In today's world of rush, rush, rush, there's often no time to say goodbye to a loved one when they die. Yet, our priorities must change. Dying is a part of life. It can't be avoided, however much we wish it, and must be accepted and dealt with.
Let's say it's been two years since your father died and your mom still won't go out socially or stop talking about wanting to join him. Similarly, perhaps you can't shake a sense of meaninglessness into your life as the anniversary approaches of the death of someone close to you. This is exactly what prolonged grief disorder is all about.
Prolonged Grief Disorder (PGD), previously called complicated grief, has now become a recognized mental disorder. Researchers at the Dana-Farber Cancer Institute in Boston developed and tested standard criteria for identifying the condition, based on the input of a team of experts in bereavement and mood/anxiety disorders. It is shortly to be included in the Diagnostic Statistical Manual of Mental Disorders (DMV-5), the psychiatric care bible for diagnosing problems. The research was done with widows and widowers but is also applicable to the general population.
What is important to recognise is that grieving is neither unhealthy nor unnatural. On the contrary. Mourning is a necessary process that also happens to be difficult to deal with. It can take many different forms, depending on the individuals involved and their relationship.
The difference with prolonged grief disorder is that the grief reaction is much more prolonged and causes such psychological distress as to create substantial disability. Laypeople tend to say someone is ‘paralyzed with grief' or ‘unable to move on'.
Some might ask whether this is merely a way of medicalizing grief. But, mental health professionals make a persuasive case against this hypothesis. For one thing, along with poorer quality of life, the health risks associated with prolonged grief disorder include increased rates of suicide, cancer, immunological dysfunction, hypertension, heart problems and other adverse health behaviour.
And the good news: talk therapy geared to this prolonged grief can successfully treat it. This kind of therapy is not designed to make the griever ‘get over' the loss of a loved one, but to allow him or her to be able to cope with the loss in a functional, more healthy way. That's why diagnosis is so important. It can steer those in need to the right kind of support.
Signs to watch out for.
Warning signs of prolonged grief disorder include yearning to be reunited to the extent that it causes physical or emotional suffering, as well as at least five of the nine following symptoms still being experienced six or more months after the loss:
A stunned, dazed, or shocked feeling
A feeling that life is meaningless
Bitterness or anger over the loss
Mistrust of others
Difficulty accepting the loss
Avoidance of reminders of the deceased
Difficulty moving on with life
A feeling that part of oneself has died
Some people don't begin to have symptoms until six months after the loss; they have higher incidence of thinking about suicide and lower quality of life. Others experience acute symptoms immediately that continue for a year or more; they also tend to experience major depression, post-traumatic stress disorder and generalized anxiety. People in both situations have a ten-times higher risk of a depressive disorder than those whose grief runs a more conventional course or who are treated.
But, is the modern way of dealing with death actually contributing to Prolonged Grief Disorder?
There's no data (because this is still a ‘new' disorder). However, the modern emphasis at the end of life on hope, survival and high-tech ‘fighting' to prolong life, even in final-stage disease where the prognosis is clear, may leave families all the more unprepared for eventual death.
Sometimes hospice nurses report scenarios where, say, a middle-aged man sits at the bedside of his dying father. Each day his father is shorter of breath and one day closer to death. The son invariably continually requests treatments his father may not want or need. When asked how long do you hope for your father to live?", the son will reply:"I don't ever want my father to die".
Death is the inevitable process none of us relishes. But, we must recognise that it is an entirely normal process for the generation above us to die at some point. We must accept it and make sure that our loved ones go through as dignified and pain-free a death as possible. What is less acceptable, and more difficult to deal with, is when the dying process occurs out of synch, e.g. the generation below us.
Therein lies the rough road.
Whatever happens, we must allow the grief to come out and to remember our late relatives as they were in life. That way, there is less likelihood that our grief will become prolonged and an actual mental disorder.