Is Grief a Mental Disorder? No, But it May Become One!
A Different Way of Naming Grief
Let me be clear: most people who experience a major loss or setback do not develop a major depressive episode. Even most people who have lost a loved one are more likely to experience “normal” grief—I’ll have more to say on “normal” in a moment—than to develop clinical depression. Most will recover with simple support, kindness, and empathy from friends and family. Uncomplicated grief is not a disease, nor does it require medical or professional treatment.
But a certain percentage of the bereaved do not travel this benign path of “natural healing.” Many years ago, Freud described a kind of pathological mourning in which the grieving person experiences profound guilt and self-reproach—sometimes irrationally blaming himself or herself for the death of the loved one. Recently, Dr. Naomi Simon and her colleagues have described a syndrome that closely resembles pathological mourning, termed Complicated Grief (CG). This condition follows the loss of a loved one, lasts at least six months, and consists of:
- A sense of disbelief regarding the death
- Persistent, intense longing, yearning, and preoccupation with the deceased
- Recurrent intrusive images of the dying person; and
- Avoidance of painful reminders of the death.
CG is chronic, debilitating, and associated with the development of medical problems, reduced ability to work, and suicidal tendencies. Yet most patients with CG don’t meet the full criteria for a major depressive episode. So—is CG “normal” or “abnormal”?
I often think the term “normal” creates more problems than it solves. If 99 out of every 100 stockbrokers jump off the George Washington Bridge when the market tanks, is their behavior “normal”? Does normal mean “average”? Does it mean “healthy”? Does it mean “one standard deviation from the mean”? When it comes to describing grief, I prefer the terms “Productive Grief” and “Non-productive Grief.” You can also think of these as “Healing Grief” versus “Corrosive Grief”, respectively.
If you have ever lost a loved one, or experienced some other major loss — let’s say, having an important relationship break-up — you may have been fortunate enough to experience “Productive Grief.” Family and friends may have gathered around you, giving you love and support. You felt sad, of course, lost sleep, ate poorly, and probably wept off and on for days, or even weeks. But you appreciated the support of others. And, with time — maybe 4 or 5 weeks, maybe several months — you were able to reflect back on all the good times and good memories, surrounding the lost loved one. You were able to place the person’s death in the larger context of your own journey through life, and actually take quiet pleasure in looking back at old photos and letters that reminded you of the one you lost. In effect, you were able to grow as a person, even as you grieved your loss.
In contrast, the person who experiences Non-productive or Corrosive Grief experiences a kind of shrinkage of the self. He or she feels not only deep sorrow, but also a pervasive sense of being “eaten up” by their grief. Try as they might, friends and loved ones do the person no good: their efforts at comfort and support are rebuffed, or are experienced as intrusive. The person with Non-productive grief usually prefers to be alone, and resents attempts to bring her out of her shell of self-involvement. Often, these unfortunate souls feel worthless, guilty, or “not worth keeping around.” Many of these individuals would probably meet Dr. Simon’s criteria for Complicated Grief—and some will develop a full-blown episode of major depression.
The Fallacy of Misplaced Empathy
Many people who are experiencing intense and distressing forms of grief or bereavement are reluctant to seek professional help. To make matters worse, some well-meaning friends and family do not believe the grieving person should seek help. Why? I already alluded to one reason in my opening vignette: we are heirs to the Puritan tradition, with its emphasis on enduring suffering, and “picking yourself up by your bootstraps.” There is a time for this sort of robust, self-reliant philosophy: namely, when you have “boots”. The severely depressed person feels not only “bootless”, but legless. He or she usually lacks the energy and motivation to get up and get on with life.
I believe there is another reason why friends and family are sometimes slow to see that their loved one is clinically depressed. I call it “The fallacy of misplaced empathy.” This usually takes the form of the statement, “You’d be depressed, too, if…” or “You should be depressed if…” Let’s say that Pete, a good friend of yours, receives a diagnosis of prostate cancer. Three weeks later, Pete has stopped eating, stopped visiting friends, given up his favorite hobbies, and says to his wife, “There is no point in going on. I’m a goner!” He is awakening at three a.m. every morning, and has lost 10 lbs. since his diagnosis. He does nothing all day but sit staring at the TV. He refuses to shave or bathe. What is the proper response on the part of friends and family?
Pies, R. (2009). Is Grief a Mental Disorder? No, But it May Become One!. Psych Central. Retrieved on October 20, 2017, from https://psychcentral.com/blog/archives/2008/10/04/is-grief-a-mental-disorder-no-but-it-may-become-one/