Grief’s normal, right? It’s a natural response to losing someone or something that we love. Yet these days, we often question ourselves and one another. Are we doing it right? “I still haven’t cried,” or “I can’t seem to get through a day without crying.” “My brother hasn’t missed a beat, going on with his usual life. He’s still in denial.” “It’s been two years, (or ten). Is mother ever going to get over this?”
A new mental disorder, prolonged grief, has been added to the DSM-5. This recently updated handbook is used my mental health professionals as an authoritative guide to diagnose mental diseases. The controversial and widely discussed criteria applies to 1) a person still grieving one year after experiencing a loss and, 2) still being unable to return to everyday activities. It is expected to apply to 4% of bereaved people.
As a grief advocate, I maintain that in most people’s lives, grieving loss is a frequent, episodic necessary process we must get good at in order to have a happy and rewarding life. But like other natural processes, as in birthing, (bringing life in), and dying, (helping a loved one leave), something can happen during the grieving process that could inhibit the process and medical assistance might be helpful in navigating its transitions. Listing prolonged grief as a disease however is most likely going to be, as the Chinese say, “a dangerous opportunity.”
The opportunity is that, with this designation, insurance companies can now be billed, which means more people can have access to professional help if needed. Since it’s now official that people can access care, more money for research into treatments may be forthcoming.
Since the way things are handled in the early days of bereavement lays the groundwork for how the process will unfold, the earlier the help the better. Waiting a year before help is available doesn’t seem to offer an advantage over the way things were in the old version of the handbook. An “adjustment disorder” was the diagnosis professionals often used for someone experiencing distress 1) in excess of what might be expected, given the nature of the stressor, or 2) experiencing significant impairment in social or occupational functioning within 3 months of a stressor. Stressors that people were dealing with were often grieving the loss of a job, death of a loved one, diagnosis of a disease, or a divorce.
I worked with a young 30s something woman hospitalized with a depression unresponsive to various trials of medication. Our work together finally uncovered the details that had been kept from her regarding the accidental death of her father who was a police officer. Her depression finally lifted when she connected with Project Blue Light, a nationwide program of recognizing police officers who have died in the line of duty. This gave her a way to honor her father and their relationship. For her, earlier access to mental health treatment would have saved years of pain and hundreds of thousands of treatment dollars.
One danger I foresee, as a mental health professional with 40 plus years of experience, is that our pill popping society will rely on drugs alone to address grief challenges. I’m reminded of more than one client who, with all good intentions, was given medications to help them “get through” the rituals and community gatherings after the death of a loved one. The neighbors’ casseroles, the reminiscent stories, the flowers, the music, the hugs, – There was little to no recall of those precious times when we spoke of them a year later. The woman was so drugged and “out of it,” the dendrites didn’t get laid down. She had no memories of the support that had been there to help her cope.
In the many years that I have been experiencing grief personally, and studying and teaching professionally about it, I have come to strongly mistrust our cultures common knowledge and understandings of grief. Do we have a common agreement on what constitutes “prolonged?”
Shortly after I had learned of the death of my 26-year-old brother I asked a Native American man I was working with in Nebraska, “how long should grief last?” His answer, “The elders say,’ eight seasons.’” I liked that his culture had a time frame, but I also knew that the circumstances of my brother’s death might prolong the time needed to process it. As a family we had endured a year and a half of not knowing what had happened to Kenny, and when the body was discovered, we learned that the cause of death was a bullet to the back of his head. Now we were in the territory of traumatic death, and perhaps the term “complicated grief” might apply better than “prolonged.”
Who should we expect to be grieving and how should it express? Our culture often looks at grief as an individual experience and treatment focuses on the patient expressing symptoms. But the loss of my brother and the fact that I was a teacher in family therapy at the time taught me that the individual is a fiction when we are talking about grief. One night in class I was using the story of my brother’s disappearance and death to illustrate the effects of the loss of a loved one on other family members.
Looking back at the list I’d written on the blackboard gave me a new perspective. The list delineated how six months after recovering Kenny’s body my mother had a heart attack, my sister in Dallas had an emergency trip to the ER with a burst ovary, my sister in Kentucky had an incident that required surgery on her esophagus, my father had a painful bout with kidney stones, and I was diagnosed with colitis. Though mostly healthy before and after, we family members each responded to the loss of our loved one in a similar yet different way. The view from the back of the room showed me we were one organism – each carrying the wound in a different part of our individual bodies.
In the studies that led to the need for this diagnosis it was clear that intense grief is different from depression and while most people navigate episodes of grief well if not always gracefully, a small percent get stuck and suffer miserably. There have been 16-week programs that have helped these people get unstuck and be able to move forward in their lives. I’ve known people who have benefited from them.
But in a multi-cultural, multi-religious, multi-ethnic environment, we must be careful to judge what practices and behaviors we consider “normal.” Sustaining a relationship with a loved one after their death is an important task in the art of grieving and people have many ways to accomplish this. Some visit a medium or the gravesite or spread ashes in places full of meaning to the diseased. My relatives print prayer cards to remind them to pray for loved ones who have crossed from this life. Some set a place at the table on the person’s birthday and share stories of the ancestors gone from their sight. Some make a point of contributing through money on service to a cause on behalf of their loved one. But some do none of the above. They move on, put it behind them, distract themselves in any and every which way possible in order to not have to grieve what they have lost. We don’t have a pill or a program to heal that dis-ease.
