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AUGUST 24, 2010 7:56AM

Genuine Grief is No Illness.

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Recently, the NY Times published an Op-Ed piece by Allen Francis entitled "Good Grief."  Allen Francis is a past professor of Psychiatry at Duke University and led the task force that created the fourth edition of Diagnostic and Statistical Manual of Mental Disorders, or, D.S.M.-IV. The D.S.M.-IV is the bible of mental disorders.  Psychiatrists use the D.S.M.-IV as a guide for both diagnosing mental disorders and for prescribing appropriate medications.

In May of 2013 the new D.S.M.5 will be published.  According to Dr. Francis, buried within the pages of the new manual is a redefinition of what is called, "major depressive disorder."

Here is a quote from Dr. Francis' Op-Ed piece:

Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, don't sleep well and don't feel like going to work.  In the proposal for the D.S.M. 5, your condition could be diagnosed as a major depressive disorder.

In other words, a person in grief has the potential to be diagnosed with a serious mental disorder.  Further, this grieving person can potentially be given psycho-tropic drugs in order to combat what could be diagnosed as a mental condition. 

During my tenure as a hospital chaplain, I had the honor to lead a Grief Recovery Group.  For several years, I heard the stories of people who were grieving the loss of loved ones.  In addition, I sat with those who experienced those first moments of what could only be described as one of the most difficult journeys any human being can take.  I sat with a team of chaplains who not only companioned me through my own grieving process, but, shared their grief as well.  During this time, I learned a few things about this painful, long and life-changing human experience.

First, I learned of grief's universality.  Walk along the crowded sidewalks of any metropolitan city.  Look into the faces of those whom you pass.  It is entirely possible the majority of those whom you see are going through some form of grief.  Change is a constant human condition.  With all change, no matter how large or how small, comes the experience in some form or another of loss.  And loss is experienced as grief.

Even those events whom one would think of as positive - a marriage, a new job, a new place to live, the birth of a child - all of these, carry with them some form of loss.  To the new marriage partner, this loss may be perceived loss of freedom, or singleness.  To the new job holder, the loss could be of contact with now former colleagues.  To the new resident, a loss of the old neighborhood.  To the new parents, a loss of free time.

These losses are real.  The grief felt because of these losses very real.

No one is immune and no one escapes from these various levels of sadness, mourning and missing.

And this does not even begin to include those who have lost significant others, family members, relationships.  

Secondly, I learned that intense grief is fraught with deep feelings, moments of incredible sadness, physical ramifications such as lack of sleep, appetite, energy, as well as, the soulful reorientation of a person's outlook on life.

Persons in grief often told of an inability to concentrate, to remember, to find joy, to celebrate, to be able to summon up the even the will to live, to hope, to love again.

This does not mean that those who mourn are sick.  This simply means that their lives have been turned upside down, tossed about like fruit some kind of cosmic blender. 

Thirdly, my experience with the grieving taught me that at it's depths, the journey of grief was a spiritual one.  Spiritual in that for those in grief, the very foundations of their beliefs about life, about themselves, and about their relationship to that which they deemed Holy were challenged. For those in deep grief,  it is as if all one believes to be timeless, unchanging and secure is  suddenly tossed in the air like juggling balls leaving that person  with the extremely unsettling task of deciding which ones to catch, if any are to be caught at all.  

I learned that at it's very core, grief is a spiritual process. 

In addition, I learned that grief is not a" stages"kind of experience.  A person who is in grief cannot be described as a person in this stage or that stage.  Grief is fluid, dynamic, changing.  For every two steps forward, there are five or six steps backward.  For instance, just when a person thinks they are over the sadness of their loss, something can occur that throws them back into it.  They may hear a song, see a picture, hear a story, visit a relative, and the tears will flow once more.  Feelings of anger will resurface.  Feelings of guilt return.  People in grief are not simply stepping through stages.  People who mourn are in what I learned to call the "flow" of grief.

Lastly, I learned that there is no "cure" for grief.  Not really.  For those who has lost loved ones, the pain of that loss never goes away.  Not completely.  There is no "recovery" really.  There is re-orientation.  Re-investment.  The end of the journey is a re-investment in life with new parameters, new insights, new ways of dealing with a pain that never completely goes away.

