child loss.

One who loses his parents is an orphan; bereaved spouses become widows and widowers. These
are losses so profound that a special word is needed to express the new state of being. By
designating a specific term, shakhul, for parents who have lost a child, the Torah is calling for
added sensitivity towards the pain parents endure and is demonstrating awareness of the enduring
emotional scar.

A Source of Strength

As I have learned over the three years and nine months since my son’s passing, every individual
experiences grief differently. But there are some general recommendations as to how one can be a
source of strength for those who have suffered this kind of tragedy.

Carefully choose the words used when speaking to a bereaved parent; not only during the few days
of shiva, but for the years to follow. Never say, “You’ll get over it” or ‘I’m sure you will find
closure.” Better to say, “I am thinking about you” or “Today I thought about your son/daughter,”
and share a memory.

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Parents who have lost a child do not ever want their child to be forgotten. One of the best things
others can do is to show that they care and help ensure that the child’s memory endures. A close
friend of ours made a small memory book of pictures and thoughts that she gave to us and to each
of our parents. That small book continues to be meaningful to us, and through it we feel the
embrace of that person.

Caring friends can also show love and sympathy by sending an email or a note on each birthday
of the deceased child or on each yahrtzeit, or support a project that the family may have initiated
in the child’s memory. People can also give to other charities or perform other acts of kindness
and let the parents know that they have done so in the child’s memory. These and other gestures
offer loving support that can make a real difference to the broken-hearted family.

When the Torah describes the great blessing of peace and tranquility that will one day in the future
come to the Jewish people, we again find the use of the term shakhul (Exodus 23:26). God
promises that parents will no longer witness the death of their children, and the verse concludes,
“I will let you count the fullness of your days.” Of the multitude of gifts the Torah could have
promised for the future, the Torah chooses to highlight the removal of the trauma of child loss and
its harsh pain.

The Torah is well aware that until that great era of blessing arrives, we continue to grapple with
this heartbreaking mystery, and struggle to cope with one of life’s greatest tragedies. The story of
Jacob opens a door for us to discuss our tradition’s perspectives and insights regarding the loss of
a child. As the descendants of Jacob who pursue the sacred task of building noble and caring
communities, we are reminded to open our collective hearts with compassion and loving care.

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 Data Shows the Death of a Child Changes Parents Forever

Studies have shown that, when a parent’s worst fears are realized, the psychological and physical

damage can be more intense than perhaps any other grief response.

Joshua A. Krisch writes:14

Grief and loss are a normal part of life. But mourning the death of a child is certainly
not. Studies have shown that, when a parent’s worst fears are realized, the
psychological and physical damage can be more intense than perhaps any other grief
response. It makes sense. The loss of a child is the loss of promise, potential. A cruel
violation of the natural order.

One detailed study of how parents cope in the aftermath, published in 2008, surveyed
449 parents who had lost a child to cancer 4 to 9 years earlier. They found that, while
both mothers and fathers healed over time, about 20 percent still reported unresolved
grief even a decade after the loss. The findings also suggest that mothers and fathers,
while both bereft, grieve differently. Mothers were more likely to display low
psychological and physical well-being overall. Fathers were more likely to report low
quality of life, difficulty sleeping, and nightmares.

Here’s the data behind these conclusions:

How Long Does It Take For Parents To Heal?

For the study, researchers asked each parent one simple question: “Do you think that
you have worked through your grief?” Four to nine years after the loss of a child, 26
percent of parents (116 participants) reported that their grief remained “unresolved”,
and these parents became the focus of the study. One key finding was that the

14 https://www.fatherly.com/health-science/death-of-a-child-data-father-response/

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situation does seem to improve over time, before it levels off. Forty percent of fathers
and 35 percent of mothers reported unresolved grief at year six. But by year seven,
that figure dropped to 25 percent of fathers and 18 percent of mothers. Unfortunately,
at year 8 and 9, there is nothing more than incremental improvement.

