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Grief

Letting Go of a Relationship: Is Grief a Disorder?

In the context of personal history grief is logical rather than pathological.

Key points

  • Responses to loss are as distinctive as the individuals who experience them.
  • Diagnoses such as prolonged grief may encourage the misunderstanding that grief is something we need to get over.
  • Navigating through the grief of loss may be far more complicated if we are involved in a soul mate relationship that shapes our self-concept.
  • The logic of profound grief remains mysterious, in part because it is as unique as the life stories from which it emerges.

Grief is uniquely personal. Responses to loss are as distinctive as the individuals who experience them. There may be some generalizable similarities and patterns among people, but there is no template for the grief experience. Moreover, the perception that a person has “moved on” from a loss may have little to do with what they feel inside. Many people continue to hold silent bonds with those they loved and lost.

Long Term Bereavement

A recent New York Times article, “How Long Should It take to Grieve? Psychiatry Has Come Up with an Answer” (Barry, 2022) explains the recent inclusion of Prolonged Grief Disorder in the Diagnostic and Statistical Manual of the American Psychiatric Association (American Psychiatric Association, 2022).

Prolonged grief disorder was added to trauma and stressor-related disorders following an extensive review to develop consensus around the criteria for the diagnosis. The disorder involves a preoccupation with thoughts or memories of the deceased and an intense yearning or longing for them (American Psychiatric Association, 2022).

Ten percent to 15% of people suffer from prolonged grief (Boyraz et al., 2015; Neimeyer & Thompson, 2014). Granted, recognizing very extreme grief as a disorder has an upside, such as making insurance coverage possible for those who seek psychotherapy or medical assistance.

In some cases, an identifiable diagnosis can lead a person to perceive their distress is finally understood and can be treated. However, the existence of a diagnosis may encourage the misunderstanding that grief is something we need to get over. It is not.

In an attempt to make sense of the differences between recovery from grief and long-term bereavement, researchers have primarily focused on dependency, attachment styles, and the capacity for resilience (Carr et al., 2000; Denckla et al., 2011; Fraley & Bonanno, 2004). Factors such as interpersonal dependency, an avoidant or anxious attachment style, and limited resilience certainly may contribute to later complex grief symptoms. Yet one often-overlooked dimension of long-term bereavement involves relationships between “soul mates.”

Among my clients, grief is certainly more prolonged and complicated among those who were deeply connected to a lost loved one. Theorists refer to the idea that people in a close relationship may experience a cognitive overlapping of their self-concepts, whereby features of the other are subsumed into one’s own self-knowledge, and they may even confuse the self with the close other (Mashek et al., 2003; Swann & Bosson, 2010).

The soul mate experience involves the sharing of emotional and subjective experiences, including the echoing of intellectual and personal interests that can bind two people together. Thus, navigating through the grief of loss may be far more complicated if we are involved in a soul mate relationship that shapes our self-concept. Psychiatrist Colin Murray Parkes (2015) described the pain of grief as “just as much a part of life as the joy of love; it is, perhaps, the price we pay for love, the cost of commitment” (p. 1).

Many studies based on attachment theories indicate that people for whom deep attachment and dependency fostered a sense of emotional security are most vulnerable to grief problems when the person with whom they were entwined dies or leaves (Fraley & Bonanno, 2004; Maccallum & Bryant, 2008). Individuals who developed a dependent attachment style early in life tend to form later relationships that are concentrated on one person, and that person satisfies their need for human bonding (Archer, 1999; Parkes & Weiss, 1983; Prigerson et al., 1997).

As a result, the attached person experiences profound and prolonged grief when that person is gone. People whose stories are heavily interwoven with the deceased are more likely to view their self-identity as closely linked with the deceased than bereaved people who do not meet the criteria for prolonged grief disorder (Bellet, LeBlanc, et al., 2020; J. G. Johnson et al., 2006; Maccallum & Bryant, 2008). Focusing attention on the absence of their loved one activates feelings of yearning and distress because these people are more likely than other bereaved individuals to recall memories that involve the “lost self” (Maccallum & Bryant, 2008).

The Silence of Grief

Our bonds with a deceased loved one can live on and on, but grief is often silently held in Western culture. Exposing one’s long-term grief may result in social isolation. Researchers have found that regulating, suppressing, or hiding negative emotions tends to foster a griever’s connection to others, allowing them to gain support (Harber & Pennebaker, 1992).

Since emotions such as distress or anguish can create discomfort or stress in the listener, they may limit potential support for the griever (Bonanno, 2012). Therefore, and unfortunately, emotional avoidance and self-deception can be a way of successfully coping in the face of the pain of loss (Keltner & Bonanno, 1997). For example, a study of marital loss in midlife found that smiling and genuine laughter in the bereaved while they discussed their deceased spouses resulted in better relationships with others and evoked compassion and the desire to comfort, as opposed to those who displayed only non-genuine or social laughter (Bonanno, 2012; Keltner & Bonanno, 1997). In Eastern cultures, where there tends to be a more dominant belief in the deceased’s continued presence and a continuity between the living and the dead, the pressure to express positive emotions and “get over” one’s grief is less prominent (Bonanno, 2012).