When my mother died, I grieved the loss of a woman who meant the world to me.  Even now, I will see a picture of her and once again, feel the sharp pain of not being able to call her, talk with her, see her.  I miss her laugh, her shining green eyes, her Irish temper, her passion for the lost and downtrodden, which in her case, usually meant abandoned pets.

These feelings well up even though she died some fifteen years ago.

This does not mean that I am stuck in my grief.  It means that I loved her. It means that made a place for her in my heart and this place is still empty. It means that when she died I was broken-hearted, wounded.  It means I still carry with me the scar of that wound.  

This does not mean that I am sick, depressed, or suffer from a disorder. This simply means that I am human.  This means, too, that I opened my heart in love to another human being and when that person died, I felt their loss. Deeply.

We live in a society that tends to embrace the quick fix.  We live in a society that is enamored with it's ability to medicate.  And, I would say, that we live in a society that is not tolerant of grief, or those who are locked in the throws of this universal human experience.

For there was something else I learned as I companioned the grieving.

One night, I asked some fifty or so people to share all the pieces of advice they had been given from friends, family, even doctors, strangers, anyone.  The list filled a complete wall of white board.  I could not write fast enough.

Then, once completed, I asked a simple question.  I asked, out of all these now multitude of pieces of advice, what percentage of those could be considered helpful?  The answer was both alarming and not surprising. The group agreed that about 10 percent of advice given was helpful.  10 percent!

Moments went by as the group of us simply sat in silence.  They knew. Grief is not easily "fixed," nor, is there some magic pill that will make it go away.

Grief takes time, patience and most of all, togetherness.  What the grieving need are not platitudes, nor a pill, but simply a listening ear from persons who are not afraid to lovingly ask how the person in grief is doing and who are willing to sit down long enough to hear the whole answer.

Or as Allen Francis stated it, people who are willing, "To let us experience the grief we need to feel without being called sick."









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Thank you for your intelligent, sensitive words on a subject that leaves no on untouched.
What an excellent, clear-headed post. Grief just IS. It changes us almost on a molecular level, and is assimilated. It's part of life. Thanks for sharing this so close to 9/11, when my (and so many others') energy kicks into a gear that can only be related to some psychic muscle memory of loss. Every one has their own touchstone for that feeling kicking in. Season is a big one, because we are naturally attuned. (r)
RA, yours is the first post I read this morning as I sip my coffee. I've been having some thoughts on grief lately, so your message is very timely.

I wonder what the powers that be that are putting forth the DSM5 are thinking when they redefine major depressive disorder to include the signs of grief. Don't tell me, the pharmaceutical companies are "sponsoring" the DSM5.....(she said innocently...).

As you say, grief isn't a mental illness. It's not something that's experienced, treated, and cured (neither is mental illness). The whole world would fall under that category right now I think if we were to think about it. What good would that do though? None.

As a nurse, I see the obvious value of the DSM. But I wonder, if we took away the DSM, and the categories, if we could see that we're all just humans on a long continuum. And our lives go up and down the continuum as we live our lives. That's how I see my life at least. Back and forth, not necessarily in one direction. But hopefully, at least trending towards the "+" end of the continuum.

I need to hang out with you more. You're just an awesome person. Love what you write.
This is outstanding. I don't know if the subject of grief has ever been written about as accurately as you have here. It is a huge bear to tackle. Like most people, I've lost people who were dear to me: my father, my best girlfriend, my infant son. I have come to know grief as a force of nature-much like a tsunami or an earthquake. We cannot control the process, which, as you pointed out is not linear. We can only surrender to it, take care of ourselves in the process and assimilate the loss and the experience into our lives. I believe it is a state that should be honored. (Other cultures are much more respectful of the grieving process than we are in the U.S.) I also believe that in the grand scheme, the grieving process is a good thing, at least from a spiritual perspective. In my experience, the grieving process helped me keep an open heart, to get a measure of clarity in an acutely ambiguous situation and to ultimately expand my sensibilities and deepen my compassion.
Can I rate this 100 times? I would if I could. This is just excellent.
Nicely done, Richard. I was sorry to see you bury your "attaboy" post, but this is another keeper.
it rains on everyone's parade as someone who lost a four year old child told me once.
the hardest part i think sometimes is that those you count on don't know how to react, and they get tired of wanting the old person to come back, and that person may never come back, not in the same way.
Thank you for waving off the "stages" of grief. I appreciate Kubler-Ross's attempt to deconstruct the phenomenon into easily digestable categories, but it just made me feel like I was perhaps sick (mentally ill) if my grieving process did not conform in lockstep with those "stages." I agree that it doesn't. Grief is indeed fluid and not linear in any sense. I apparently still deeply mourn the passing of a high school crush, but did not know how much until I set pen to paper and it all came rushing back.

