Grief isn't a medical problem to be solved. Prolonged grief disorder diagnosis
Grief isn’t pathological. Our society’s response to and handling of it is.
The #1 question I get from people in grief is “how long will this last?” No one wants to hear the truth: there is no predetermined end date and it's untrue that time heals all wounds (on its own).
Yet, as described in a recent New York Times article How Long Should it take to Grieve? Psychiatry Now Has Come Up with an Answer (Ellen Barry, March 18, 2022), psychiatry is attempting to give a numerical answer. “Designed to apply to a narrow slice of the population who are incapacitated, pining, and ruminating a year after loss and unable to return to previous activities.” In the article, “prolonged grief” (defined as over a year for adults, 6 months for children and adolescents) only affects about 4% of people. That’s misleading. They wouldn’t bother if it were that low.
The DSM (Diagnostic & Statistical Manual of Mental Disorders) is not the "professional Bible of mental health" as it's sometimes described. It's for categorization for billing and insurance reimbursement purposes. Therein lies the problem. The chances of over diagnosing and overmedicating are high. Particularly when you consider that grief affects nearly everyone eventually.
We’re medicalizing something that isn’t medical. Whether we want to admit it or not, there's still a great deal of stigma around mental health. There are efforts to change this, and progress is being made, though we've got a long, long way to go. Taking something like grief and labelling it "abnormal" exacerbates rather than alleviates things. Grieving people already often feel like they’re “going crazy” --and the people around them often reinforce this--because they’re comparing themselves to who and how they were before the loss(es), and they cannot be that same person anymore.
We don’t go back to being our “normal selves” after major loss, because we literally can’t, we’re forever changed by it. But that’s exactly what is so often expected of people to somehow do. Those who haven’t experienced significant loss cannot relate to that, nor can it really be told to them or truly understood.
Grief seems to be a language spoken and understood only by those who have directly experienced it. That’s a big reason why grieving people may withdraw. They’re often horribly misunderstood because it's like they start speaking in a foreign language no one around them except sometimes other grievers understand. Complicated by the fact that grief itself is so unique to each person. So even those around them who lost the same person may respond in their own grief and to each other very differently.
“Give them what they want, not what they need.”
We want a quick fix in this society, and unfortunately, that's not how mental wellness--or life--works. Only bad things happen quickly. Everything else takes time, effort, and often more of it than we'd like.
Grief is a part of life. It’s a biological, neurological response and process to the loss of someone or something important to the individual. We’ve evolved that way. Is there such a thing as complicated grief? Certainly. The course of natural grief can get tangled up with a host of other issues. With deaths come other losses. We don’t need to diagnose grief itself.
There’s been a massive amount of loss and grief (and not just from deaths) in this pandemic. Essentially, they’re creating a market. The creation of a diagnosis opens it up to pharmaceutical companies to create or repurpose medication, the “magic bullet”.” I foresee that as potentially catastrophic in the sense that it’s not solving a problem but creating a dependency.
Pills for grief—which isn’t one emotion but a response to loss—would be akin to creating a pill for anger. You may suppress it, but the underlying issues aren't being addressed, so it’s still going to be there. Even if a true addiction isn’t the result, you’d still have to keep taking the pill to keep emotions suppressed or “numbed out.”
A pill will likely be viewed as more cost effective by insurance companies than counseling. The result will be an increased medication-only addressing of grief, not a combination of medication and counseling. Even if the argument is that the prescription would be for “short term,” consider what would happen when the person is taken off the medication when the underlying issues haven’t been addressed.
Grief often has nowhere to go. If a grieving person is fortunate, they have a strong support system that rallies around them with support and acceptance for the long haul. Many people are not so fortunate. After a while, support fades, if it were there to begin with. Many people discover they’ve lost friends or other connections. Too many people avoid grievers for a multitude of reasons.
The problem isn’t that grievers “can’t handle it,” but that people around them—even professionals—can't—which makes grievers feel instead like it’s their problem. It’s a case of blaming the victims, really.
It’s almost like grief is treated as though it’s contagious. This is actually one of the fundamental problems. Grief is already treated like a pathology or disease. Officially labelling it as one isn’t solving the problem, it’s solidifying the stigma that’s already there.
When someone close to us dies, we don’t just lose the person. We lose so much beyond that. These are “secondary losses” and they can be as profound as the primary loss of the person themselves.
Secondary losses occur with any type of death of someone close to us. Is it fair, for example, to expect a parent to recover from the death of a child in a year? People say things like “they never got over it.” Of course not.
People who have experienced the death of someone close may not have lost one person: they may have lost nearly everything.
Sudden, traumatic losses, such as suicide, homicide, accident, natural disaster or heart attack typically result in even more pronounced secondary losses as well as sometimes trauma. Too many to name. The worldview of the survivors has been violently shattered.
Most of the research so far around prolonged grief disorder has been with elderly widows whose husbands have died. That’s statistically a likely scenario, though it doesn’t account for the many other variables and types of losses. Let's start there as an example.
When people marry, they may say things like they’ve found their “other half” and are surrounded by messages of “two becoming one” and sharing of a life together. Is it any surprise that when someone loses a spouse that they describe it as feeling like they lost a part of themselves? Because isn’t that what they’ve been told at the beginning? Is it somehow less true at death?
When someone loses a spouse, they can lose so much more. They lose their partner, their routine, some friends, their identity as a wife/husband, sometimes financial means, loss of home or having to relocate, just to name a few.
People often expect the bereaved to bounce back within an arbitrary time frame. “Socially accepted” as a timeframe is inherently unfair as a guideline. Because social expectations are entirely out of sync with the realities of grief.
Consider that most employers give a few days to a week of bereavement time, if they provide it at all. Everyone grieves in their own timeline. The problem is that it can make other people uncomfortable and seek to hurry grievers along. The implied message is that it’s unacceptable outside of some prescribed timeline. People around grievers generally go back to their own regular lives within weeks or months after a death, and seem to expect grievers to follow suit.
Grief lasts for as long as the person remains dead. It’s our relationship to our grief, ourselves, other people, and our environment that can change. If there's a silver lining in all of this, perhaps it's that at least grief is being recognized and talked about more since the pandemic, instead of relegated to the hushed shadows.
