The enormity and everlastingness of the grief following a traumatic loss are not manifestations of psychopathology; they are a measure of the depth of love for the lost beloved. Read More
So why do so many folks seem compelled to diagnose my deep, immediate, raw pain over the loss of my beloved brother four years ago? Why are folks so deeply comforted by calling it "complex" or "complicated grief" or making sense of it as "a magnet of grief where this one loss pulled in others..."
Can't I just miss my best friend/brother/guide/mentor/teacher/co-writer/co-teacher? In one person I lost so, so many deep connections to my personal and professional world. He was my life's witness. My dearest confidante. We were supposed to have 40 more years to laugh, teach, write, collaborate, parent, raise our kids, care for our parents together. And he died in a horrifying, unnecessary, senseless, brutal way, a way that could have been prevented. So yeah, it feels like it happened two seconds ago. And I am inconsolable. Now what? I did talk therapy, EMDR therapy. You name it. And here it is. I remain in a walking grief coma. Exhausted, depleted, desperate. Highly functioning as a parent, at work, in love. But gone in so many ways. What does the world do with a grief like mine? My family cannot stand being around it for too long. I refuse to pretend I'm grateful. I refuse to be inspired or inspiring in my pain. I hate my birthday. I hate Tuesdays. What if this is simply how life is, until it isn't? What do I tell people for whom my grief feels so threatening, so crazy?
Pathologizing grief allows people to evade the recognition that it is built in to finite human existing. I think you'll appreciate this blog post: http://www.psychologytoday.com/blog/feeling-relating-existing/201110/tra...
The only time I've sought psychiatric help was after the death of my "boyfriend." I call him that only because we weren't legally married -- we lived together and were raising children together...but that isn't legally sanctioned mating, hence a high school sounding word. (but that's a diatribe for another day)
I fell into a depression that led to suicidal thoughts and plans. My therapist helped me enormously because through her I began to realize that it wasn't his death that grieved me, it was my guilt. Guilt over not feeling like I loved him enough. Guilt over all the hurtful things I had said. Guilt over not being the perfect woman. The list could probably become endless with further thought. It did help me to "get over it" and realize I had done the best I could and so had he. We all die and I will too eventually. I like to think his death helped me to have more patience, more empathy and a lot more thoughtfulness towards other people. And, I hope that that would make him proud.
The distinction between grief and guilty depression is a crucial one!
I think this is a wonderfully informative and fascinating piece and the comments too are beautiful and very thoughtful and helpful. I think guilt is a huge part of all loss and not relegated to special cases. The reason I say this is because it is our job to take care of one another as social animals and as individuals with profound attachments. So when a loved one dies on our watch though we understand cognitively it may not have been our fault, emotionally it is our fault and this is a part of our finitude too. We lose the very ones we are emotionally mandated to protect; it happens on our watch. That the DSM relegates grief to pathology is one more absurdity but in a sense this merely reflects the unempathic demands of society. I have long felt that depression is actually a form of grief that the world does not accept as worthy of grief. When an individual must grieve alone that is not grieving; grieving is a social phenomenon. As Robert says, we need a relational home for our grief. When that home is not found then grieving cannot occur and an isolating and self-attacking depression sets in. We grieve for many things that our social world may not consider worthy of our grief. Or our grief extends beyond the time the social world allots. And so grief turns in on itself and becomes depression, a salient characteristic of which is isolation--exactly the condition that caused the depression to begin with.
Thanks for this great comment, Josie!
Thank you for your comments Josie -- you're so right.
When my partner died, my fundamentalist family told me I got what I deserved because I had been living in sin. It was god's punishment for my wickedness. So, I was isolated from family.
Then, my boss began asking when my work was going to be back "up to par." I was told several times that the company didn't exist to provide for me -- I had to continue to work and perform like nothing had ever happened.
Yes -- lots of support from everyone!
My therapist literally saved my life. She taught me to see the difference in the guilt I was feeling, which was coming from all directions, and the grief I had for losing my love which no one seemed to care about -- or at least thats how it seemed. I felt bad for not being able to "move on" as fast as society wanted me to. "Don't wallow" or "don't be a victim" was a constant mantra from people.
I still miss him and think about him often. But I no longer feel guilty for just being me.
This is a heartbreaking story. Re the pressure to move on, see this blog post: http://www.psychologytoday.com/blog/feeling-relating-existing/201110/tra...