The Psychological Trauma

Researchers then asked each of the 116 parents with unresolved grief to respond to a
battery of surveys, including the Spielberger State-Trait Anxiety Inventory (which
measures anxiety), Center for Epidemiologic Studies Depression Scale (depression),
and a seven-point scale reporting their quality of life. Across the board, about 25
percent of parents with unresolved grief reported very low quality of life, and very
high levels of anxiety and depression. There were few differences between the sexes,
but fathers were at slightly higher risk of depression and low quality of life, while
mothers had higher rates of anxiety and low overall psychological health.

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The Physical Health Impacts

Grief does not only affect our mental health—it can impact our physical health, too.
Indeed, when the researchers moved into the final phase of their study and the
assessed physical well-being of these bereaved parents, they found that 84 percent of
mothers reported low or moderate physical well-being (far higher than the 45 percent
of fathers who reported this). Mothers were also significantly more likely to be on
medication or have taken sick leave for their distress. Interestingly, however, fathers
were more likely to report sleep problems and nightmares. One reason for this could
be that mothers still spend more time with their children during the way, on average,
while fathers work. It is possible that men feel the loss most acutely in the evenings,
when work is finished, their minds are clear, and there is no child to play with.

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GRIEVING THE DEATH OF A CHILD

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The death and loss of a child is frequently called the ultimate tragedy. Nothing can be more
devastating.15 Along with the usual symptoms and stages of grief, there are many issues that
make parental bereavement particularly difficult to resolve. And this grief over the loss of a
child can be exacerbated and complicated by feelings of injustice — the understandable feeling
that this loss never should have happened. During the early days of grieving, most parents
experience excruciating pain, alternating with numbness — a dichotomy that may persist for
months or longer. Many parents who have lost their son or daughter report they feel that they
can only “exist” and every motion or need beyond that seems nearly impossible. It has been
said that coping with the death and loss of a child requires some of the hardest work one will
ever have to do.
The relationship between parents and their children is among the most intense in life. Much of
parenting centers on providing and doing for children, even after they have grown up and left
home. A child’s death robs you of the ability to carry out your parenting role as you have
imagined it, as it is “supposed” to be. You may feel an overwhelming sense of failure for no
longer being able to care for and protect your child, duties that you expected to fulfill for many
years.
It must be remembered that bereaved parents can mourn the death and loss of a child of any
age, and that it feels unnatural to outlive a child. It does not make a difference whether your
child is three or thirty-three when your son or daughter dies. The emotion is the same. All
bereaved parents lose a part of themselves.
The search for meaning in a child’s death is especially important to parents. An understanding
of how a death fits into the scheme of life is difficult and often unattainable. Faith is a source
of comfort for some parents, but others with religious beliefs report feeling betrayed by God.
Religious confusion is normal, as is questioning many things that you may have believed to be
certain. One father dealing with the death of a child reported that his faith in life in general had
been shattered. He had long believed that if you lived your life as a good person, striving to
make a positive contribution to the world, life would turn out well. The death of his son robbed
him of that belief. This reaction isn’t uncommon; losing a child feels like the ultimate violation
of the rules of life.
Surviving the death and loss of a child takes a dedication to life. As a parent, you gave birth to
life as a promise to the future. Now you must make a new commitment to living, as hard or
impossible as it may seem right now. You will survive this; however, the experience may
change you.

15
https://behindthebadgefoundation.org/resources/grieving-the-death-of-a-child/

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A renowned grief expert and neuroscientist shares groundbreaking discoveries about what
happens in our brain when we grieve, providing a new paradigm for understanding love, loss,
and learning.

For as long as humans have existed, we have struggled when a loved one dies. Poets and
playwrights have written about the dark cloak of grief, the deep yearning, how devastating
heartache feels. But until now, we have had little scientific perspective on this universal
experience.

In The Grieving Brain, neuroscientist and psychologist Mary-Frances O’Connor, PhD, gives us a
fascinating new window into one of the hallmark experiences of being human. O’Connor has
devoted decades to researching the effects of grief on the brain, and in this book, she makes cutting-
edge neuroscience accessible through her contagious enthusiasm, and guides us through how
we encode love and grief. With love, our neurons help us form attachments to others; but, with
loss, our brain must come to terms with where our loved ones went, or how to imagine a future that
encompasses their absence.

