Pathologizing Grief – Restorative Grief by Mandy Capehart

Welcome back to Restorative Grief with Mandy Capehart. You are listening to episode 24, titled “Pathologizing Grief.” This week an article published in the New York Times caused quite a stir. The conversations around the new conclusion on grief with a timeline are wild. But, rather than offer my own hard and fast opinion, I wanna invite us into the gray space here. After all, grief is a gray space all its own. It deserves a little nuance. So let’s dive into this article and talk about how pathologizing grief can be helpful and harmful. After all, this is not a new conversation. It’s just becoming more mainstream – and thank goodness it is.

Before we go too far, let’s acknowledge a few things. At no point will this episode hit all the right notes. I’m not going to get through every issue, address every question, or be able to comment on all the impacts of this significant definition of prolonged grief. This is not just about helping grievers get medical intervention, or encouraging grievers to “wrap it up” on their grief journey. There are so many intersections here to walk through. Grief is about so so so much more.

As a quick overview, the NYT article explained that the DSM-5, aka, the Bible of modern psychology, now includes “prolonged grief lasting up to a year” as a mental disorder. To be clear, the field of grief professionals have argued over this topic for decades. We know grief carries no timeline, and the truth is that about 10% of people tend to struggle with adaptation and integration of their loss into their lives. The problem with a lot of the research that finds such a conclusion? It’s dismissive of cultural norms and rife with bias. It ignores a lot of those intersections and all of the privilege that comes along with them. Researchers were using their medical opinions to determine what symptoms of grief were problematic. Whereas grievers know very well that if two of us have a shared symptom, it could be easy to carry for one and devastating for the other.

Let’s also destigmatize the word “disorder.” It’s the opposite of ordered. Meaning when something is out of place, even a spice jar on a rack, it can be disordered. A disorder is morally neutral, friends. I just want us to keep this in mind – because mental disorders and their subsequent correlated behaviors are so easily moralized, vilified, and dismissed. Let’s not be these people – let’s remember we are the people learning to hold space for other humans, no matter what pain or needs they carry.

So at its simplest terms, the DSM is classifying grief lasting a year or longer as a type of disordered thinking. They say this disorder prevents people from integrating loss into their lives that keeps them connected to their memories but also allows them to move forward in a way they find meaningful and satisfying.

I often say life and grief are two sides of the same coin. If we experience life in an orderly fashion, it stands to reason that we would experience grief as disordered, right? But that’s only if you’re measuring life and grief with a black and white framework. In reality, life is not orderly. We may have socially acceptable steps to an ordered, “correctly” established life: You graduate high school after growing up in the American dream family, attending college, meeting a sweetheart and repeating the cycle. There’s nothing inherently wrong with that, either.

But I don’t actually know anyone who lives this ideal life and worked through it in an orderly fashion.
Life is disordered by nature. The natural order is actually more in line with grief, loss, and decay. A few episodes back, we explored the concept of Wabi sabi, an elegant Japanese principle of approaching life. This concept brings us into a more connected way of living, both to nature and through that, to ourselves in the truest sense. It’s kind of like intentional soul minimalism, and in the middle of loss, that is a concept that appeals so deeply to my overworked mind and spirit.

Wabi sabi reminds us that all things fade, and are beautiful in their process of growth and in their decay, and EVEN in their renewal as a new thing. Anyone who loves to sing The Circle of Life from Lion King will remind you there is a necessary cycle associated with our very existence.

So if that is true, why then do we need to classify grief as pathological or as a mental disorder due to duration and disruption of our lives?

I think what may benefit us here is a distinction between grief and grieving. It’s similar to the distinction between emotions and feelings – which many of us cannot actually tell apart. Gaining some language and clarity around the differences helps us navigate what we are experiencing and find a new pathway through it. So feelings are internal responses to stimuli; emotions are the external expression. Grief is the internal response – grieving manifests in our emotions. Makes sense, right?

While one is an internal state, one is an outward expression, and the outward expressions tend to reflect the internal state. When we ignore the internal states, we tend to wonder where the outward expressions are coming from. There’s a disconnection between the two – our insides feel awful but our outsides may look like calm waters, and vice versa.

Or maybe our emotions feel like a tidal wave, and grief sometimes is exactly that wave – ready to drown us when we thought we were handling loss well. And we probably were handling loss well. There have been days and entire weeks in the last six years of life without my mom on earth that felt like a tidal wave, and I’ve been keenly aware of my grief – processing and holding space for myself as needed. I would call those sudden waves expected, as much as they can be, because memories are powerful and can be as real as the chair beneath us when they emerge unexpectedly.

When our outward expressions do not match our internal states – whether that is intentional or unintentional, we are out of alignment. We could easily call it disordered, because there is a whole being within our physical body that requires alignment to function and engage our lives as we intend. If we are whole beings – mind, heart, body, and spirit – then we need the reminder of how to care for each part of our whole.

Grief distracts us from finding realignment / one area of our being hurts the most, sounds the loudest, and gets the most attention. That’s a reasonable response.

I think this is where we get into the mud classifying grief as a disorder after a certain timeframe can be helpful, as well as harmful. If you’re the person with a steady support in your life, one who knows they’re grieving and is actively looking for ways to process the loss and find hope, your ongoing misalignment is already somewhat clear to you. While you may not yet feel empowered to move forward or have total clarity about what works for you, your attention to the griefy center of your life is your secret sauce – you are doing the work, no matter how small the steps may seem. And it might take a really long time – and that’s okay.

But if you’re not the person with steady support, you can experience an isolation that deepens your grief. I think this is where so many of us exist, wondering if anyone can handle us and concluding that most cannot. We assume (often rightly so) that people don’t want to hear about our story or cannot hold space, so we quiet our pain and try to push through our days. Before we know it, a year has passed and we feel just as confused and hurt as day one of our loss.

This is the point where a grief “diagnosis” could be helpful. When you’ve been conditioned to stay quiet and alone in your pain, an outside perspective can be a boost to your confidence. This may help you find what moving forward looks like for you, as well as teach you some methods of creating the steady support you need.

But it can also be so very harmful. For the unfamiliar, grief appears as a mental problem to be solved. As if a quick visit to the doc and a prescription can heal our pain. This is a point where grief supporters might check out – they could too easily assume you have professional help, meaning they no longer bear a responsibility to your relationship for deeper connection or compassion. This is subconscious, of course. We hope no one could intentionally dismiss our pain so easily.

When you unpack the core concepts of the NYT article and the rationale behind the conclusion, you can start to understand why specially trained grief professionals and grievers are upset. We are working to create understanding and include the layperson in grief literacy education. Slapping a label on grief as a slow burn mental disorder dismisses the general public’s responsibility to their fellow human to engage and learn. Grief professionals know that grievers need true, helpful, loving supporters to heal. I’m over here now concerned that the conversation is going to shift toward even more dismissive behavior for those actively grieving long term.

However, I will say this. If I decided for myself at the one year mark of grief to take a more clinical approach to working through my loss, I don’t know if we would be here today. The entire healing process I experienced included learning about the brain, the human emotional body, and the psychology of loss. This was my own path, and it took me over a year to start digging into the topics in the first place, because of grief brain! Grievers struggle to read – often for years – because of brain fog and that alone can elongate the grief process simply because we can’t focus.

Everyone I respect in the field agrees that grief is an individual process, impacted by cultural, social, economic, political, religious differences. There are variables we cannot even begin to comprehend in a person’s grief story, and that’s just it. We know a formal, medical definition to grief is not the solution – maybe it will create some resources; maybe not.

I don’t have the answer. But I do know this: We are talking about grief. On the main stage. From the microphone. In the NYT and the daily news shows. We are discussing loss and helpful methods of healing online, in chat rooms and Twitter feeds. In public forums, we are embracing the idea that loss is not meant to isolate us. We are becoming united in our common experience of grief, and while we move through grief differently, we are beginning to acknowledge our shared humanity. We grieve as we live – for some, a quiet introspection. For others, it’s with a passionate outcry and big expressions. So if I could offer you one last thought about this prolonged grief business? Keep telling your story. No amount of pathologizing, research, or intellectualizing about grief can diminish your lived experience unless you allow it to do so. Be open. Share your insights and understanding. Your contributions add richness and color to our understanding of loss and life. Continuing the conversation about loss in public, whatever that looks like, means we are collectively increasing our grief literacy – our experiences of loss and how it changes us. And that will never be a negative.

Thank you for listening to episode 24 of Restorative Grief. It’s safe to say that we are navigating some uncharted and yet familiar territory this week. Increasing grief literacy in the world is the reason I started in the field. This morally neutral life event we all experience brings no conclusions – other than we are woefully underinformed about the “meaning of life” and how the world works. The article this week, however, triggered so many people. Some of the responses I read were accusatory, fearful, or just plain enraged while others were quietly curious and thankful. There’s no right response. But if you were like me and experienced a trigger, consider it a small waving flag from your heart. You might be misaligned internally, and need a little support for your healing journey. If you think that might be true for you, I would welcome you to join our Restorative Grief Project on Facebook for some insight about triggers, alignment, and tools to move through the fog. Talk therapy, medical intervention, social support groups, journaling – they’re all necessary and powerful methods of interrupting the unhelpful narratives we internalize seasons of loss. And no matter how long they last, each method is meaningful – so don’t let any news article tell you otherwise.

If this is your first time listening to Restorative Grief I just want to THANK YOU for showing up and sticking it out. We would love for you to subscribe and leave a review wherever you listen, and maybe share this episode with someone you know was just riled up about that article. It can be helpful to hear another perspective on the thing. Diffuse that bomb, if you will.

One last thing – please remember, the only solution for grief is to do the work of grieving. Thanks for listening – I’ll see you next week.

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