Mourning without Judgment and Rules
Religions, societies, employers, family members and friends often express views about how people should be mourning, when it is time for them to move on, and how they should express or not express their grief. If a loss has been part of a public news story, microphones are shoved in front of the mourning family members with little respect for privacy and there is often a not so subtle pressure for them to be feeling better very rapidly.
In 2022, the American Psychiatric Association raised some controversy when they incorporated a new diagnosis into the revised Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DMS-5-TR) of “Prolonged Grief Disorder”. This diagnosis is given when a person has experienced a death of a person they were close to at last one year earlier and where since then they have developed “a persistent grief response characterized by one or both of the following symptoms, which have been present most days to a clinically significant degree (which means that they are interfering with daily living), and occurred nearly every day for at least the last month”:
1. Intense yearning/longing for the deceased person.
2. Preoccupation with thoughts or memories of the deceased person.
In order to diagnose whether the symptoms are clinically significant, the following symptoms have occurred nearly every day for at least the last month:
1. Identity disruption (e.g., feeling as though part of oneself has died) since the death.
2. Marked sense of disbelief about the death.
3. Avoidance of reminders that the person is dead.
4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
5. Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with friends, pursuing interests, or planning for the future.
6. Emotional numbness (absence or marked reduction of emotional experience) as a result of the death.
7. Feeling that life is meaningless as a result of the death.
8. Intense loneliness as a result of the death.
There should be clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual’s culture and context.
How much confidence should we place in these criteria? On the one hand it may help mourners to have a diagnosis to point to if, for example, they continue to have difficulty returning to work or other responsibilities. It may help people to feel less alone to see that the pain they are experiencing is recognised and that other people have experienced it.
But we find the diagnosis to be full of judgments and ‘rules’ of when normal grief is considered ‘prolonged’ and we have concerns about the impact on people, especially on mourners who have experienced traumatic deaths of a loved one. The webpage which Bonnie and Ray Vail have created is meant to provide support to “Parents and victims of murdered children”. It is nearly impossible for those who have not experienced such a loss to fully comprehend the layers of grief which are added to what is usually expressed as the worst loss – the loss of a child (as it goes against the usual life cycle when parents would die first) – with the further unexpected horror of your child’s life having been unnaturally ended by another human being. We would like to share that we have not personally experienced this loss, but we have experienced the loss of friends and colleagues to murder and we have worked in our role as psychologists to support families whose child has been murdered. We are moved by the strength and resilience of families who express their grief in a myriad of ways with a variety of strategies for going on living, often one day at a time.
What gives any society, culture, or religion the right to determine when the bereavement has “clearly exceeded” expectations? In the diagnosis, it must be more than a year since the death. Can there not be exceptions in what is considered ‘normal grief’ for those experiencing deaths due to extraordinary circumstances that are senselessly beyond comprehension?
Is it a psychological problem if a person continues to have “intense emotional pain” related to the death or “emotional numbness”? Is it not understandable that people feel estranged from others who have not experienced the loss and who may be complaining about minor inconveniences in life, thereby making it difficult to “reintegrate into one’s relationships and activities”, and is it so hard to comprehend that life may feel “meaningless” when life has been so cruel? Is loneliness for a missed loved one something that a person should “get over”?
Intense yearning and longing for the deceased person may be something that one has to adjust to for the rest of their lives, rather than something which dissipates after a year. Thoughts and memories of the deceased person may provide comfort rather than being judged as being a “preoccupation”.
We have offered our views in an attempt to bring perspective and possibly comfort to any mourners that may be reading this. We believe that everyone should have the right to grieve in any way that they are able to without feeling that they are being judged by mental health professionals as to what the ‘appropriate’ reaction should be. We are against ‘rules’ that do not acknowledge individual differences. At the same time, we encourage anyone who needs psychological help to seek it as we also believe that there are times when it is very important to reach out for support. We are truly saddened to contemplate your loss and wish you all the best in your future.