Beautiful work, Richard. I am privileged to know you.
This so well stated, insightful and correct.Thank you.
great post. I think grief is a sibling of seems harder to think of love that experienced no grief after loss....

but the human continuum for feeling is bigger than we know/expect even within ourselves...
Any loss usually results in grief, which can manifest in hundreds of activities, thousands of thoughts, and leave us unable to fully partake of or participate in what is going on around us as we mourn. You are absolutely correct in saying there is no time table, some losses we never get over. Timely post as we come up on September 11.
Your years of experience shine through in this piece. We are not machines and we cannot be labeled and diagnosed as if we are so easily understood. Some grief lasts many years, but is not a disease, however, if treatment helps, a good physician should be able to determine that. I wonder if in our urgency to categorize we might do more harm than over all good. We are provided with rituals that are practically timeless to assuage our grief. We all recognize its impact, but we hope that in time it leaves us touched but in tact. Your writing here is profoundly on point. R
Grief may fade but it can come back at any time. because we're alive. Nice work.
Thanks for this. I have been following this story in a number of outlets and your response is compelling. On a personal level, I would disagree with your statement, "I learned that at it's very core, grief is a spiritual process." I would say it is a human process. And yes, it is a psychological process. But to quantify and cut off the process, to fence it off, and say, "Beyond this line is too much," that is folly, pure and simple.
Thank you for a thoughtful post. American culture struggles to accept mortality. Death is not acceptable although this is the one absolutely definite experience all humans will experience. Has this denial created the void for traditional behaviors to experience tragic loss or recognize and respect the loss occurring to others? It truly shocked, the number of friends and relatives that push anti-depressants or barbiturates at me after my son died. I wonder if their discomfort is because of my grief, their reaction to sharing my grief, or pressure to conform to the shared social fantasy that everything is just allright and we can’t be depressed and downtrodden because America is number 1.

The resident cynic in my mind suspects that pharma and insurance need to define this natural condition as illness to suck more lucre from the system of their own design.
It all makes perfect sense to me! Can you tell us what some of the 10% of advice items people found to be actually helpful? I have grieved a lot, but still never know quite what to say. My truth is that it will eventually get better, but it is never gone, as you said. I think acknowledging that fact out loud with the grieving person is helpful. But I really have no idea.
"We live in a society that is enamored with it's ability to medicate. And, I would say, that we live in a society that is not tolerant of grief, or those who are locked in the throws of this universal human experience."

These two sentences encapsulate my experience with grief; both with others and the medical industry. Others always want you to find the quick fix, too. Very few people are able to sit and hold you and just listen. Fascinating that - the answers are always so simple yet we humans always find a way to complicate them.

Thank you, immensely, for this piece.
oops - added a rate.
Don't get me started on the DSM5.
"Genuine grief is not an illness."

It is a measure of how far we have sunk that someone has to say this, but thanks for saying it.
Oh my goodness, thank you for this! xox
and sometimes grief needs time alone to lick its wounds....and the understanding from friends when their calls are not returned.
great piece
There is no cure for grief. Yes. We don't forget those we loved just because they no longer occupy our living world. They are still part of us; we miss them because we care.
RAR, thank you for this. I am following this issue with great concern.

