Over the summer, the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- a go-to guide for mental health professionals -- began considering a proposal that could undermine bereavement as a universal, normal, if profoundly painful, experience. Editors compiling the next edition, DSM-V, are considering that the diagnosis of major depression could apply to someone exhibiting certain aspects of grief within weeks of the death of a loved one.
This leads us in the wrong direction. Grief is not a pathology, and it is not a medical condition. It is neither a luxury nor something to just get over. Grief is a part of life.
If the DSM proposal comes to pass, my colleague Dale Larson notes that it could encourage avoiding the natural process of grief rather than working through it -- which is critical to healing. "This is a huge incentive," he predicts, "for psychiatry and big pharma to expand their market by treating bereaved people." He envisions the pill of the future, GriefAway, which works to neutralize the part of the brain triggered most directly during grief.
Considering a medical treatment for grief, Allen Frances wisely posits in the New York Times: "Because almost everyone recovers from grief, given time and support, this treatment would undoubtedly have the highest placebo response rate in medical history."
Contrary to our there's-a-pill-for-that cultural aesthetic, grief is hard work. And it should be.
Five Steps Along the Way
Previous editions of the DSM contained a "bereavement clause," which has prevented clinicians from giving a diagnosis of depression within the first two months of the death of a loved one. That two-month buffer is an appropriate way to prevent confusing one set of conditions with another.
For some, of course, death of a loved one does trigger clinical depression -- triggers, but it does not cause it. For most, however, grieving is long, hard work, but not a clinical condition.
We each grieve in our own way, and on our own timetable. But there are certain commonalities in what I might call "healthy grieving," certain steps to begin to glimpse a manageable future in the midst of a monumental journey:
Allowing yourself to grieve is the most important step in actually beginning the process. Don't suppress the grief or try to "power through" it. Delaying grief only leads to complications down the road, even physical manifestations of the suffering.
One of our most iconic national images of grief -- Jackie Kennedy, as photographed after the President was assassinated -- is also one of our most misleading. The nation was impressed with how stoic she was, how she didn't cry. But I'm sure that in private she did cry -- or at least let down her guard. Feeling the pain and emptiness of loss is the only true way to rebuild and heal.
One of the reasons grief can feel so turbulent is that the bereaved is still in a relationship with the loved one who has died. That relationship evolves and changes, and bereavement often involves acknowledging the relationship -- the good and the bad -- and accepting its evolution.
In the earliest days following loss, an overwhelming amount of energy goes toward the lost loved one. Over time, that balance shifts. Where you used to think of the person you lost during eight or 10 waking hours, perhaps now you think about him or her in the morning, over coffee, creating that space in your day for the relationship -- then moving on to other business at hand.
My colleague Janet King, a bereavement counselor at the Visiting Nurse Service of New York, recently worked with a client who was so devastated by her husband's death that she didn't think she could go on. She remained cloistered in her apartment, rarely opening the curtains or turning on a light.
The client eventually followed her creative spirit to a ceramics class and, to her great surprise, she blossomed and discovered a new talent and new friends. Loss and pain came through in her new art, but so too did hope and expression. "This," says Janet, "will be her bridge out of grief."
The pain never truly goes away, so what are the most useful objectives of grieving and bereavement counseling? As a way of gauging the strength and success of her clients, Janet asks them a simple question: "Can you live with this?"
"I hope they get to a place that feels okay," she explains. "If they can live with how they're feeling right now, that's my goal. It gives them some comfort. They realize that they can start to trust some sure ground under their feet."
If there is such a thing as "good grief," it is when the process of grieving prompts self-discovery -- and even change. One client was so tethered to visiting his wife's grave -- every week for more than a year -- that he never seemed to progress.
Upon further conversations, our bereavement counselors discovered that he felt guilty for what he saw as his selfishness towards his wife when she was alive. His work commitments often kept him from joining her in cultural and social events that she loved. That realization -- and the vow to better accommodate the desires of his adult children and grandchildren -- released him from the most paralyzing aspects of grief and allowed him to become a full participant in his life.
Jeanne Safer, a writer and psychotherapist, talks about this discovery process for adults who lose a parent. For some, a parent's death may offer the first real chance to reflect on -- and alter -- a lifelong, unmovable relationship. Following the death of a parent, she recommends that an adult child "conduct an inventory" of the parent's character, determining what to keep and what to release. This inventory can also be carried out concretely, holding on to certain physical objects of a parent's life and giving away others.
"Parent loss is the most potent catalyst for change in middle age," Safer writes in "Death Benefits: How Losing a Parent Can Change an Adult's Life -- For the Better." "I have found it ... can offer us our last, best chance to become our truest, deepest selves."
There is no pill for that.
How have you coped with the loss of a loved one? Have you created new rituals for the holidays after the loss of a loved one? Please continue the conversation by passing along your own thoughts and experiences in our comments section below.
Judith Johnson: More About Carrying Your Grief Through the Holidays
Richard C. Senelick, M.D.: Driving Safety: When to Take the Keys Away From Your Aging Parent
Dr. Hendrie Weisinger: What to Tell Your Depressed Friend
Our unrealistic expectations and childish belief that we should not have to listen-see-hear-do-think about-etc if we don't want too attitude brought us here .
I agree but most people have never been (in the case of males allowed) or trained to deal with their feelings in many circumstances. Most people I know deal badly with negativity.
7 months ago my son was mugged and beaten within an inch of his life. He is only barely now back to work and still taking antiseizure meds and a lot of therapy.
Over the summer my teen daughter had a complication from a minor surgery and ended up in the hospital for 6 months and is now undergoing treatment and testing for a still unknown condition.
One month ago I finally went on Celexa. I simply could not handle feeling so much pain and anger. It has helped a lot. Obviously all the reality is still there. It is much easier to deal with all of it when I'm not "mad"
This example is similar to what we observe when we visit with our elders in nursing homes run by corporations that love to medicate their clients or consumers so they don't have to employ whole health practitioners who can use healthy touch or physical interaction and other integrative methods to engage and support them daily.
Mental or Behavioral Health, sick care systems, including most nursing homes and other human services that label and drug their patients/clients going through natural human processes rather than treating them with dignity, respect and quality health approaches should be closed and/or changed.