Grief gives. It allows a process to unfold that leaves one to surrender to their love and look at it with personal deep regard and validation for their love. Love and grief are one. They are only separated by indeterminate time. If you say yes to love inturn you are committed to grieve. Love separated from grief is a split of the worst kind because grief that strays away from love becomes a warping of human need.
This comment is gorgeous, Peggy!
And yes, even people in palliative care they consider accepting the GSM classification of grief.
I really thank you for this article. i have been considered to have a complicated grief, because my loss and grief has changed the sense of time in me. Because the past I shared with my loved one is stretched to my present; because i refuse to date any other; because after 4 years I still cry for him, because although I function in everyday life, it is hard to find new meaning. I wonder if there are any therapists in London thinking similarly to you.
Have you seen my blog post on how traumatic loss alters the sense of time?: http://www.psychologytoday.com/blog/feeling-relating-existing/201110/tra...
One thing that is often forgotten is the managed care society we live in. Insurance did not pay for services related to grief. Now that there is a code in DSM for grief, they will pay for it. Every time a client comes in with insurance, a DSM code is required or their insurance will not pay. Just because there is a code attached to an issue someone is having, does not mean there is something wrong with the person. Many codes are transient in nature and as such are expected to not last.
Equating a code in the DSM to pathologizing is not exactly the case. It's used for insurance payments, it's also used for research. I wish everyone could just go in for therapy and not have to worry about a label or a diagnosis, but that's not the world we live in right now.
I really appreciate how your blogs all interact with each other, answering thoughtful questions from readers who are discovering your writing. How comforting your words are for those who are grieving, and who feel so alone and pathologized.
Thank you for your appreciative words, Helen.
I find in many of my clients an avoidance of grieving because they can't support the experiencing of it. I remember a client I had years ago who did some great work in his long-term therapy and had made great strides in his life. He suddenly announced during one session that he felt fine and wanted this to be his last session. When I explored with him why he wanted to do it so suddenly without talking about it first, it turned out he wanted to avoid the grief of saying goodbye to someone (me) with whom he had had a very meaningful relationship. There were many reasons for his need to avoid grief in the past history in his family. His parents avoided expressions of grief and sadness, and discouraged him from experiencing and expressing these emotions. We worked on this necessary part of the therapeutic process for another six months and he then was ready to terminate.
Although this was not the case with this man, I often find that clients who avoid grieving do become depressed. It takes a lot of energy to suppress or repress grief and it can result in a lack of energy and vitality. These people are also often unable to form new loving relationships, e.g., someone who's spouse has died or gone through divorce, until they can go through the grieving process. They can't say a heartfelt "helol" to a new relationship until they say "goodbye" to the one that's gone.
Freud referred to grief as work, a gradual process of grieving each feature one experiences that reminds him or her of the missing person, a restaurant they shared, a song they both loved, etc.. Other cultures, with their rituals around grieving--e.g., the Jewish ritual of sitting shiva--often do a better job of grieving than we do in the US. The ritual gives them the needed support, the "home" you refer to, Bob, the holding environment, that enables them to do the grief work.
Thanks for this topic on your blog.
Thanks for this excellent comment, Stephan. Yes, people who avoid grieving tend to become depressed, because the grief becomes stripped of its narrativity and becomes somatized (lethargy, fatigue, etc.)
I never thought about why incomplete grieving can morph into depression. It makes sense that the dissociation from the grief affects would almost inevitably lead to an inability to articulate the grieving process to oneself and others. And since all affects have somatic components, one would be left only with those alone.
Spot on, Stephan!
My personal experiences of significant losses and subsequent grief in relation to this, leaves me with the sense, that each grief is a different one. This is not easily articulated in a brief comment, but perhaps suffice to say, that each of these people have and hold a different meaning in my emotional life.
Professionally, I see that for some/many, grief is felt/feared to be death itself. Sometimes a baby's experience is felt to be that, in terms of loss of contact with the (m)other and the subsequent abyss that opens in this psychic gap.
As therapists and fellow human beings, can our hearts, and minds as well as our ears, be open to the (felt to be) unbearable pain of loss? This pain, once entered into, rather than fleed from, can be the opening to life itself. The 'life force' as Neville Symington calls it. However, our intellectual understanding and our emotional capacity are often not so well aligned and thus we reach to the intellect to pathologies. One of the vehicles employed to circumvent pain.
Thank you for this very thoughtful comment, Rosealeen.
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Robert D. Stolorow, Ph.D. is one of the original members of the International Council for Psychoanalytic Self Psychology, which stems from the work of Heinz Kohut.
When and how should we open up to loved ones?