Also, I read your post too quickly at first and misread a phrase to say, "grief's university." not a bad slip of the eye, actually. We are all students there. peace,
so very, very true. I'd be far more concerned about the mental health of those who don't grieve after a major loss.
"flow" is an apt description... and medicating a grief can only the dam the flow temporarily...
The only time the DSM is a friend is if a person needs help but has to "qualify" for services, not necessarily medical services. I quite agree that grief is fluid and sure fits the major depressive disorder category.

I really appreciated this piece.
Thank you. I am experiencing this right now..and this could not have come at a better time. Thank you so much.
THANK YOU for this!

I had a major WTF moment while reading this. The DSM is misleading at best and outdated at worst. Damn, we're getting to a point where we are medicating ourselves to the point of numbness. Just more drug pushing BS from big Pharma, who no doubt has their fingers in this.

Peppermint makes a great point, lets hope people don't repress their grief for fear of being "labeled"
Bravo for a piece well said. I lost my father this summer and I ache. Any pill invented by Big Pharma to make me feel "happier" is not a pill I'd want to take. I never want to be so pharmaceutically normalized that I lack the complexities of human emotion.
Thank you for this thoughtful piece. It is needed. For some reason, grief makes many others supremely uncomfortable. People often want to "fix" you or somehow "spin" the grief. I actually had someone tell me recently (this after losing my only son) that it was now just all a "new beginning for me." Sheesh. No, it was actually the profound end of something! I could scarcely refrain from throttling this woman. There's something in our culture that relentlessly looks for the positive in everything. Newsflash: not every cloud has a silver lining.
My sincere gratitude to all those who both commented and rated this post. Each comment has touched me.

I wish I had the time to respond to each one of you, however, suffice it to say, your comments are thoughtful, intelligent and reading each one has reinforced my belief that the experience of grief is both universal and powerful. Powerful, too, is the need for some level of both validation and normalization of all that grief brings.

This is not to say that there are not those who need more than what a support group, friends or counselors can provide. At times, this is so very true. And we dare not stigmatize those who require more.

Again, my thanks to you all. I continue to be inspired and humbled by this amazing OS community.
Excellent and beautifully rendered. And my thoughts exactly.
To me, grieving is another form of the rebirth of the spirit that is challenged. It is inevitable to be grieved by events one cannot undo. It is equally possible to learn to accept how events change our outlook, adding to our wisdom through experiencing life's ever changing hue.
Pills may take away volition towards this gift, that is learning via what nature intended, that all things have their end point, at times without our permission. I was offered a prescription treatment against the sadness of a past event, but was empowered by declining.
I now feel better, and not worse off, after enduring this learning period of the last several years.
Just goes to show you, a human heart may yet reveal a new strength just when applied for.
I tend to believe in that far more than any of the current drugs used to "treat" depression that is born out of an actual event or series of events. Give me the right to grieve any way I see best. And as long as I'm coping or learning what coping is for, that's all that would be required.
Very much respected and Rated
I appreciate the depth and intensity of thought that you have put into writing this piece. I agree with what you have posted, particulary that we are immersed in an era where people want a 'quick fix' to everything, and can easily be cajoled into believing that a 'pill' will take away the blues. Sadness, despair and grief all must be felt in order that one can pass through feel the 'flow', as you would say. I don't think you can ever 'get over' a loss that great; but rather, one must incorporate the loss in an effort to live a full life, and hopefully experience peace and happiness again.

I also agree with j lynne, when she suggests that we get rid of all the categories of the DSM, but must admit, I have not 'heard' or 'seen' any evidence of this new hidden caveat you mention. I think it should be noted however, that there IS a 'medical' condition, known as inconsolable , or complicated grief and it is generally differentiated from 'normal' grief. I stumbled on this definition from Wiki very recently, when trying to help a colleague process some grief of his own, and I think it shows the distinction nicely.

"Complicated grief responses almost always are a function of intensity and timing: a grief that after a year or two begins to worsen, accompanied by unusual behaviors, is a warning sign. Deaths such as suicides, murders, accidents, and other sudden and unexpected deaths can result in complicated grief due to the sudden shock.

"The surprise (of the loss) makes it difficult to integrate the "story" of the loss, so the person struggles with an initial task of simply believing that the loss has occurred. Variables surrounding the death such as expectedness, naturalness, presence of violence, ambivalence, degree of attachment, and others play into the presence of complicated grief. All too often complicated grief can last for years. Most people (friends of the mourner) will recoil when hearing that this sort of grief may still be present after several years.

