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Is Grief Healthy or Pathological?

A book review of "Grief: A Philosophical Guide."

This post is a review of Grief: A Philosophical Guide. By Michael Cholbi. Princeton University Press. 219 pp. $24.95

Socrates often described grief as a “sickness,” commonly experienced by women and inferior men. Poetry depicting “wailing and lamentations of men of repute,” he declared, should be censored.

When a close friend he had known since childhood died, Augustine, the Christian theologian, acknowledged that his “heart was black with grief.” He could not explain why he then sought out the places they had frequented and the pain these visits elicited.

In our own time, the Diagnostic and Statistical Manual of the American Psychiatric Association noted that grief involved sadness, anxiety, and mood changes similar to depression, but did not classify it as a mental disorder because it is “the normal and culturally typical response to the death of a loved one.” A committee proposed removing the “bereavement exception” from subsequent editions of the DSM and adding diagnostic standards for “complicated grief disorder.” When critics denounced the medicalization of grief, the editors compromised, eliminating the bereavement exception but rejecting a grief-specific mental disorder.

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In Grief, Michael Cholbi, a Professor of Philosophy at the University of Edinburgh and author of Suicide: The Philosophical Dimensions, provides an informative, sweeping, and provocative examination of grief as a complex phenomenon when undertaken in response to the death of others. Grief, Cholbi maintains, is an intense, multi-stage emotional process that can help us grow by prompting a re-examination of our “practical identities” in light of our estrangement “from familiar patterns previously defined” by a relationship with the deceased.

Cholbi distinguishes between mourning, which tends to be public and ritualistic, and grief, which he associates with distinctive ties of intimacy, love, and/or well-being. Grief is a series of affective states, but they do not necessarily come in the order (denial, anger, bargaining, depression, and acceptance) proposed by Elisabeth Kubler-Ross, and contain other emotions (guilt, fear, confusion).

A “practical identity investment,” which necessarily includes commitments, concerns, and values involving others that are essential to understanding who we are, unites all who grieve. That grief is not “egocentric” and “self-focused,” Cholbi insists, “is an illusion.” More a matter of building from than letting go or holding on, “good grief,” he writes, is an inquiry pursued in service of the backward and forward-looking question: “Who shall I be in light of who I have been?”

Perhaps inevitably, given his subject, Cholbi does not hesitate to speculate. Some of his claims, in my judgment, are less persuasive than others. Cholbi asserts that grief is rational, only to acknowledge that it is “not necessarily and always rational.” He maintains that absent a search for self-knowledge, an essential “good,” grief “may well prove bad for us” and ties his conviction that we have a duty to grieve to that search. Cholbi admits, however, that bereaved persons grieve, “more or less instinctually,” without understanding that they are pursuing self-knowledge. Most important, he doesn’t make a compelling case for his contention that grief “is especially well-suited” to that pursuit.

That said, Cholbi does make a compelling case that although grief is “perhaps the greatest stressor in human life,” altering us physiologically and psychologically, it should not be viewed as a mental disorder. He endorses the view of clinical psychologist Kay Redfield Jamison: “There is sanity to grief, in its just proportion of emotion to cause…” A person who has suffered a grievous loss, Cholbi adds, “ought to experience negative emotion and disrupted functioning.” If and only if these symptoms persist for a protracted period of time, should they be cause for medical concern.

Far more often, Cholbi concludes, “in manifesting several of our most human traits, grief represents our human nature in full flower.”