Nancy Berns Ph.D.

Freedom to Grieve

Grief

“Am I Grieving Right?”

We pay a price when labeling grief as an illness.

Posted Jan 27, 2012

We sit at the kitchen table, brushing off the chill of a winter evening. Gloria puts down her coffee mug and reaches for a picture of her children. Through tears, she tells me about her oldest son's life, and quietly laughs when describing his antics. He died three years ago, and she obviously misses him.

After reflecting on her grief for an hour, Gloria mentions that she is not angry about his death. Never has been. Then she turns to me, and whispers in a pleading voice, "Why am I not angry like I'm supposed to be? Why am I still crying three years later? What's wrong with me?

To understand why Gloria asks these questions, we need to look at our misconceptions about grief.

Bereavement research generally goes in one of two directions. Some researchers say there is no universal roadmap for grieving. Each person's grief is uncharted territory.

Then there are other scholars who sketch a universal roadmap for grieving and label people who go "off-road" as abnormal or pathological. Popular applications of the universal roadmap often describe closure as the destination. When people travel a different route, park too long in one spot, or do not want to go in the direction others suggest, they are often defined as abnormal. Frequently, the concern is that people are not getting to the "closure destination" fast enough.

Also, the common myth that people go through stages of grief—such as denial, anger, bargaining, depression, and acceptance—lingers in our culture, distorting our understanding. But contemporary research does not support "stages of grief." In fact, that idea was never based on bereavement research. In 1969, Elisabeth Kübler-Ross introduced her stages of grief model after observing people dying. Soon others took the ideas out of context and applied them to grief.

Gloria wonders what is wrong with her because she was not angry. But people's experiences with grief do not go through orderly or predictable stages. Nor is there a clear ending. Our grieving lessens and changes over time, but we experience waves of grief throughout life.

Some researchers damage our understanding by defining departures from the universal road map as a medical or mental health problem. People who don't grieve the way someone else thinks they should are diagnosed with disorders like "complicated grief," "prolonged grief," "traumatic grief," "delayed grief," "exaggerated grief," or "chronic grief." Grief becomes a disease in need of a cure.

Treating grief as a disease threatens our freedom to grieve. And it will get worse.

The "normality of grief" is on the chopping block in the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM5, scheduled for release in 2013, frames grief as a mental disorder.

Until the DSM5 proposal, bereavement has been seen as an exception to the criteria used to diagnosis major depression. In other words, grief often shares many of the symptoms of major depression, but the circumstances following the loss of a loved one make those feelings and experiences "normal" or "expected."

The new DSM5 eliminates the understanding that grieving is normal. It also opens up the flood gates for pharmaceutical companies, as a whole new wave of people, who used to be seen as "understandably upset" by a death, would now be diagnosed with a disorder and perhaps prescribed unnecessary drugs.

Grief comes in many colors. It can be painful and unrelenting, and sometimes sweet. It is unpredictable, mysterious, and profound. But grief is not an illness.

No wonder people question their grief: Am I OK? Is this normal? Am I grieving right?

Gloria asks what is wrong with her because she still cries for her son, three years after he died. She does not have closure. But neither does she want it.

We pay a price when labeling people with a disorder because they are grieving differently than expected. We further individualize the experience of grief by treating it as a medical problem. Rather than encouraging cultural rituals that increase social support from friends, family, and other groups, we push grieving behind closed doors.

Consequences follow when we force people to use a universal roadmap for grieving, and then judge those who do not follow it as wrong or sick. We deny the normality of grief. We deny the differences in our grieving experiences. We deny people the freedom to grieve.

I look in Gloria's eyes as tears roll down her face, and say, "There is nothing wrong with you."

Nancy Berns is the author of Closure: The Rush to End Grief and What It Costs Us. To read more, go to the blog Freedom to Grieve or her personal page, www.nancyberns.com.