Imagine that you are a mental health professional and you meet with a new client who describes the following symptoms: "I haven't been sleeping well. I don't have much of an appetite and I've lost a few pounds in the last month. I feel sad most of the time and once a day I find myself crying. Basically it's all I can do every morning to get myself out of bed and start the day."
What would be your "diagnosis" and "treatment plan" for the above person? In reality, both would depend in large part on the context in which these symptoms appeared. If the person reporting them told you that a child, spouse, or parent had died of cancer a few weeks earlier, chances are you would conclude that this person was experiencing grief. On the other hand, if these symptoms were something that this client had experienced several times before, and for no apparent reason, you might suspect he or she was suffering from a depressive disorder. Depending on this context, your ideas about the most appropriate "treatment" would almost certainly be very different.
The Jan. 25, 2012 edition of the New York Times includes an article titled "Grief Could Join List of Disorders." The subject is a pending decision by the American Psychiatric Association, in the forthcoming revision of its Diagnostic and Statistical Manual (DSM) to eliminate the current exclusion of grief as a result of the loss of a loved one from the diagnosis of depression. In effect, a grieving person who exhibits the above symptoms for as little as two weeks or more may soon qualify for a diagnosis of "major depressive disorder." This amounts to opening the door to "diagnosing" what until now has been thought of as normal grief as a serious depression, and therefore treating it as such.
In defense of this pending decision, some have argued that bereavement and depression have much in common; therefore they should be treated in the same way (including, presumably, using medication). Others argue that some grief-struck individuals find themselves going over the edge into total dysfunction or suicidality. This may be the case, but the fact is that these individuals have always been the exceptions, not the rule. Given the way our culture has responded to problems such as anxiety and difficulty sleeping, it is highly likely that we stand poised to try to eradicate grief on a mass level through medication. Keep in mind that in today's world of defensive medicine it's a short step from thinking that someone may be experiencing some symptoms of depression to believing that they must be given medication for it.
In her book, The Year of Magical Thinking, Joan Didion chronicles the many "symptoms" an individual may experience when they are grieving the loss of a loved one as she records the year following the death of her husband and closest confidant, the writer John Gregory Dunne. To be sure it is a raw, unvarnished, and wrenching account. At the same time, it is clearly bereavement that she is describing. We must respect it for what it is and allow individuals the dignity of grief.
My colleague Dr. Barbara Okun and I have coined the phrase "the new grief" to refer to the process that families experience after a loved one has been diagnosed with a terminal illness. By this we do not mean to imply that grief has ceased to exist, or that bereavement has fundamentally changed. On the contrary, as long as we as humans are able to form interpersonal attachments we will grieve those attachments when they are lost. Our attachments enrich our lives, and in a sense they define who we are. When we lose someone we love, we lose a part of ourselves. To say that it is "abnormal" to grieve such a loss for longer than two weeks seems to fly in the face of what it means to be human.
What we have noted from the families we have interviewed is that some family members begin to experience some of the symptoms noted above even before their loved one dies. This appears to happen in what we call the upheaval stage of family grief. It seems to be the result of the stress that a prolonged terminal illness creates not only on the terminally ill patient, but on his or her family members as well. The protracted process of dying that is the result of modern medicine's ability to arrest terminal illness and stave off death creates unprecedented stresses in families seeking to cope with this protracted crisis. One concern we have is that these "symptoms" may also be erroneously "diagnosed" as a major depression, and therefore treated out of the context in which they occur.
An Alternative to Diagnosing Grief
The National Center for Complementary and Alternative Medicine is a repository of information and research findings on the effectiveness of what are commonly called "complementary" treatments. Increasingly, patients with cancer and other potentially terminal illnesses are turning to these treatments, not in place of medical care, but in addition to medical care. These treatments include meditation, yoga, and massage, among others. An increasing body of sound research (see the NCCAM site) is indicating that these treatments can reduce stress and improve the overall quality of life of these patients. If practiced regularly they may even extend the life of these patients. What we would recommend is that not only patients, but their loved ones as well, avail themselves of these complementary therapies as soon as possible. Doing so will not by any means prevent grief, but it may help to ameliorate the chronic stress that comes with coping with terminal illness, and which can can complicate the grieving process.
We should continue our cultural tradition of recognizing grief as a normal (and expected) human experience. It may vary in intensity and duration from person to person, and also depending on the nature of the loss. If anything, the grieving person may benefit from support and sympathy, rather than being diagnosed as mentally ill and treated as such.
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The fact that it is being considered as a "new" addition to mental ailments only makes one speculate that there is money behind the thought! Can you guess where that will lead?
So then why is it that we morn 911 every year and people get that? Why do we remember our Vets? Because they are important to us that's why:-) It is because we don't want to forget! We want to retain the memory of those who were stolen from us.
Your sorrow is your own and you are entitled to it. However, don't let your sorrow run your life in the direction of losing what you have. Remember your Dad and honor him with your life. Suicide is never the answer, though we often think it will give us peace. True peace comes from knowing that you have a purpose, which I am sure is what your Dad would want you to fulfill. Set aside a day to remember him, and then live every day knowing that you are still here for a reason:-)
Life after a great marriage of 37 years becomes surreal.
Just now am getting a bit better.
Really wanted to die!
The study of grieving over those with long-term illnesses may be new, but the process isn't. It's not just modern medicine that has made for long-drawn-out deaths. Tuberculosis is a good example of a disease that took years to kill - but kill it did, and people knew it, and grieving started well before death. Of course people start grieving when they know, or fear, they're soon to lose someone they love, of whatever species. I grieved for my Katie-cat more in the two weeks between her cancer diagnosis and her passing than I did afterward, but the difference there was that she was in contact with me only two days after her crossing, and that eased my grief a great deal. But then I suppose these rigid, everyone-the-same so-called physicians would think that was some sort of mental illness too ...
As a mental health worker I have seen more and more people depend on drugs rather than their own abilities to move on. However, that being said the propaganda is so moving and enticing ,anyone in any time of emotional pain would be fair game! No one wants to suffer! So now adding "a new ailment" will reinforce the distribution of MORE drugs.
Take care.