Is Grief a Medical Disorder or a Part of Life?

California sunriseEvery once in a while I write a post that really strikes a chord with people, and such a post was The Half-Life of Grief. It’s garnered over 126 shares on Facebook alone, so apparently it’s an important message: grief is not simply emotional, but it’s physical, too. And if it’s physical, then no amount of sublimating our emotions will get rid of the grief. It’s in our very cells.

This is a message that the American Psychiatric Association doesn’t get. According to the updated Diagnostic and Statistical Manual of Mental Disorders to be released by the American Psychiatric Association, grief is considered a medical disorder, and should be treated as major depression. There used to be a bereavement exclusion in the description of major depression, but they have taken that away, and now more than a few days of pain after the loss of a loved one is considered a crisis. There can be “a few days of acute upset and then a much longer period of the longing, the tearfulness. But typically sleep, appetite, energy, concentration come back to normal more quickly than that.”

As I said in 2010 when I first posted the information about the APA getting rid of the bereavement exclusion: In whose world is grieving a medical condition that needs to be treated? Not my world. In my world, grief is one of the bookends of a relationship. Love. Grief. If grief is a medical condition, then watch out. One day love is going to be considered a treatable disease.

During the past couple of years, there has been a concerted effort by grief counselors, therapists, and other health professionals to rectify this gross misrepresentation of grief, but the American Psychiatric Association is sticking to their decision that grief is a medical disorder.

A medical disorder? For cripes sake, it doesn’t take a fistful of degrees to understand that for the majority of people who have lost someone important in their lives, grief is a completely sane and healthy reaction. So what if grief is hard? Someone we loved dearly is gone from our lives and will never return. What do they expect us to do, just blithely continue with our lives as if nothing important happened? As if the dead had never even existed? As if we’re happy about the situation? And even if we wanted to be joyful despite it all, there is the simple matter that our bodies also grieve, and we’d have physical reactions even if we were drugged into placidity.

I realize that in certain cases people do entertain thoughts of suicide, but those thoughts are part of the grief process. It’s only when people start stockpiling pills or buying guns or starving themselves on purpose that grief might become a medical concern.

Admittedly, some people do manage to continue after a major loss as if nothing happened, and to be honest, I thought I would be one of those people, but death and loss have a way of making themselves felt even in the strong and stoic.

It might seem from these grief posts that I dwell on grief, but I don’t. I dwell on life. And grief is part of life. I understand that. And so should the American Psychiatric Association.


Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+

Grief and Our Lizard Brain

Last August I posted a couple of bloggeries about the American Psychiatric Association’s decision to consider grief a medical disorder that needs to be treated as major depression. (Grief is Not a Medical Disorder and One Woman’s Grief.) As I explained, there used to be a bereavement exclusion in the description of major depression in the APA’s Diagnostic and Statistical Manual of Mental Disorders, but they have taken that exclusion away, and now more than a few days of pain after losing even a life mate or a child is considered a crisis. There can be “a few days of acute upset and then a much longer period of the longing, the tearfulness. But typically sleep, appetite, energy, concentration come back to normal more quickly than that.”

A therapist friend who also lost her mate reminded me of this recently. She wrote, “The DSM-V team is still trying to say that someone two weeks after a huge loss of any kind who is still showing symptoms (like depression) is mentally ill. That is the world of Psychiatry. Lots of mental health folks including me are rebelling as that book is the bible and they are desecrating people who grieve. . . .”

After studying grief from both the inside (my grief) and from the outside (communicating with hundreds of others who have suffered grievous losses), I’m not certain that grief is a psychological matter, let alone a medical one. I have suffered a couple of severe depressions in my life, so I am familiar with that black pit, but grief is something completely different (though depression can be a side effect at times).

Grief seems to be more visceral than mental, coming from somewhere far beneath conscious or even subconscious thought, perhaps from a place known informally as our “lizard brain.” The lizard brain is the pre-verbal part of us that communicates with the rest of the body by means of chemical and electrical signals. It automatically controls our bodies and our survival mechanisms, such as breathing, heartbeat, body growth and maintenance, establishing territory and nesting, the fight/flee/freeze response to threats, and the ability to adapt.

Perhaps most grief could be considered emotional or mental distress. When my brother and then my mother died, my “acute upset” lasted a few days, and within a month, I was back to normal, so my grief fell right in line with the American Psychiatric Association’s guidelines. But when my life mate/soul mate died, I felt such grief I had no words for it. (I’ve spent the last two years looking for the words, hence all my writing about grief.) I felt a feral, animalistic pain, from somewhere so deep inside I’d never been there before. I felt as if my psyche was a bloody stump where he had been ripped away.

When you are profoundly connected to another person; when their well-being is as important to you as your own; when the two of you share the air you breathe, the electrical emanations from your hearts and brains, the atoms in the atmosphere, the cell information that gets passed one to the other via viruses, you grow so entwined that in many ways you become a unit. And your lizard brain adapts.

When your loved one dies and the unit is dissolved, your lizard brain goes into a panic. Where is the rest of you? What happened? What do I do? Do I freeze you? Make you run? Make you fight? It sends so many chemical and electrical signals throughout your body, setting off a cascading series of hormonal reactions, that it leaves you feeling bewildered and traumatized. This is all in addition to your so-called “normal” grief. (Since the lizard brain also controls reproduction, this could account for the overwhelming arousal some people feel when dealing with a mate’s dying.)

When your loved one remains dead, the lizard brain comes to understand that it, too, will die. And then it really goes into a panic. Until that moment, it only knew survival. Life. But now it also knows death. It feels what death means. And consequently, so do you. Despite the psychiatric world’s belief that grief needs to be treated as major depression, no amount of drugs or therapy or medical intervention can undo this new knowledge.

So much of grief is about pain, yearning, angst, loneliness, but it is also about panic — that falling-elevator feeling you get when you remember you will never see your loved one again in this life. It is the panic of finding yourself in a suddenly alien world. And it is the panic of a creature who has no words to communicate what it feels. At the beginning, I used to scream. It was the only way I had of giving voice to the realization of my mate’s death, but the screams did not come from my lungs. They were visceral, like the screams of a tormented beast.

Grief has taught me many things. I’ve learned how to bear the unbearable. I’ve discovered that by daring to be vulnerable I can reach out and touch strangers as they touch me. And I know, with utter certainty, that beneath my conscious mind, beneath my subconscious, there lies a creature so primal that until two years ago, it did not know it was finite. And now it grieves.