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I would like to note that I am not a mental health or medical professional. I have an interest in psychology (I minored in it) and I love to do research, in general.
In late March, a proposal to include a disorder called “Complicated Grief” to the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V) made news. The DSM is the tool used by medical practitioners to assist them in diagnosing psychiatric disorders. Currently, there is a “Bereavement Exclusion” in the diagnosis of Major Depressive Disorder (MDD), which indicates to the diagnostician that if a patient has suffered a recent loss, a diagnosis of MDD should be excluded. The concern is that a person with MDD who had not been diagnosed prior to the loss might not be diagnosed and only treated for their grief, and not for their depression. Like many other illnesses, the sooner someone who has MDD is diagnosed, the sooner treatment and healing can begin, and the more successful that treatment will likely be. The other concern from a clinician’s standpoint is that the severe symptoms of grief, if suffered for an extended period of time, could be ignored or ascribed to some other disorder. Studies have found, for instance, that grief does not respond well to traditional antidepressant therapy. These concerns seem to make sense, on the surface. But, in a time when it seems that everything is a “disorder”, and prescriptions for psychiatric medications have increased four-fold in the last ten years, one must consider what the benefit is to create yet another disorder for something that everyone experiences in their own way and on their own timetable.
The article in Slate posed this very question of whether or not it was wise to stigmatize grief—an experience that is truly universal. Everyone will lose a loved one or friend at some point in time in his or her life. And he or she will grieve (unless they are incapable of feeling emotions, and that in itself would indicate a mental disorder!).
So what makes grief go from ordinary mourning and bereavement to “complicated”? The full criteria can be found here, but, in a nutshell, there are a few criteria, aside from the amount of time (more than a year has passed since the death) that distinguish “complicated” grief, from plain, old, garden-variety grief: the bereaved has more bad days than good, the feelings and symptoms of grief interfere with normal functioning, and the bereaved feels life is meaningless and wishes to die in order to be with the deceased. These things seem fairly reasonable as a cause for concern, right?
If you’re a bereaved parent, that may not seem reasonable to you at all. As a bereaved parent myself, I’ll explain why.
What if you didn’t start to experience these things until a year after the death? My son died in February of 2010 from complications due to CHD. He was 10 days shy of four months old. It was traumatic and shocking, even though we knew he was very sick. I was numb for nearly a year. I had two other children and responsibilities to take care of. I also had a health issue of my own 9 months after he died. I didn’t have time to really grieve him, and I didn’t appear to be able to, anyway. A year later, I began to fall apart. My brain was finally ready to process what had happened. There were more bad days than good. And what parent hasn’t wished for just a moment to be with their deceased child—even if it meant dying?
I could have been diagnosed with complicated grief. But what I really had was delayed grief. And I sought out help, because it was becoming a problem for me. After three months of therapy, I was ready to start remembering my son more than I mourned him.
I am concerned about people who are only processing the death of their loved one in their own way and their own time being treated as though they have a disorder rather than just being given the tools to learn how to grieve and remember in a constructive way. Slapping a label on a person who has sought out counseling or treatment for grief seems, in many ways, counterproductive, especially for grieving parents, who already feel stigmatized for having experienced something so “unnatural”. Grief is a lifelong journey and the manner in which it unfolds is as unique as the individual who experiences it.
What do you think? I would love to read your comments and to answer any questions you may have based on my research. There was much I was unable to include here for fear of boring our dear readers, and would love to discuss it further!
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About Rachel
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I totally agree — grief has no “standard” timetable. It is completely individual, and should be treated such.
I agree with Beth as well.
It is very individual. In a conversation with a friend who is a counselor in training she emphasized the importance of treating the individual and not the diagnosis–in any condition. I think that most psychologists, counselors and those psychiatrists that still do counseling follow this way of thinking.
What a great article! Our society is too quick to label and slap disorders on people. No one wants to actually work their issues. They want that magical pill to fix their problems for them, but sometimes the best medicine really is time and prayer.
Thank you, Betty. The more I learn about psychological disorders, the less that I think a pill is the cure. Talking through your issues, journaling, blogging, crying, these are the things that heal us. We want so badly for things to be neat and clean. But grief isn’t neat and clean. There’s an article in the Huffington Post today that discusses this very thing. Grief is NORMAL! Grief is missing someone that we love who we wish was back with us. By that definition, it will NEVER go away. Will we ever stop missing our children? Never. Will the grief soften and metamorphose over time? Absolutely. I am 27 months out from losing my son, Colin, and I didn’t start to truly heal until I let myself feel all of the ugly, beautiful, happy and sad that goes along with death of a child. My grief has transformed and changed over time. But I will always, always, grieve the loss of him.
I agree with you completely. Also if it makes a difference DSM 5 is very controversial and we may not see it become our current Diagnostic Manual for many years, if ever. I don’t think that everyone who goes through such horrible experiences needs that stigma of a diagnosis of “complicated grief” or any labeled diagnosis. I agree with you, Rachel, that everyone grieves differently and in their own way and time. Placing a diagnosis on someone because they are grieving (or not) sometimes can do more harm than good I would suggest. Great article!