Based on O’Connor’s own trailblazing neuroimaging work, research in the field, and her real-life
stories, The Grieving Brain does what the best popular science books do, combining storytelling,
accessible science, and practical knowledge that will help us better understand what happens when
we grieve and how to navigate loss with more ease and grace.

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 Functional Neuroanatomy of Grief: An fMRI Study
Harald Gündel, Mary-Frances O’Connor, Lindsey Littrell, Carolyn Fort
and Richard D. Lane write:16

OBJECTIVE:

In this study the authors examined the functional neuroanatomy of grief, which to their knowledge
has not been studied previously in functional neuroimaging research.

METHOD:

Grief was elicited in eight bereaved women through photographs of the deceased versus a stranger,
combined with words specific to the death event versus neutral words. Use of both pictures and
words resulted in a 2×2 factorial design.

RESULTS:

Three brain regions were independently activated by the picture and word factors: posterior
cingulate cortex, medial/superior frontal gyrus, and cerebellum. The two factors also activated
distinct regions: for the picture factor, they were the cuneus, superior lingual gyrus, insula, dorsal
anterior cingulate cortex, inferior temporal gyrus, and fusiform gyrus; and for the word factor, they
were the precuneus, precentral gyrus, midbrain, and vermis. The interaction of the two factors
showed significant activation in the cerebellar vermis.

CONCLUSIONS:

Grief is mediated by a distributed neural network that subserves affect processing, mentalizing,
episodic memory retrieval, processing of familiar faces, visual imagery, autonomic regulation, and
modulation/coordination of these functions. This neural network may account for the unique,
subjective quality of grief and provide new leads in understanding the health consequences of grief
and the neurobiology of attachment.

Grief after the death of a loved one has received increased attention in psychiatry in recent years,
with the realization that 40% of bereaved individuals suffer from major or minor
depression (1) and are at increased risk for mortality from all causes (2). Bereaved individuals are
at high risk for suicide (3), while treatment with antidepressants can lead to significant
improvement in bereavement-related depression (4).

Despite this interest, to our knowledge grief has not been the subject of previous neuroimaging
research. Findings from several related phenomena, however, provide direction regarding the
possible neural correlates of grief. Recent functional imaging research has revealed that during the
successful retrieval of autobiographical memories elicited by name-cued recall of family members

16
https://pubmed.ncbi.nlm.nih.gov/14594740/

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and friends, the strongest and most consistent activation is in the caudal portion of the left posterior
cingulate cortex (5). Perception of familiar faces and voices also is associated with increased
neural activity in the posterior cingulate cortex, including the retrosplenial cortex (6). Transient
sadness induced in a variety of ways has been associated with increased activity in the subgenual
cingulate (Brodmann’s area 25) as well as the anterior insular cortex and prefrontal cortex (7, 8).
In addition to other emotions evoked within a single positron emission tomography study, sadness
induced by the free recall of a close relatives or friend’s death was associated with activation of
the bilateral insula, anterior cingulate cortex, orbitofrontal cortex, basal forebrain, caudate nucleus,
lenticular nucleus, left thalamus, midline cerebellum, and anterior and dorsal pons (8).

We therefore predicted that in bereaved participants, the induction of transient grief would be
associated with activity in the posterior cingulate cortex, anterior cingulate cortex, and prefrontal
cortex. Given that grief is a complex cognitive, emotional, and physiological state, we anticipated
that grief would be mediated by a distributed network of structures that would include, but not be
restricted to, these areas.

In order to elicit grief, we used a 2×2 (person-by-word) factorial design, creating four conditions.
Each of the four conditions consisted of 15 picture-word composites. By comparing a picture of
the deceased with a picture of a stranger (person factor) and the personalized grief-related words
with matched neutral words (word factor), we were able to elicit grief through two distinct methods
in bereaved subjects.

