Not-So-Complicated Grief

I have been awash in grief since the day not-so-long and forever ago when a Lahey Clinic surgeon pointed to a scan of my husband’s pancreas and said “This is your tumor.”

Afoot in clinical circles is a debate about revising the next editions of both the Diagnostic and Statistical Manual of Mental Disorders and the World Health Organization’s International Classification of Diseases to include “prolonged grief” as a mental disorder.

The central study in support of this proposal to recognize “pathological” grief in  DSM-V came in a 2009 article.  The clinical criteria for such “disordered” response?  Essentially, possessing “the experience of yearning” for a loved person following a “significant loss,” while going five-for-nine (“daily or to a disabling degree”) among: “feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life.”

I have had, in spades and cavalcades, every criterion proposed for this “disease” of “prolonged grief.”  Indeed, I believe I hit the six-month mark for these psychometric criteria before my husband died, given the near-certainty of his loss from the devastating diagnosis of pancreatic cancer.  The same “symptoms” are going strong now, a year after his death.

I am not mentally disordered–at least, not in this respect.  

Nor do I believe there is anything complicated or otherwise pathological about my grief. If anything, it is remarkably uncomplicated, because I know my husband left this world without regrets for the choices he made in life, to join an occupation of service and to make a family with me and raise four children during his far-too-short years.

Two immediate consequences of the proposed classification come to my inherently suspicious prosecutor’s mind.  First, in nearly every jurisdiction, a DSM-enshrined category of a mental disease or defect can be used towards building a criminal defense of lack of capacity and/or legal insanity.

I suspect, however, that the suggested reclassification of “prolonged grief” as a mental disorder will lead to some far more concrete and commonplace results.

Already I have seen advertisements from a major teaching hospital seeking patients for new pharmacological studies about “complicated grief.”   Is there any doubt that such reclassification would facilitate new forms of coding, for duly “prolonged” periods of time, to dispense and to compensate expenditures for psycho-pharmaceutical drugs to. . .well, everyone?

After all, to paraphrase REM, everybody grieves sometimes.

According to Rachel Adler, “We must consent to be bereaved in order to be renewed.”

To be sure, there already exist diagnostic criteria for a variety of pathological conditions following the loss of a loved one–like the Post-Traumatic Stress Disorder not infrequently seen following the murder of a loved one.

But culling nearly universal characteristics of grief—at least, the kind of grief that attends loss of a loved person with whom one had a healthy relationship–into a DSM-certified mental disorder would, in my opinion, be at war with renewal.

Trying to chase away such commonplace characteristics of profound loss by labeling them and treating them as a disorder seems to me hardly conducive to “consent[ing] to be bereaved.”

The siren call of pharmaceutical relief is ubiquitous as it is.  And it is more than tempting enough for the non-grieving to shy away from the bereaved without affixing a label of “disease” to the latter.

To transform grief’s trademark transformations into a mental disorder seems to me to take as literal the ironic, and to provide a justification for the kind of uncomfortable societal reaction described by Jonathan Franzen in his novel Freedom, where, following the death of a woman he loved, one character’s “hermitlike existence now strongly smacked of grief that, like all forms of madness, feels threatening, possibly even contagious.”[1]

In his Ode on Melancholy, John Keats perhaps wrote as poetically as anyone could  about loss—and about the need to maintain one’s place in the natural world and among companions:

No, no, go not to Lethe, neither twist 
    Wolf’s-bane, tight-rooted, for its poisonous wine; 
Nor suffer thy pale forehead to be kiss’d 
    By nightshade, ruby grape of Proserpine; 
Make not your rosary of yew-berries, 
    Nor let the beetle, nor the death-moth be 
        Your mournful Psyche, nor the downy owl 
A partner in your sorrow’s mysteries; 
    For shade to shade will come too drowsily, 
        And drown the wakeful anguish of the soul.

But when the melancholy fit shall fall 
    Sudden from heaven like a weeping cloud, 
That fosters the droop-headed flowers all, 
    And hides the green hill in an April shroud; 
Then glut thy sorrow on a morning rose, 
    Or on the rainbow of the salt sand-wave, 
        Or on the wealth of globed peonies; 
Or if thy mistress some rich anger shows, 
    Emprison her soft hand, and let her rave, 
        And feed deep, deep upon her peerless eyes.

Plunking me into a category of disorder will not “glut [my] sorrow.”  Only I can do that, living as my husband would have wanted me to, and taking care of our children as he would have done.  

Grief is not madness or illness.  It is not a contagion.  It is love’s, loss’s and life’s inevitable companion.