Surviving Profound Grief

"In the current environment, we are likely to see more people whose grief doesn't lessen with time, and whose intense suffering disrupts their ability to function."

Holly Prigerson, professor of sociology in medicine, Weill Cornell Medical College, New York City

"...For a small but significant group of people, grief doesn't resolve. It is ongoing, pervasive, intense and debilitating. This is what we call prolonged grief disorder [PGD]."

"Research showed that neither antidepressants nor standard depression-focused therapy are very effective for complicated grief. That's why we developed complicated grief treatment."

Katherine Shear professor of psychology, School of Social Work, founding director, Center for Complicated Grief, Columbia University

"People ask us 'Am I going crazy?' all the time, and having PGD recognized will validate their suffering and show them there are others suffering in a similar way."

"Sudden and traumatic deaths, and deaths by suicide, are more likely to lead to complicated grief.:

"If the grieving person is dealing with multiple losses, poor social support, has a lot of stress in their life, or a history of psychological disorders or prior trauma -- those are risk factors, too."

Natalia Skritskaya, clinical psychologist, Center for Complicated Grief, Columbia University

 

With over five million deaths worldwide and growing, the international community has faced an overabundance of human deaths and familial grief in the past two years, thanks to the zoonotic SARS-CoV-2 virus causing COVID-19. With those mounting deaths a corresponding number of bereaved people are suffering irretrievable loss and the mental anguish that accompanies such events. It  hasn't helped that during the pandemic relatives have been barred from being with their dying loved ones, nor that rituals long honoured in mourning the dead, have been suspended.

Dr.Prigerson of the Weill Cornell Medical College has studied the anguish of grief caused by loss of a loved one for three decades, in collaboration with researchers from the U.S., the U.K., the Netherlands and Australia, leading to the decision to include a new disorder in the official major guide of diagnosis in the field of mental health problems. 

The natural reaction to the death of someone who is loved is often brought on by internal or external reminders of the time before that final separation; anniversaries and holiday events are particularly evocative of times past and the loss that occurred through death. Those reactions differ from person to person; everyone grieves in their own way. Some mourners speak incessantly of their loss others become more introspective and removed, mourning silently, and alone.

Most people, as time passes, accept something they have no capacity to prevent, learning to live with the loss. Finding purpose and meaning in life post-bereavement and gradually reintegrating into society, difficult as it is. When after the passage of a year following death of a loved one, the daily intense yearning for their presence or constant, limitless thoughts or memories of the absent one continues, PGD can be diagnosed. 

 

Symptoms required for a diagnosis are: identity confusion, disbelief, avoidance of reminders of the loss, intense emotional pain, difficulty engaging with others and with life, emotional numbness, feeling that life is meaningless, and intense loneliness -- where any three of these symptoms qualify an individual for the diagnosis of PGD. While newly designated as a disorder, these conditions have been documented and investigated for countless years under the descriptive of "complicated grief".

PGD bedevils an estimated one in ten people who have lost someone near and dear, an intimate and loving companion. Many might have wondered whether their sorrow might ever lift. PGD is "neurobiologically and epidemiologically different" even while it shares some symptoms with depression and post-traumatic stress disorder, according to Dr.Prigerson. Those diagnosed with PGD are known to be at higher risk of medical problems, other mental health disorders, disability, hospitalization and suicide.

Professionals in the field harbour the expectation that the classification will assist health-care professionals to identify sufferers of PGD so they can be helped properly. Treatments have been identified and practised since the late 1990s and much earlier. An Australian study found grief-focused cognitive behaviour therapy was helpful, a therapy that included noticing thinking traps to mire the sufferers deeper in grief.

Psychotherapy continues to represent a first-line treatment and antidepressants can be useful in the depression often accompanying complicated brief. As well, grief support groups are highly recommended, where other mourners with similar grief problems recount their struggles and a bond is created of sympathetic trust.

"We run a risk of stigmatizing the grieving, reducing their dignity and medicalizing the natural process."

"Some practitioners, especially in primary care after a ten-minute visit, might overuse the new label, over-diagnose and over-prescribe."

Allen Frances, professor and chairman emeritus, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine