Grief

Grief is not considered a mental disorder.  It is not even listed by its own name, but goes under the title of “bereavement” in the DSM-IV.  Most English speakers will typically use the term of “grief” to describe their emotional reaction after the death or separation from a significant other.  The mental and physical symptoms are not readily distinguishable from a Major Depression or an Adjustment Disorder.  About 30% of grief reactions meet the criteria of a Major Depression, and about 10% have psychotic symptoms.

Professionals do not regard grief as abnormal if the worst of the suffering is over by 6 months; a year at the longest.  Death from suicide or a medical illness is increased significantly during the grief reaction.  The immune system is depressed, cortisol levels increase, and there is an increased risk of heart disease and cancerous malignancy during the course of a grief reaction.

Most mental health clinicians will not diagnose grief or bereavement before six months from the time of the loss, though the DSM IV gives 2 months as the guideline.  It is normal to have thoughts about actions one might have taken to save their life or keep the person as an intimate attachment.  Grieving individuals often feel as if they should have died, instead of their significant other.  They typically feel worthless, and experience a profound slowing of thoughts and actions.  There is often impairment in social and occupational functioning for several months.  It is even common to hear the voice of, or see a fleeting image of, the lost significant other.

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It is not the intensity of suffering, but the duration and quality of the suffering that differentiates depression from grief.  Visual and auditory hallucinations are common in grieving, but considered abnormal if they persist longer than 6 months.  Additionally, the hallucinations of a grieving person are always associated with the missing object; never with someone physically present or personally unknown to the bereaved.  For example, if a person experiences hallucinations of their dead father, after the death of their mother, and a voice tells them to kill their brother, this is less grief than a psychotic disorder.  Expressions of worthlessness and regret are directly connected to the missing object; otherwise the grief is likely part of a chronic mental illness.  Thoughts of death are focused on the missing object.  Desiring to die in the place of the deceased, or feeling that life is not worth living without their significant other, is expected and considered normal.  Harboring a plan to commit suicide unrelated to the missing object is severe Major Depression.

I hope this article clears up some of the confusion between normal grief or bereavement at the loss of a significant other, and the more unrelenting chronic forms of mental illness.  Many people are surprised to learn the level of suffering mental health professionals consider normal in the bereaved individual.  They are also surprised that auditory and visual hallucinations of the lost object are common and considered to be within normal limits.  As professionals do not recommend treatment for normal bereavement, family and friends of the grief stricken play an invaluable role.  Mental health professionals may be consulted if the condition fails to lessen, or even becomes increasingly severe.  Most importantly, do not criticize their emotional reactions to the loss.  It is best to be a kind and patient listener, rather than an ersatz psychologist.  Encourage the mourner to talk at their own pace and rate.  Encourage the bereaved to participate in life without being pushy or critical.  Also pay special attention to important dates in the relationship between the bereaved and the lost object.  Mourners may have worked through most of their grief, but find themselves falling to pieces during times when they would have been together; e.g., the Christmas holidays, birthdays, etc.  Please leave comments about this article on grief in the space provided below.