There is a clinical problem of becoming "identified" with the grief. In this situation, mourners are reluctant to release the grief because grieving has been integrated as part of their identity. Reporting in the journal NeuroImage (May 10, 2008, online), scientists suggest that complicated grief activates neurons in the reward centers of the brain, possibly giving these memories addiction-like properties. The authors found activity in the nucleus accumbens, a region of the brain most commonly associated with reward. It is one that has also been shown to play a role in social attachment, such as sibling and maternal affiliation.[5][6]"
Monica, your thoughts and observations are well noted. I must say, I published this with some fear and trepidation. In no way did I want to trivialize the grief experience, nor, suggest that there are cases in which grief is so debilitating that it requires more than what a support group, counselor or friend can provide. In these cases, medication, as well as other measures, may indeed be required.

In addition, I think it important to mention incidents of trauma and the effect these have on those who endure it. Certainly the circumstances of a loved one's death creates new and different complications to the process of grief.

So, your distinctions and observations are deeply appreciated and worth noting.

Thank you.
Wonderfully insightful. Grief like life in general is not an event. It is a process--it has it's rise and fall, it's ebb and flow--and hopefully meaning. The ache of longing never goes away.
Believe it or not a mental disorder is not static either--it can be a process of growth and meaning if one is willing to do the work.
Creating new disorders out of perfectly normal behaviours---like grieving, mild depression, general anxiety, excessive but not dysunctional neatness, and just plain shyness---has become a very big business. It opens up new areas for drug research and broad new markets for expensive drugs. And of course often the formulation of a new drug precedes the actual defining of a new psychiatric condition. There's a great blog about the subject at Psychology Today called "Side Effects," very critical and very well written:

I grieve the loss in this country of common sense and connectedness and respect for the emotions we all experience as humans. Our appreciation of the human experience replaced with a ridiculous fast fix zombie life.

Oh. And I'm not mentally I'll.
Thanks for this intelligent analysis. I especially liked this part, because it's not something people normally consider, but is still completely true:

"To the new marriage partner, this loss may be perceived loss of freedom, or singleness. To the new job holder, the loss could be of contact with now former colleagues. To the new resident, a loss of the old neighborhood. To the new parents, a loss of free time."

Rated, with admiration.
Christine...Thank you. I agree.

Thank you, BOKO. I will check it out. Thanks for the heads up.

Well said, maddie.

Caroline...I am glad you noticed. Thanks.
The “flow” of grief makes so much more sense than to progress through “stages” of grief. I’ve been through this “flow” over the past year and have watched others go through this as well. Grief is definitely a spiritual process. I have wrestled with my own faith and, just tonight, watched someone dear to me wrestling with the spirituality of his own grief. I can say that my grief brought me to a clear understanding of the power of God and His grace. I saw how lost this friend of mine was tonight for he does not have the same foundation. It made me aware of how my own grief had literally turned my life around and ultimately had a positive effect on me. As you said, there is no cure for the pain, but there can still be a richness that comes from the pain if we are willing to look for it.
"We live in a society that tends to embrace the quick fix. We live in a society that is enamored with it's ability to medicate. And, I would say, that we live in a society that is not tolerant of grief, or those who are locked in the throws of this universal human experience."

I simply wanted to see that repeated.
I appreciate your concern about the "medicalization" of grief. Our drug pushers (oops, pharmaceutical companies) will seize whatever opportunity they can to increase sales.

But I was lifted out of 25 years of terrible grief by a program designed by Dr. Katherine Shear, now of Columbia University. Her "complicated grief" therapy allowed me to return to life after so many years of darkness following my husband's death. The treatment has been written about in the NYT and JAMA.

There are indeed many forms of grief -- and some of us need help to overcome a form so severe it continues to eat away our lives.
RA: what an excellent, professional, and empathetic post. I love the "flow" of grief. That really is true; my dad died in 1968 and I still have thoughts of him that make me tear up. Thanks for sharing your knowledge with us. R-