How We Misinterpret (And Pathologize) Grief
What People Who Are Grieving Should Know
Posted September 7, 2011
People react to loss in different ways. One mistake, as I see it, in the medical and psychological literature is that there is an assumption that we all grieve the same way. Further, there is also a disquieting trend to label grief reactions as normal or abnormal.
I am wary of descriptions of pathological grief or even descriptions of so-called normal grief. In almost twenty years, I have seen people react to loss in a variety of ways. Seeing people who have lost their partners after decades-long marriages has made me hesitant to diagnose people who are bereaved. I have seen many men and women reporting good relationships who have lost their partner in the fourth, fifth, or even sixth decade of their marriages. Such a loss cannot be comprehended by those who do not have close marriages or who do not have marriages that have lasted this long.
I remember one man telling me after his wife of nearly sixty years died, “Everything we did, we did together. What am I supposed to do now? We talked about it—death—we did. But we never really knew how each of us would manage.”
This man did go on to develop symptoms consistent with depression, well over a year after the death of his wife. Yet, I found myself thinking, “Who am I to judge his response? This hardly seems abnormal, given the context.” Especially at the time, I was relatively young and felt ill-prepared to pronounce his condition, as we often do when we diagnose people.
But even now, I find myself critical of models of grieving that are so prevalent in the fields of medicine and psychology. Contrastingly, I have seen people in long marriages seemingly move on quite well after losing a spouse. Some people might look for another partner right away and some never think of being with a partner again. Either way, as long as people are comfortable with how they do things, I am reluctant to make a determination.
Relationships are unique. We can never really know what two people mean to one another.
When we diagnose grieving and the consequences if it, we assume some special knowledge about a relationship that we have had no part of.
I am not alone in this thinking. Other authors have criticized North American models of grief that include the assumptions that 1) grief follows a specific pattern, 2) the experience of grief is finite, 3) grief occurs in stages, 4) prolonged grief is abnormal, and 5) the “working through” of the grief process is necessary. The authors
Breen and O’Connor point out that the way some have framed “normal” grief reactions sets patients up for being pathologized; when patients show too much emotion or,
contrastingly, not enough, they are perceived to be grieving in the “wrong way.”
Indeed, there is a curious tendency to evaluate where someone is in the grief process.
An article by Megan O’Rourke in a 2010 issue of The New Yorker talks about a “one size fits all” model for grief. O’Rourke points out the inherent problems in stage models of grief. People fluctuate in their feelings about loss—sometimes they feel okay and sometimes they do not. Some people can be remarkably resilient about grief. Some people simply do not need to grieve intensely, even if someone they love has died.
That being said, O’Rourke points out an interesting paradox: in countries with fewer mourning rituals, people who are grieving report higher levels of physical symptoms (often a marker of grief) in the aftermath of a death. In other cultures, there are more rituals around grief. In the United States, certain religions have expectations around grief (funerals, sitting shivah, and so on), but our culture as a whole has a curious idea about grief: it should last about a year, and people should move on after that.
But what if loved ones can’t or don’t feel like “moving on”? And what does moving on even mean? Does moving on mean looking for a new partner a year after someone has died? What if someone does not wait a year? What if they never want to find a new partner?
Since grieving involves relationships, actual feelings of grief may be related to how a relationship was valued and understood. If a relationship was close, grieving might be more intense. If not, then grieving might be less intense. On the other hand, even people in close relationships may not necessarily grieve intensely. People have all kinds of different strategies for managing emotions. My point here is that individuals, as well as relationships, are complex and unique. Grieving is similarilarily unique. Ideas about what is normal should not be imposed.