Reviews | Update from the American Psychiatric Association on the Abused Grieving Process as a Mental Disorder

Soon it will be two years since I lost my best friend and father, Garry Greenberg, to covid-19. He was 68 years old. I think of him everyday. I pour coffee and hear her laugh; I run and I think of something I want to tell him.

I think back to a football game I played when I was 12. There were only a few minutes left. Equal score. A tense and respectful silence between the parents on the touchline was broken by the sudden sound of a foghorn: womp, womp, wooooomp. “Come on, Dev, come on! »

It was my father. It was always my father, beaming with boundless love and support. When I picture him, I imagine the sparkle in his huge “Greenberg eyes,” days at the beach filled with Billy Joel and gritty snacks, his 6-foot-4 bear hugs that left me breathless.

I also imagine the first time I saw my father on Zoom. It was April 2020 and he was sedated on a ventilator in a crowded New York hospital. I was shaking hands with my brother Kyle from nearly 100 miles away and it felt like an octopus was clutching my heart. My father was thinner than I had ever seen him. He looked scared and alone. The machines were beeping everywhere, so the social worker held her phone closer to him. Every word I spoke sounded sweet and false.

Since his death on April 25, 2020, I have immersed myself in a world of grief and loss, seeking solace and connection. I’ve joined support groups, read dozens of bereavement books, and explored ways to dedicate my career to supporting those who are grieving.

The purpose of this work has been to internalize the message that what I feel is correct. If grief is the corollary of love, if grief East love, why set expectations on its rhythm or texture? Why pathologize love?

It’s not just personal outrage that moves me at the association’s decision. I worry about others who have loved and lost – at some point, all of us. I fear this framing will make us even more alone in our pain, even more convinced that our nonlinear and unpredictable paths through loss are “wrong.”

Grieving is an experience without a roadmap. Ask anyone who has lost an immediate family member what the “five stages” of grief are and you’ll likely get a nod. No, heartbreak is more like bushwhacking through a gnarled forest. Each of us needs confirmation that we can shout thorns from our side, that we are not crazy to take advantage of a sudden clearing, that whatever route we take (provided we do not harm ourselves or that we do not harm others) is the good one.

Many of the symptoms the psychiatric association uses to define “prolonged grief” are surprisingly common. “Intense emotional pain (eg, anger, bitterness, grief)”? Let’s call it a Tuesday. “Break of identity”? When you have passed through a portal through which you cannot return, of course, your sense of yourself changes dramatically.

Moreover, the duration of grief is not the appropriate parameter to define who needs medication for what he feels. A therapist I spoke to said that grief only departures after a year. “Prolonged bereavement” is perhaps a way of defining each case of bereavement.

The choice of association risks creating false positives: doctors could tell people they are mentally ill, while they work through their losses constructively. We live in a society that fears death and fails to honor loss (see: lack of bereavement benefits in the workplace). The last thing grieving people need is another layer of alienation.

Some bereavement cases, of course, are debilitating in the extreme and deserve tailored support. The association is right to offer additional research and treatment options for such cases. Yet, to properly care for these people, we must not confuse their experiences with the intense but ultimately normal pathways of most grieving people.

CS Lewis compared the death of a loved one to an amputation. The loss of WS Merwin went through him “like a thread through a needle”, all “sewn with his color”. Linda Pastan described mourning as a “circular staircase”, an inescapable trap.

It’s time we agreed not to “move on”, but to move on. It’s time to stop pathologizing grief.

Here we can all learn something from my father. When he lost his beloved sister Lenore on April 25, 2007, exactly 13 years before his own death, he let himself be broken. He had the courage to face his pain, embrace it, and not force it to go away in weeks, months, even years. He recognized the centrality, the necessity, of grief. A circular staircase, a hike in the woods and a condition of love.

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