Method
Participants

The participants were eight volunteers who had experienced the death of a first-degree relative in
the past year. They were recruited through general advertisements in hospices, hospitals, mental
health clinics, and university classes. All participants were female, right-handed, and native
English speakers. The exclusion criteria included axis I psychiatric disorders (including current
depression, based on condition A from DSM-IV) and medical conditions (including neurological
disorders), which were evaluated with a structured clinical interview. The human subjects
committee at the University of Arizona in Tucson approved the study. The participants provided
written informed consent and were compensated for their participation.

Picture and Word Stimuli

Each participant provided one photograph of the deceased loved one. The deceased was the only
or central figure in the photograph; any other persons were digitally removed from the image. The
photograph was then matched for sex, age, and environment with one photograph of a stranger.
The participant was also interviewed about the diagnosis, course of illness, death, and memorial
service for the deceased. From this narrative, 15 personalized grief-related words were chosen that
had an autobiographical connection to the death of the loved one (e.g., “collapse,” “funeral,”
“loss”). These 15 grief-related words were then matched for part of speech, number of letters, and
frequency of usage in the English language (9) with 15 neutral words (e.g., “announce,” “ceiling,”
“list”).

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The grief-eliciting procedure constituted a 2×2 (person-by-word) factorial design with four
conditions. Each condition consisted of 15 picture-word composites. Each composite consisted of
one picture paired with one word at the top of the screen. Condition 1 consisted of each of the 15
grief-related words, one per picture, presented simultaneously with the picture of the deceased.
Condition 2 consisted of the 15 grief-related words paired one at a time with the picture of the
stranger. Condition 3 consisted of the 15 neutral words paired one at a time with the picture of the
deceased. Condition 4 consisted of the 15 neutral words paired with the picture of the stranger.
Comparing conditions 1 and 3 (both with the picture of the deceased but differing in grief-related
versus neutral words) with conditions 2 and 4 (both with the picture of the stranger but differing
in the type of words) constituted the pictorial evocation of grief (“person factor”). Comparing
conditions 1 and 2 (both with the grief-related words but differing in the picture of the deceased
versus the stranger) with conditions 3 and 4 (both with neutral words but differing in the picture)
constituted the verbal evocation of grief (“word factor”). Finally, the interaction of the person
factor (deceased versus stranger) and the word factor (grief-related versus neutral) addressed the
regulation of grief intensity in the context of different combinations of pictures and words.

Procedure
Imaging was performed 24 to 72 hours after the interview. The photographs were presented with
Display Master DirectX (DMDX) (10) with a high-resolution stimulus presentation goggle
system. Each picture was presented for an average of 9.0 seconds, with a range of 7.5 to 10.5
seconds. The screen was blank during the 0.5-second interval between pictures. The picture-word
composites were presented in a random order with regard to the four conditions. The
randomization procedure was constrained so that there were equal numbers of the four conditions
every 20 pictures. The pictures were also counterbalanced so that half of the grief-related words
were seen first with the deceased and half were seen first with the stranger. The average length of
presentation of each picture was also random, within the range just noted. The 60 pictures were
presented continuously for a total average duration of 10.5 minutes.

Skin conductance was monitored during picture presentation. We placed Ag-AgCl unpolarizable
electrodes, designed for environments like magnetic resonance imaging, on the middle phalanx of
the index and middle fingers on the left hand, and a skin conductance coupler provided a constant
0.5 V across electrodes. The psychophysiology setup was modified to work with functional MRI
(fMRI). The electrodes were routed through a patch panel to amplifiers located outside the
scanning room. The low-pass filter was set at 1.0 Hz, and the high-pass filter was set at 0.5 Hz to
minimize electrical artifacts due to the changing magnetic gradients. Skin conductance responses
were scored in an event-related analysis with AcqKnowledge software (AcqKnowledge version
3.5 for PC/Windows, BIOPAC Systems, Goleta, Calif.). The largest amplitude of the skin
conductance response was measured from the window between 1 second after picture onset to 6
seconds after picture onset relative to the baseline for that stimulus. The baseline consisted of the
skin conductance value 1 second after picture onset.