Is Grief Logical or Pathological?

The grief we experience and the choices we make after a loss are intensely personal. Many people struggle with the process of grief because they never truly get over it; instead, they live their lives while silently continuing their bonds with a loved one. The logic of profound grief remains mysterious, in part because it is as unique as the life stories from which it emerges. For the past 100 years, serious thinkers have attempted to make sense of grief, applying various theoretical frameworks and diagnoses that might give it a recognizable face. But in the context of deeply personal history grief may be logical, rather than pathological.

[This post is excerpted in part from my forthcoming book, Grief Isn't Something to Get Over: Finding A Home for Memories and Emotions After Losing a Loved One.]

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books. 9780890425596

Barry, E. (2022, March 18). How long should it take to grieve? Psychiatry has come up with an answer. The New York Times. https://www.nytimes.com/2022/03/18/health/prolonged-grief-disorder.html

Bellet, B. W., LeBlanc, N. J., Nizzi, M.-C., Carter, M. L., van der Does, F. H. S., Peters, J., Robinaugh, D. J., & McNally, R. J. (2020). Identity confusion in complicated grief: A closer look. Journal of Abnormal Psychology, 129(4), 397–407. https://doi.org/10.1037/abn0000520

Bonanno, G. A. (2012). Emotional dissociation, self-deception, and adaptation to loss. In C. R. Figley (Ed.), Traumatology of grieving: Conceptual, theoretical, and treatment foundations (pp. 89–108). Routledge.

Boyraz, G., Horne, S. G., & Waits, J. B. (2015). Accepting death as part of life: Meaning in life as a means for dealing with loss among bereaved individuals. Death Studies, 39(1), 1–11. https://doi.org/10.1080/ 07481187.2013.878767

Carr, D., House, J. S., Kessler, R. C., Nesse, R. M., Sonnega, J., & Wortman, C. (2000). Marital quality and psychological adjustment to widowhood among older adults: A longitudinal analysis. The Journals of Geron- tology: Series B. Psychological Sciences and Social Sciences, 55(4), S197–S207. https://doi.org/10.1093/geronb/55.4.S197

Denckla, C. A., Mancini, A. D., Bornstein, R. F., & Bonanno, G. A. (2011). Adaptive and maladaptive dependency in bereavement: Distinguishing prolonged and resolved grief trajectories. Personality and Individual Differences, 51(8), 1012–1017. https://doi.org/10.1016/j.paid.2011. 08.014

Fraley, R. C., & Bonanno, G. A. (2004). Attachment and loss: A test of three competing models on the association between attachment-related avoidance and adaptation to bereavement. Personality and Social Psychology Bulletin, 30(7), 878–890. https://doi.org/10.1177/0146167204264289

Harber, K. D., & Pennebaker, J. W. (1992). Overcoming traumatic memories. In S.-Å. Christianson (Ed.), The handbook of emotion and memory: Research and theory (pp. 359–387). Erlbaum.

Johnson, J. G., Vanderwerker, L. C., Bornstein, R. F., Zhang, B., & Prigerson, H. G. (2006). Development and validation of an instrument for the assessment of dependency among bereaved persons. Journal of Psychopathology and Behavioral Assessment, 28, 261–270. https://doi.org/ 10.1007/s10862-005-9016-3

Keltner, D., & Bonanno, G. A. (1997). A study of laughter and dissociation: Distinct correlates of laughter and smiling during bereavement. Journal of Personality and Social Psychology, 73(4), 687–702. https://doi.org/ 10.1037/0022-3514.73.4.687

Maccallum, F., & Bryant, R. A. (2008). Self-defining memories in complicated grief. Behaviour Research and Therapy, 46(12), 1311–1315. https://doi.org/10.1016/j.brat.2008.09.003

Mashek, D. J., Aron, A., & Boncimino, M. (2003). Confusions of self with close others. Personality and Social Psychology Bulletin, 29(3), 382–392.

https://doi.org/10.1177/0146167202250220

Neimeyer, R. A., & Thompson, B. E. (2014). Meaning-making and the art of grief therapy. In B. E. Thompson & R. A. Neimeyer (Eds.), Grief and the expressive arts: Practices for creating meaning (pp. 3–13). Routledge.

Parkes, C. M. (2015). The price of love: The selected works of Colin Murray Parkes. Routledge.


Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. Basic Books.


Prigerson, H. G., Wolfson, L., Shear, M. K., Hall, M., Bierhals, A. J., Zonarich, D. L., Pilkonis, P. A., & Reynolds, C. F., III. (1997). Case histories of traumatic grief. Omega, 35, 9–24. https://doi.org/10.2190/TDYG- MRB4-H5H8-HHR7

Swann, W. B., Jr., & Bosson, J. K. (2010). Self and identity. In S. T. Fiske, D. T. Gilbert, & G. Lindzey (Eds.), Handbook of social psychology (pp. 589–628). Wiley. https://doi.org/10.1002/9780470561119. socpsy001016

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