Alan Weiss’s Monday Morning Memo® – 03/21/2022
Something called “prolonged grief disorder” has been added to the DSM (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association. It is now, therefore, classified as a “mental illness” and subject to reimbursement by insurance companies and makes it possible to prescribe drugs for the condition.
Sometimes known as “persistent complex bereavement disorder,” a simple explanation is that those afflicted have trouble recovering from grief and resuming a normal life. It is a constant preoccupation with grief, overwhelming one’s life. I’ve experienced this with people who abandon their businesses, give up their hobbies and interests, and withdraw (very similar to depression). They are irrational in their sorrow and loss.
Pain in life is, of course, inevitable in many forms, from disappointment to grievous loss, from setback to trauma. But suffering is voluntary, and I think that a “need” for suffering is the catalyst for long term grief.
The practice of holding a wake for a few days for someone who dies (sitting Shiva for seven days in the Jewish faith) is a means to set limits on formal grief and suffering. It doesn’t mean that the loss isn’t continually felt, but it does create a certain limit on focusing on the loss to the virtual exclusion of all else.
My anecdotal observations over decades (which would probably get me thrown out of the APA if I ever belonged to it) is that some people—that minority who would be diagnosed with PGD—have a need to suffer, to atone for a perceived responsibility for the cause of the grief. The Catholics use Lent and the Jews Yom Kippur to stipulate atonement times, but for some the atonement is eternal.
Why the need for long-term suffering that expresses itself as grief? I’m not sure, I’m not a psychiatrist. But I’d suggest that the polemic needs be about low self-esteem that creates huge guilt, and that guilt can’t be assuaged by short-term grief and/or designated periods of mourning. Hence, those suffering tend to engage in long-term emotional self-flagellation.
How many times have you had to tell someone, “It wasn’t your fault,” or “There was nothing more you could have done,” or “We all make mistakes”? That sometimes helps rational people with high self-esteem, but not those who are being irrational in their intent to suffer.
I agree that help is needed, interventions required. But I question the focus. I don’t think this is about grief, I think it’s about perceived guilt and a determination to suffer in atonement for it. Life is tough enough without feeling responsible for the losses we all endure.
No one ever told me that grief felt so like fear. —C.S. Lewis
Grief is in two parts. The first is loss. The second is the remaking of life. —Anne Roiphe