Finding Happiness in the Midst of Grief

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Grief, mental illness and psychiatry’s sad refrain

Scientific American covers a coming shake-up in how grief is defined in relation to mental illness as the forthcoming DSM-5 diagnostic manual aims to radically redefine how mourning is treated by mental health professionals.

It’s worth saying that the DSM-5 has yet to be finalised and will not appear until 2013 but the changes to how grief is classified seem quite drastic.

Two proposed changes in the “bible” of psychiatric disorders—­the Diagnostic and Statistical Manual of Mental Disorders (DSM)—­aim to answer that question when the book’s fifth edition comes out in 2013. One change expected to appear in the DSM-5 reflects a growing consensus in the mental health field; the other has provoked great controversy.

In the less controversial change, the manual would add a new category: Complicated Grief Disorder, also known as traumatic or prolonged grief. The new diagnosis refers to a situation in which many of grief’s common symptoms—such as powerful pining for the deceased, great difficulty moving on, a sense that life is meaningless, and bitterness or anger about the loss—­last longer than six months. The controversial change focuses on the other end of the time spectrum: it allows medical treatment for depression in the first few weeks after a death. Currently the DSM specifically bars a bereaved person from being diagnosed with full-blown depression until at least two months have elapsed from the start of mourning.

It is particularly striking that normal grief could be classified as a mental illness under the new proposals as this brings into question how we define mental illness itself.

Contrary to popular belief, there is not one ‘standard way’ of grieving and people’s response vary widely in response to losing a loved one. However, it’s true to say that being sad and withdrawn is certainly common enough for it to count as a normal reaction to loss.

This brings to mind psychologist Richard Bentall’s tongue-in-cheek proposal to classify happiness as a mental disorder due to the fact that it is “statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system”.

Perhaps we can also look forward to simmering anger, dashed hopes and unrequited love disorders for the DSM-6?

Link to SciAm article ‘Shades of Grief’.

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No grief for clichés

Time magazine has a fantastic article that tackles common myths about the psychology of grief and the experience of losing a loved one.

We’ve discussed previously how many of the grief clichés (there are specific stages, you have to ‘let it out’ etc) have already been shown to be false but this Time piece goes in greater detail and traces the origin of these myths in the work of Elisabeth Kübler-Ross.

Kübler-Ross was an important pioneer in understanding grief, but she was basing her theories on very little evidence and we now know from more rigorous studies that many of her conclusions were wrong.

Although Kübler-Ross modified her position with regard to the famous ‘stage model’ of grief, where we supposedly pass through distinct stages – saying that they were never intended to be one after the other, later empirical studies have found little evidence for any consistent stages.

One of the reasons that the five stages became so popular is that they make intuitive sense. “Any natural, normal human being, when faced with any kind of loss, will go from shock all the way through acceptance,” Kübler-Ross said in an interview published in 1981.

Two decades later, a group of researchers at Yale decided to test whether the stages do, in fact, reflect the experience of grief. The researchers used newspaper ads and referrals to recruit 233 recently bereaved people, who were assessed for “grief indicators” in an initial interview and then in a follow-up some months later. In the Kübler-Ross model, acceptance, which she defined as recognizing that your loved one is permanently gone, is the final stage.

But the resulting study, published in the Journal of the American Medical Association in 2007, found that most respondents accepted the death of a loved one from the very beginning. On top of that, participants reported feeling more yearning for their loved one than either anger or depression, perhaps the two cornerstone stages in the Kübler-Ross model.

The article tackles many more common beliefs about suffering loss and is a highly recommended look into what is often thought to be ‘common knowledge’.

Link to Time on ‘New Ways to Think About Grief’.
Link to previous Mind Hacks post on grief myths.

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