Thank you, Sara. I think we need to work toward shedding light on child loss or any loss and be more open about it. We have to move forward in our lives, of course, but we always carry our lost loved ones with us, until we can join them again.
It seems to me like our culture would like to explain away grief with a diagnosis – probably because most of our culture is so uncomfortable with grief. Less than two months after my preemie son passed away I had friends suggesting I go on medication for depression because I felt like hiding away from the world and being left alone. What mother wouldn’t feel that after the loss of a child?
I believe what we really need is not another diagnosis, but a greater understanding of grief, and appreciation for the grieving process, no matter how long it takes. Our culture seems so obsessed with life being “comfortable” or “happy” that we want to explain away grief as a medical condition rather than a fact of life. Grief and bereavement makes us uncomfortable and sad, so we’d prefer to dismiss it quickly so we can get back to being comfortable and happy again.
I’m grateful for your thoughts, and for your desire to recognize grief for what it is.
Amanda, you said that so beautifully. A greater understanding of grief and acknowledging its place in the human experience is exactly what I am seeking to foster. We don’t grow and learn and change if everything stays status quo, do we? How boring would it be to be happy all the time? While I don’t wish what I experienced on anyone, it has transformed me, and I am better for it in so many ways. I could try to think of what I would be like if he were still here, but that’s an exercise in torture. I am who I am today from the aggregate of my experiences, and that includes the life and death of my Colin.
I am thankful for your appreciation of my work. Peace.
I could not agree more with this…Grief is so individual and so ever-flowing. It’s coming and going all the time. I find myself flowing between each stage now; over 9 months after my sweet girl left. It’s a dance, back and forth, back and forth…My husband and I were forced to go to a Psychologist due to Insurance and time off work after our daughter’s passing. We went and it was an interesting experience. The man was VERY kind and very sweet and he did move my mind into some places that it had not been and I am grateful that he got me thinking. He did, however, mention some things that, he thought, would indicate someone was stuck in their grief and not moving on which in turn could be scarring to themselves and their familes. I wondered at that point if this man had ever walked in our shoes, if he had ever held a child who’s heart was not beating. He surely seemed to know what one would like if they were stuck in their grief. I was not impressed with his thoughts on that but like I said I am grateful for the experience. It taught me that each individual is different and grieving is such a unique stage of life. Each person needs room to grieve how they feel so led….Thanks for writing this, keep up the fabulous work!
Elle’s Mommy
Thank you, Nicki. I’m glad you liked the article.
I’m not sure how I feel about this. I don’t think is is all together bad thing to have this option for a diagnosis if this is what the situation calls for. I agree that at times some professional jump to the notion that there needs to be a specific disorder associated with a situation. coming t out and saying that here is no one out there who would fit into this category I thing could be harmful. as you said you are not the psychologist, and everyone does greave differently it just may be that there are some out there that would benefit from this type of diagnosis.
Thanks for your thoughts, Theresa. I think that if someone has an underlying condition that was possibly triggered by the trauma of the death of a child or other loved one, they absolutely need to be treated and diagnosed. But calling grief, a natural process, a disorder, complicated or not, is dicey and doesn’t recognize the fact that everyone grieves differently, as you said. I didn’t fully grieve until a year after my son died. I couldn’t hold it in any longer. I’ll be writing an update to this article for June as the DSM committee has revised their thinking on the matter. Stay tuned!
You know I think this is a great article. Psychology was one of my majors, and I still have lots of friends in the field. For the most part, at least with respect to what they’ve shared with me, they have similar concerns. As clinicians who have years of experience, many know first-hand how individual grief situations are… How trying to dictate categorical bullet points to be met in order to allow insurance companies to continue to pay for therapies may pigeon-hole both patients and clinicians. But, thankfully, most still believe that first, doing no harm means to allow grief to continue to be what it needs to be for each person in order to best facilitate healing. I just pray that permeates the field.
Lori, I hope it does too. I had a terrible experience with an internist (my GP, basically) who, based on my description of one night of anxiety, diagnosed me with anxiety. That set the ball rolling for a whole other set of problems. I’m just glad that I found a terrific counselor who got me and worked to meet my needs–including figuring out that I needed to fire my GP! The fact that he was a mindfulness practitioner made it all the better!
Thank you for writing this. I think labeling grief can be such a touchy issue – it might be helpful to some to know there is a “name” for what they are going through – might give it some validity for them. But at the same time, I fear these labels. I fear labeling can give grief a time limit or a set protocol. It may show up at different times in different ways for people – for a long time. I still have a day here and there where I need to cry for the babies I lost…and it has been over 2 years. And I don’t think that is a bad thing – I actually find those days are waiting to give me a special gift, something I would have missed had I not paused and grieved when I needed to. Take care!
You’re welcome, Catherine. I think calling grief “grief” is fine. I think having a diagnostic protocol to determine when you should be “done” grieving is preposterous. I will never be done grieving, because I will always miss him. I wouldn’t be human if I didn’t! I know people who lost a child decades ago. They still cry every now and then. The only way that I would ever stop crying for the loss of him is if you erased him from my memory completely. And I would not want that, for sure!