Immediately after the scanning, each participant viewed all 60 picture-word composites again for
the same length of time and in the order that they were presented during imaging. The participants
rated each composite on a scale of 1 to 10 for the peak intensity of grief experienced while viewing

66
that composite during imaging. A rating of 1 represented no grief at all, and 10 represented the
most intense grief that the subject had ever experienced in his or her life.

fMRI
Images were acquired on a 1.5-T GE Sigma whole-body Horizon system (GE Medical Systems,
Milwaukee). Two localizer scans were followed by one 10.5-minute functional scan series. The
functional scan series used a single-shot spiral sequence (11). Between 19 and 22 images were
collected obliquely and aligned on the anterior commissure/posterior commissure plane, covering
approximately the whole head (5-mm slice thickness, skip=1 mm, 3.44×3.44 in-plane resolution,
TR=3000 msec, TE=40 msec, flip angle=90°). After completion of the functional scans, a T1-
weighted set of images (256×256, TE=9 msec, TR=500 msec, field of view=22 cm, slice selection
as for the functional data set, 4 minutes 20 seconds) was collected to provide anatomical reference
images.

Analysis
The data were analyzed by using statistical parametric mapping (SPM99, Wellcome Department
of Cognitive Neurology, University College London) implemented in MATLAB (Mathworks,
Sherborn, Mass.). Automated algorithms were used to align each subject’s sequential MRI images,
spatially normalize them into the stereotactic space of Talairach and Tournoux (12) by using the
Montreal Neurological Institute standard brain (based on 305 brains), and smooth them (8 mm full
width at half maximum). While the reported activation sites refer to the stereotactic coordinate
system of Talairach and Tournoux (12), the localization was determined by using the atlas of
Duvernoy (13).

Analysis was carried out by using the general linear model in an event-related analysis. Subject-
specific low-frequency drift was removed by a high-pass filter, and global signal changes were
removed by including a global covariate (14). Effects at each voxel were estimated, and regionally
specific effects were compared by using linear contrasts. We investigated regional blood-oxygen-
level-dependent (BOLD) changes independent of variations in whole brain measurements, and we
generated separate normalized t score (i.e., z score) maps of BOLD increases during each of the
four conditions. These t statistics constituted a statistical parametric map. Statistical inferences
were based on a theory of random Gaussian fields (15). The contrasts for the individual subjects
were aggregated for the group in a random effects analysis. BOLD changes were considered
statistically significant if they equaled or exceeded a height threshold of z=3.09 (p<0.001, one-
tailed, uncorrected).

The imaging data were first analyzed for main effects of the person factor—(condition 1 +
condition 3) > (condition 2 + condition 4)—and the word factor—(condition 1 + condition 2) >
(condition 3 + condition 4). The data were then analyzed for the interaction of the person and word
factors.

Results
The mean duration of bereavement was 8.5 months (range=1–12). The participants were Caucasian
(N=7) and Asian American (N=1). The deceased relatives were mother (N=4), father (N=3), and

67
husband (N=1). The mean age was 41.9 years (range=19–58). All subjects reported that they were
able to clearly see all stimuli.

The 60 skin conductance responses (obtained during scanning) and subjective ratings (obtained
immediately after scanning) for each participant were transformed into z scores for this analysis,
in order to determine the individual pattern of responses to the pictures across conditions, rather
than the absolute magnitude of change. This rescaling allowed analyses of each individual’s
responses according to her own average magnitude of response and degree of variability across
trials.

Differences in physiological arousal among the conditions were indicated in the electrodermal
responses, which are primarily an index of sympathetic nervous system activity. There was a
significant difference among skin conductance responses (Figure 1), indicating that the grief-
related stimuli elicited stronger electrodermal responses than the non-grief-related stimuli.

