I never wanted to be a grief expert. I mean, who wants to be extra-conversant in sadness and death and forever known as a bummer at parties?
But since my husband Scott died unexpectedly from a heart attack almost seven years ago, I’ve spent a whole lot of time writing‚ talking and speaking about grief. So many people, unfortunately, can relate, because, as much as this sucks, we will all lose someone to death. The subject still weirds us out because there’s a real societal stigma that outwardly grieving is considered weakness, or even illness.
In reality, when we shut down our emotions out of fear of judgment or rejection, we shut down some life-changing conversations. It’s important to distinguish grief, the culmination of the loss we feel inside, from mourning, which is the outward expression of those feelings. Since the end of Victorian times there’s been no standard length of mourning, but people are generally expected to go back to normal within a few weeks, or whenever they have to go back to work, or when all the sympathy chicken is gone.
Grief is like a lake inside your body you can’t swim out of, suffocating and lonely. My extreme reaction to my loss — sleeping, overeating, drinking too much and melodramatically screaming at God while collapsing against my husband’s recliner — lasted for about a month. I finally started shakily emerging from my cocoon, starting therapy and pulling it together because I was now a single mother and the toddler couldn’t drive.
So I know personally how being able to say, “I’m so lost,” and finding out that I wasn’t the only one who felt that way, saved me and others. I did a lot of talking after Scott died. To my therapist. To my mom, also a widow. To anyone who read the book I wrote about the first year of my widowhood as a form of therapy, and just to release this heavy anvil of pain out of my body. To other sad, flailing people who just needed to know that they weren’t alone, and were relieved to find other people to grasp onto, to stop from going under. And we didn’t. I’m so grateful.
So I wasn’t sure what to think about “prolonged grief” being added to the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,” or DSM-5, sometimes called the psychiatric bible. The term describes an intense, debilitating grief that lasts more than 12 months in adults and more than six in children. People may suffer from “identity disruption,” meaning feeling parts of one’s self has died along with their loved one, and meaningless and intense loneliness, according to Dr. Daniel Hoover, a clinical child and adolescent psychologist at Kennedy Krieger Institute.
“They’re not only having difficulty functioning, but their reactions don’t get better as we might expect they would,” he said.
Many mental health professionals and advocates believe that acknowledging what the purported 10% of grievers feel is not just “in their heads” will make it easier for them to get therapy and other help that might not have previously been covered by insurance. Everyone should have access to that sort of care, whether or not they can pay, so this is incredibly important.
But — and you knew there was a “but” coming — grief is a tricky, personal thing. I’ve given workshops on how to navigate well-meaning but overstepping friends and family who think people should just get over their grief within some arbitrary timeline. Everyone’s got an opinion, and they can make people, including many I’ve met, afraid to talk about their feelings lest they look, well ... crazy.
Of course, I’m not a doctor, just a grieving person with a book and a bunch of Twitter followers who has been fortunate enough to share my experiences with people all over the world, even Hoda and Jenna on the “Today” show. And though we’re past those Victorian norms dictating how long you must wear black, and cease having outward joy of any kind, there are still so many suffocating ideas surrounding grief and how we practice it.
We don’t like acknowledging our mortality, even inside a pandemic that has killed so many of us. We’re all grieving something. And I’m worried that for all the good that this new designation will do, that some who are struggling even a little will be a little less likely to even start the conversation. It’s hard enough to admit what you’re feeling without worrying that everyday people will think any expression of despair or pain is mental illness. And that’s the opposite of what we need.
There sure are a lot of opinions about this DSM-5 news. Some, like me, are wary — “Our belief is that grief is far too nuanced, textured, and dynamic to fit into a DSM diagnosis,” wrote grief experts Hope Edelman and Rebecca Soffer on Modern Loss, a site that encourages the open conversation about grief, and for which I have written.
Others, including some close friends in the mental health field, think the diagnosis will save lives. Dr. Hoover, who understands grief both as a veteran professional treating kids and young adults and as a widower of 2 1/2 years, thinks both camps have a point.
The pros, he says, are that recognizing grief, in any way, as a normal part of life that shouldn’t be ignored, is a good thing. Rather than “downplaying the more severe variants, identification of it in people who are suffering greatly calls attention to it. It helps them to get help, to call it what it is, to give it recognition so people get help.”
The cons he identifies match my and Modern Loss’s misgivings — that the diagnosis can “pathologize normal progress.”
“There’s such a stigma about mental health problems, and some people think that if we start diagnosing them, people will become sensitive to being labeled as grieving,” he said
Prolonged grief disorder, Hoover says, basically considers an equation — the depth and intensity of grieving rated against the length of time that grieving lasts. Even the timeline can be up for debate; children and adolescents may grieve longer if they have had a traumatic experience.
In his own life, Hoover says he can vouch for the difficulty even close friends and family can have talking about grief — especially men, who are stereotypically not generally enthusiastic about sharing feelings. Unlike his new wife, also a widow who “had tons of support and people asking how she was,” his guy friends were not so direct.
“They would say ‘Let’s go to a game,’ and not a word was spoken,” Hoover said. “If I ever tried to speak [to them about grief] they’d go quiet, and they’re really good dudes. Going to a game is pretty good, but not necessarily what we need.”
Hoover isn’t sure that the new diagnosis will change the stigma about grieving and mental illness, but said that he sees other benefits. “If more people can eventually get the help they need, to be able to work on [their] trauma and have the funds to pay for it when they really need help, the pros outweigh the cons,” he said.
Again, I’m not a doctor, just a lady who finds herself tagged in these discussions a lot on social media by people wanting to know what I think. And what I think is that we need to talk more about how we’re feeling in general and about what we’re grieving, specifically.
We need to know that we can talk about our lost people and our pain. We need to name them, openly remember them, and even laugh about irritating things they did without shame. (Every time I go to Towson Town Center I recall a particularly gnarly Black Friday standoff with Scott over a stupid pair of $65 Ravens shorts he wanted. NOBODY NEEDS THAT.) And, yes, if that pain over our dead loved ones makes it so we wish we were dead, too, we should be able to get help.
If this diagnosis makes that possible, I’m all for it. I just hope it won’t discourage all of these important discussions about grief we’ve been having in our currently struggling world. It’s amazing to see people opening up, slowly. And we can’t stop now.