Something wasn't right with Davina Rivers. Seven years have passed since my husband died, and I still grieve for him every day, and I wish he was here to see me. She had suffered from depression before and thought her grief had settled into a kind of depression. Eric and Rivers were married in 1998 and have three daughters. She talked to Eric's brother to celebrate the achievement of one of her daughters. I just thought about how different our lives are after he said, "Oh, yes, I thought about him one day this week." Whenever I wake up, I feel like I miss him.
She has met other widows on the internet. People start new relationships and get married and have great happiness in their lives, but I don't see that for myself. I think my husband was my one. She says that losing him has changed everything. After her husband died of motor neurone disease, Rivers went back to work as a podiatrist. It was very hard for me. The trauma had a huge impact on me. I became a bit shy. I stopped going out because I didn't want to burden anyone. It's almost like I don't like people seeing me when I walk I'm able to get up and go to work, but it's hard to go for a walk. She said that she thought there was something wrong with her.
In March, after years of wrangling, the Diagnostic and Statistical Manual of Mental Disorders officially recognised long term grief as a mental illness. People who meet the criteria for being in intense grief after a year will be able to have their treatment covered by insurers. Even though the DSM is not used in the UK, it is influential, even though it is criticized for medicating and labelling common human experiences.
Rivers doesn't think it's a medical problem that needs to be fixed If she isn't healed because of grief, that is a societal problem, not a medical one. Society puts you under a lot of pressure to get over something.
Ultimately, grief can be a really transformative experience; it can change who you are as a person.
Lucy Selman is an associate professor at the University of Bristol and founder of the Good Grief festival and she says there are pros and cons to this new diagnosis. Mental health advocates have argued against the way the DSM divides up different conditions in the past. There is a lot of recognition of the damage some of those labels can do to people and how they can stick with people for a long time. It's a bit of a double-edged sword.
She says the idea that it's something you "recover" from is not helpful. It can change who you are if you go through grief. The idea of coming out of the other side the same as you were before doesn't really hold.
She says that grief has a psychological aspect but that it is more of a social issue. About 10% of people who have more complex responses to grief, so they might get stuck and ruminate, are usually supported by their social networks. She says that people within that group could end up with a diagnosis of long term grief disorder. They may be able to get help with a formal diagnosis.
Selman believes that everyone who has been widowed is likely to need some support. People would be more familiar with what grief is if we were more grief-literate. We would be happy to be there for people who have lost a loved one, as well as sharing how we are feeling. It always surprises me how difficult it is for people to say "I'm so sorry that happened to you" She says the answer to the bigger problem is that our society isn't good at grief.
Queen Victoria never stopped wearing black and no one went: ‘The Queen’s being excessive’
"We have become unaccustomed to dealing with and living with negative emotions and so we very quickly jump to pathologise those, but all those negative emotions that you experience in grief are an absolutely normal part of it." How long will it take me to feel like this for? The terrible ache, longing, and disarray will last a long time. We can't put a time frame on that, but what we want people to be is functioning. Don't expect all the negative emotions and disbelief to leave you quickly, as our benchmark is that as long as you're managing to function, then that's natural grief. She says that they won't go within a year.
Brandy Schillace, editor in chief of the BMJ's Medical Humanities Journal and author of Death's Summer Coat: What the History of Death and Dying teaches us about life and living, says that the concept of a grief that you "get over" is quite modern. She says that grief was seen in the 19th century. Queen Victoria wore black for the rest of her life and nobody said that she was excessive. There were rules to grieve. If you lost your husband, the mourning period was longer than if you lost your spouse. It was different if you lost your children. Time periods were adjusted based on grief. She says it's possible to tell when someone is in mourning. They normalized grief by making it public.
Many children died before the age of five, and they were also more visible, and a state of grieving was considered normal. In the west, we are screened from death and dying. Nobody has to watch when you go to the hospital.
She believes that the change happened slowly. She thinks that the rise of capitalism and postwar productivity has had an impact. The idea of productivity being the optimum state is very American. It doesn't make space for grieving or illness within the concept. A state of non-grieving is what we have created. If you cling to your grief, that is an abnormal way to live your life, as opposed to recognizing that grief is an intimate companion. It's like losing someone close to you. It isn't like getting the flu and getting better. I have to adjust after losing a limb. You don't do the same things again.
Holly Prigerson is a professor of geriatrics and co-director of Cornell University's Center for Research on End of Life Care. She was the first to recognize it in research. She was part of a team researching the effects of antidepressants for the treatment of depression after the death of a loved one. She remembers sitting in meetings where the depression and anxiety scores dropped, but she noticed that the grief symptoms weren't going away. Her colleagues were like that grief is normal. We are psychiatrists, we care about depression and anxiety, and we are happy we are able to help. The only question is: how do you know if grief is not a problem for these people?
It’s like the loss happened yesterday; they’re still in shock and disbelief … stuck in this state of disabling mourning
She realized that thegrief syndrome was different from depression and anxiety when she studied it. What does that mean? Over a period of time, Prigerson found that grief cluster, over and above the symptoms of depression and anxiety, was a better predictor of things like increases in suicidal ideation and hospitalizations for heart attacks. She says it was associated with sleep impairment, divorce and a lot of other negative outcomes.
The criticism of the DSM has confused healthy and normal grief with long term grief disorder. She said it was rare. 4% or less of the people who have died meet our criteria. It is a distressing and disabling level of preoccupation with the dead. We have done studies on how the symptoms of grief change over time after a loved one dies. The majority of people are on the decline after 6 months. It's like someone just pulled the rug out from under them for people with long term grief disorder, they're still in a state of shock and disbelief, they don't know how they're going to get their lives together They are stuck in a sad state.
She says it's not about missing a loved one or experiencing a wave of grief. Everyone has grief. She says that every day she thinks about her mother, who died a year ago. I don't feel like I'm stuck because of the loss. Is it a feeling of grief? That is normal and not cause for worry. It's just being a human.
Therapy or drugs can be used to treat a new disorder. A drug used to treat addiction is being tested again. Prigerson said people were saying that he was calling love an addiction. We aren't saying we're trying to give you a pill that will take away your grief Certain types of therapy have not proved helpful. This is about helping people who are stuck and in a lot of pain. It's not easy to figure out which people would get better in their own time after a year. Prigerson admits that some people with long-term grief don't.
Hone is skeptical about the diagnosis and how it might be treated by people who don't understand grief. Who is training those counselors? What will those counsellors give out? The five stages of grief is the most common model of grief that is still coming out of universities and all kinds of health courses. She says that one of the most common reasons people seek bereavement counseling is because they feel they are not grieving properly. Hone says that it needs to be stopped.
She says that people expect their grief to decrease over time, but that it doesn't happen. We find in our work that it gives people hope. Everybody grieves differently and you have to find something that works for you. It challenges all that you have assumed about the world and the way that life should unfold when you lose a child. Slowly, you have to remake sense of the world again.
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