Across participants, the self-reported grief responses (on a 1–10 scale) to the picture-word
composites were also significantly different for the four conditions. The mean scores were as
follows: grief-related words plus photograph of deceased, 7.67 (range=4.87–9.93); grief-related
words plus photograph of stranger, 4.23 (range=1.13–7.93); neutral words plus photograph of
deceased, 3.52 (range=1.20–7.43); neutral words plus photograph of stranger, 1.75 (range=1.00–
4.77). The z scores for the subjective grief responses were significantly different (Figure 2),
indicating that the grief-related stimuli elicited stronger responses. The correlation of the skin
conductance responses with the self-reported responses was significant (r=0.25, N=480, p<0.01).
The brain areas activated during the verbal evocation of grief (word factor) are listed in Table 1,
and representative areas are displayed in Figure 3. The table demonstrates that verbally induced
grief was associated predominantly with activity of the bilateral precuneus, the left medial frontal
gyrus, the bilateral posterior cingulate gyrus, the right precentral gyrus, the midbrain (dorsal pons),
and various cerebellar subregions.

Table 2 and Figure 4 show sites that were activated during the pictorial evocation of grief (person
factor). Significant increases in neural activation centered on the left cuneus, the left posterior
cingulate cortex/cuneus, the right superior lingual gyrus, the right insula, the right anterior
cingulate cortex, the left superior frontal gyrus, the left inferior temporal gyrus, the left fusiform
gyrus, and various cerebellar regions.

In the analysis of the interaction of the word factor and person factor, none of the predicted regions
of interest (posterior cingulate cortex, anterior cingulate cortex, prefrontal cortex) showed
significant activation. However, the cerebellar vermis (coordinates=6, –36, 2) showed significant
activation (z score=3.69, cluster size=267; p<0.001, corrected).

In the single-subject analysis, the majority of the eight subjects showed a pattern of neural
activation consistent with the predicted group results for verbal and pictorial evocation of grief.
Five of the eight subjects showed increased neural activity in the posterior cingulate
cortex/retrosplenial cortex (p≤0.05, uncorrected) associated with the word factor. In the
cerebellum, seven subjects showed increased neural activity in the posterior lobe that was related
to the person factor (p≤0.05, uncorrected). Seven subjects showed significant activation in the

68
medial frontal gyrus associated with the person factor (p≤0.05, uncorrected). Five subjects
revealed significant activation within the superior frontal gyrus in relation to the person factor
(p≤0.05, uncorrected).

Discussion
In contrast to basic emotions such as sadness or fear, which may be elicited by using the same
standard stimuli for all subjects, grief is a highly personal experience that is potentially difficult to
elicit in the artificial neuroimaging environment. The picture-word composites used in this study
to evoke grief were highly effective, as revealed by self-report and skin conductance data.
Although the grief responses were genuine and intense, their duration was relatively brief, as
indicated by the significant differences in skin conductance responses across the different
conditions in this event-related paradigm. The combination of a general context (picture of the
deceased or stranger) and a more specific memory elicitor (grief-related word or neutral word) was
adapted from the procedure developed by Teasdale and colleagues (16), in which emotional
responses were successfully elicited by congruent but not by incongruent picture-caption pairs.

Our findings revealed that while the combination of the picture of the deceased and the grief-
related words evoked the most intense grief response, the picture of the deceased elicited a
moderate grief response when paired with the neutral word. Similarly, the grief-related word
elicited a moderate grief response even when paired with the picture of the stranger. As such, the
person factor and the word factor provide different routes into the neurobiological state of grief.
These two perspectives provide both similar and dissimilar information about the neural substrates
of grief, analogous to a radiologic examination of a given anatomical structure from more than one
viewing angle. Consequently, we discuss the findings for the word and person factors as
complementary and overlapping. Collectively these factors indicate that grief is mediated by a
distributed network of neural structures that subserve affect processing, mentalizing, retrieval of
emotion-laden episodic memories, processing of familiar faces, visual imagery, automatic motor
responses, autonomic regulation, and modulation/coordination of this combination of functions.

