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How Our Grief Can Linger for a Year or More

How to address prolonged grief disorder.

Key points

  • The most recent publication of the DSM-5-TR added “prolonged grief disorder,” now the focus of intense scrutiny.
  • The American Psychiatric Association gives tips for professionals to help better understand what is considered “prolonged grief.”
  • Some of the symptoms include identity disruption (feeling as though part of oneself has died) and a marked sense of disbelief about the death.
  • Other symptoms include intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
Kristin Meekhof
Source: Kristin Meekhof

The addition of “prolonged grief disorder” to the most recent publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is currently the focus of intense scrutiny. It carves out this disorder as a type of grief that goes beyond a year after a death/loss for adults, and six months for children and adolescents. For multiple reasons, the medical community prefers to view grief and loss as something that can be completed within a short time frame. However, the very structure and nature of grief, with complex emotions and memories, isn't time-sensitive.

After all, grief isn't something like a subscription plan where one signs up for 12 months, and when time comes to an end the healing is done, and one can simply choose to "unsubscribe." Grief is a raw and tender wound; each experience is akin to an emotional tsunami.

This article from the American Psychiatric Association gives tips for professionals to help better understand what is considered “prolonged grief." Some of the symptoms include:

  • Identity disruption (e.g., feeling as though part of oneself has died).
  • A marked sense of disbelief about the death.
  • Avoidance of reminders that the person is dead.
  • Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.

With children and adolescents, I think it is particularly cruel to give them six months or less. In 1979, I was two weeks shy of my fifth birthday when my father died from cancer. Neither my grief as a young child, nor my paternal grandmother’s grief from losing her son, were resolved within these suggested timeframes.

In fact, when I was six and in kindergarten, my class was asked to make Father’s Day cards. This moment came more than 12 months after my father died, and yet, I couldn’t bring myself to tell others he died. Was it denial? Was it prolonged grief? Was it an illness? Perhaps it is because death in many ways is an adult issue that as a very young child I was being tasked with processing.

Whatever the reason as a child, I can tell you not only did I feel intense feelings when people asked my father, but my identity as the daughter of my father was deeply disrupted. And I can also recall my paternal grandmother telling me a full three decades after her son died, she still felt as though a part of had died. She often said, “It was the reverse order of things.”

Parents shouldn’t bury their children. And yet, it happens. Millions of parents lament their children, and they do it with intense sorrow.

The truth of the matter is, no matter how hard the bereaved tries to suppress their sadness, nothing and no one can fill the void. People and relationships aren’t furniture. Simply removing them from one’s line of vision and replacing them with something similar or new won’t mend a tattered heart. What makes the difference is accepting that the death of a loved one significantly alters one’s life. Nothing ever is the same. This doesn’t mean one can’t live with purpose and love after loss, but if grief healing doesn’t happen in 12 months or less it isn’t a sign of weakness.

In doing research for my book about healing after loss, I interviewed over 100 widows. The causes of the deaths varied as did the widow’s socioeconomic status, as well as the types of support (i.e., individual mental health therapy, group support) they sought. Some had children; others did not. And the age range of the children varied from infants to adult children.

Not one woman reported to me feeling their grief was complete within a 12-month time frame. In fact, to the contrary, many widows said their feelings of sadness and grief intensified after the first year because they felt less support. In addition many widows believed they were made to feel something was “wrong with them” if they didn’t feel better one year post-loss. Many widows also reported feeling pressure from others to “get over” their loss and move on.

It would be ideal, if time could heal and transform lives. This time period of 12 months could be used to corner off and redo the less desirable inner parts of one’s life. One could decide what they’re holding on to and what they’d part with, but grief isn’t a happy mix of refreshing one’s life and upgrading one’s inner strength. Instead, what compliments resilience and mental wellness isn’t a stopwatch but rather an understanding that grief can’t be folded neatly into a 12-month planner and seeking professional mental health help for grief is a testament to your depth of love.

Facebook image: simona pilolla 2/Shutterstock

References

American Psychiatric Association (2021). "APA Offers Tips for Understanding Prolonged Grief Disorder". Washington D.C.

Meekhof,K., Windell, J. (2015). A Widow's Guide to Healing: Gentle Support and Advice for the First 5 Years. Naperville, IL: Sourcebooks.

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