A new psychological diagnosis entered the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) this week: prolonged grief disorder.
The condition, also sometimes called complicated grief, is a controversial one. Grief, of course, is a normal process. It comes about as the result of tragedy: the death of a loved one, ending a significant relationship, or losing independence through disability or illness. These are difficult situations that require mourning and may take a long time to work through. And given the changes that the pandemic has caused in our lives, as well as the 37,000 Canadians who have died from COVID, there are lots of reasons to grieve — but whether or not grief requires medical treatment isn’t always obvious.
But grief is now considered a disorder for people who are unable to resume their daily lives a year after their loss, according to the New York Times.
The American Psychiatric Association (APA) describes prolonged grief disorder as when someone experiences “intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
Symptoms, according to the APA, include many of the normal qualities of mourning, including intense emotional pain and loneliness, a sense of disbelief about the loss or deliberately avoiding reminders of what’s been lost, emotional numbness, and difficulty pursuing interests or connecting with friends. Studies have show that living this way comes with significant health impacts — increasing the risk of medical conditions, like cancer and high blood pressure, as well as mental illnesses like depression and suicidal ideation.
It’s always existed, but we didn’t know what to call it
Some experts say this kind of withdrawal into an extended period of grief has always existed — we just didn’t have a name for it.
“They were the widows who wore black for the rest of their lives, who withdrew from social contacts and lived the rest of their lives in memory of the husband or wife who they had lost,” Dr. Paul S. Appelbaum, chair of the committee that made changes to the DSM, told the New York Times. “They were the parents who never got over it, and that was how we talked about them. Colloquially, we would say they never got over the loss of that child.”
Others, though, worry about pathologizing a normal part of how people function. “We run a risk of stigmatizing the grieving, reducing their dignity and medicalizing the natural process,” Allen Frances, a professor and chairman emeritus of the Department of Psychiatry and Behavioural Sciences at the Duke University, told the Washington Post. “Some practitioners, especially in primary care after a 10-minute visit, might overuse the new label, over-diagnose and overprescribe.”
Treatment that’s shown to be helpful for people struggling with prolonged grief includes psychotherapy similar to what’s used with victims of trauma — that is, developing a narrative for what they’ve experienced, Robert Neimeyer, director of the Portland Institute for Loss and Transition and a psychology at the University of Memphis, told the Washington Post.
“After loss, we need to reconstruct life meaning and find a way to reinvest in living,” he said.