The caudal posterior cingulate/retrosplenial region was activated for both the person and word
factors. This complex receives major hippocampal projections (17), has strong reciprocal
connections with the parahippocampal and entorhinal cortices, and is intensely linked by reciprocal
pathways to the dorsolateral prefrontal and anterior cingulate cortices. Thus, it may serve to
connect the dorsolateral prefrontal cortex with the hippocampal formation. Activation of the caudal
part of the posterior cingulate cortex is most strongly associated with the retrieval of
autobiographical memories (5). Lesions of the left posterior cingulate cortex have also been
associated with the loss of verbal episodic memory and retrograde amnesia for personal events.
Indeed, low activity in this region is the most prominent functional imaging finding in the earliest
stages of Alzheimer’s disease (18). In addition, the caudal posterior cingulate cortex is reciprocally
connected to regions engaged in emotional processing, such as the anterior cingulate and
orbitofrontal cortices. The posterior cingulate is consistently activated by emotionally salient
stimuli and has been hypothesized to have a role in the interaction between emotion and
memory (5). Maddock (19), in his review of the retrosplenial cortex, reported evidence that this
structure participates in the encoding of the emotional significance of episodic memories, but he

69
could not exclude its role in retrieval. The current study predominantly involved the latter and
therefore supports its role in retrieval of emotion-laden episodic memories.

The precuneus was the area most robustly activated by the word factor. This region is part of the
medial parietal cortex and is located superior and posterior to the retrosplenial cortex. It has
widespread anatomical connections to the prefrontal cortex, the temporal and occipital cortices,
and the thalamus (20). The precuneus is a principal area involved in the conscious recall of
memory-related imagery (20) and may participate in the representation of polymodal imagery
associated with successful memory retrieval (5). The activation of this area by the word factor, as
opposed to the person factor, could be due to specific memories and visual images associated with
actual events elicited by the grief-related words.

The person factor, but not the word factor, was associated with activation in a variety of extrastriate
visual processing areas, including the superior lingual gyrus, the cuneus, and the fusiform gyrus.
Activation of the inferior temporal gyrus also suggests enhanced activity in object-recognition
areas in the context of grief, particularly areas involved in the recognition and processing of
familiar faces. Emotional arousal induced by visual stimuli can itself modulate activity in visual
processing areas (21, 22).

The person factor was also characterized by activity in the dorsal anterior cingulate cortex and the
insula. The former is thought to play a superordinate role in executive control of attention (23).
Activation of the dorsal anterior cingulate is consistent with our hypothesis that emotional arousal
associated with grief engages attentional resources. Another paralimbic area, the anterior insula,
is also well established as an area specialized for the processing of visceromotor information (24).
Our procedure for eliciting grief was associated with significant skin conductance responses,
supporting the interpretation that emotional arousal contributed to activation of these paralimbic
regions.

Our finding of a significant activation in the left medial frontal gyrus (coordinates=–4, 62, 4) for
the word factor corresponds to the regions associated with mentalizing, i.e., representing one’s
own and others’ mental states (25, 26). This suggests that the participants reflected on their own
state of mind, as well as that of the person in the picture, during the elicitation of grief.

Bowlby (27) viewed grief as a natural expression of what he called the “attachment behavioral
system,” evoked to discourage prolonged separation of an individual from a primary attachment
figure. Activation of the caudate nucleus was found during a functional neuroimaging study of
romantic love (28). In the current study we also observed activation of the caudate nucleus
(coordinates=6, 6, 8) that was marginally below the cutoff value of z=3.09 (p<0.001). Caudate
activation may reflect activation of automatic motor programs, associated with the feeling of
“being drawn toward” the person depicted. If so, the caudate nucleus may contribute to the
attachment system hypothesized by Bowlby.

Growing evidence suggests that the cerebellum contributes to affective, autonomic, and cognitive
functions as well as to motor control (8, 29). The cerebellar contribution to cognition is modulatory
rather than generative. Damage to the cerebellar vermis leads to altered affectivity (30, 31). Our
findings show that not only the cerebellar vermis, but also the posterior and anterior lobes of the

70
cerebellum, may indeed play an essential role in the coordination of emotional and cognitive
functioning in the context of grief, as they were activated in response to both the person and word
factors.

A limitation of the study is the absence of a comparison group. Without a comparison group of
nonbereaved women, it is possible that grief was confounded with familiarity or attachment.
However, two fMRI studies have investigated brain activation in subjects while they were
remembering familiar people (5) or viewing familiar faces and listening to familiar voices (6).
Both demonstrated activation predominantly of the posterior cingulate/retrosplenial cortex, but in
contrast to our results, no anterior cingulate or cerebellar activation was observed. The dorsal
anterior cingulate cortex is greatly, but not exclusively, influenced by emotional processing and
may correlate with phenomenal awareness of emotion (32), and the cerebellum may be the site
where the intensity of emotional response is modulated (33). The activation of these two sites
within our study may represent a fundamental functional correlate of the intense feeling of grief
beyond mere familiarity with the person.

Because of the subjective nature of grief, which precludes studies in animals, and the lack of
previous neuroimaging work addressing the neural correlates of grief, our exploratory hypotheses
included multiple areas of the brain. The relatively small number of study participants (N=8) and
the heterogeneity of their relationships to the deceased loved ones are also potentially confounding
factors. The present study should therefore be considered preliminary and should be followed by
a larger, more definitive study with appropriate controls.

Identifying the neural correlates of grief may contribute to the elucidation of the physiological
effects of bereavement on physical health (34). For example, the “broken heart” phenomenon, the
increased rate of sudden cardiac death within 6 months of conjugal bereavement, suggests that
cardiovascular health is altered in bereavement (35, 36). Additional research is needed to
determine whether grief and depression (36) exert adverse effects on cardiovascular health through
similar mechanisms. Others have shown that traumatic grief symptoms predict a physical health
event (e.g., cancer) months later (2). Psychiatry stands in a unique position to explore these effects
of grief on mental and physical health and to improve the lives of those touched by this powerful
human experience.

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 Figure 1. Skin Conductance Responses of Eight Bereaved Women Viewing
Composites of Pictures and Words Related or Unrelated to the Deceased
Relativea
a
The physiological responses were transformed into z scores to determine the pattern of responses
and were then summed for each of the four conditions. The responses to the four conditions were
significantly different (F=2.9, df=3, 476, p<0.03), indicating that the grief-related stimuli elicited
stronger electrodermal responses than the non-grief-related stimuli.

Figure 2. Subjective Grief Ratings by Eight Bereaved Women Viewing

Pictures and Words Related or Unrelated to the Deceased Relativea
a
The ratings were transformed into z scores to determine the pattern of responses and were then
summed for each of the four conditions. The responses to the four conditions were significantly
different (F=197.7, df=3, 476, p<0.0001), indicating that the grief-related stimuli elicited stronger
experiential responses than the non-grief-related stimuli.

72
Figure 3. Brain Images Showing Activated Areas in Eight Bereaved Women Responding to
Grief-Related Words (Word Factor) in Picture-Word Compositesa

a
Top images: adjusted changes in blood-oxygen-level-dependent activity at the voxel of maximal
activation in the left retrosplenial cortex (Talairach and Tournoux coordinates: x=–2, y=–50, z=24;
z score=3.44; Brodmann’s area 30/31). Bottom images: changes in the medial frontal gyrus
(Talairach and Tournoux coordinates: x=–4, y=62, z=4; z score=3.85; Brodmann’s area 9/10).

73
 Figure 4. Brain Images Showing Activated Areas in Eight Bereaved Women
Responding to a Photograph of the Deceased Relative (Person Factor) in
Picture-Word Compositesa
a
Adjusted changes in blood-oxygen-level-dependent activity at the voxel of maximal activation
in the right dorsal anterior cingulate cortex (Talairach and Tournoux coordinates: x=6, y=22,
z=28; z score=3.77; Brodmann’s area 24).

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