Grieving after a loss normal, not a disease

LITTLE ROCK — As each year ends, we look toward the future, to new beginnings, a clean slate, and we resolve to make the new year a better year than the last. So grief is the last topic I would prefer to write about now. But sadly, we cannot choose the time when tragedy strikes our nation or ourselves.

The senseless murder of 26 people, 20 of them children ages 6 and 7, has deeply wounded our nation, our leaders and us.

Grief was in the news already as the new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is scheduled to be released in May. Hundreds of psychiatrists worked in groups beginning in January 2010 to develop revisions to the manual, which was first published in 1952 and characterizes mental diseases and documents the criteria needed to make a diagnosis.

Most controversial is the recommendation by a group of psychiatrists that grief should be labeled a disease after as little as two weeks. This condition is referred to as “abnormal grief,” “prolonged grief disorder,” “traumatic grief ” or most frequently “complicated grief.” Ten thousand mental-health professionals have signed a petition asking for independent review of this classification.

Virtually every grieving person experiences profound sorrow and sadness, disbelief, loneliness, anger, insomnia, inability to concentrate and an unwillingness to engage in normal conversation. Grief may express itself through crying and wailing or complete silence and withdrawal.

The key question is how quickly should a mourner no longer grieve? Labeling grief an illness after as little as two weeks may lead to inappropriate and excessive use of antidepressants (which are not without side effects) and the recommendation for grief counseling, which has been shown to be of little value in the healing process except for those with mental disease.

The late psychiatrist Elisabeth Kubler-Ross was the first to describe characteristics of profound grief.

First comes denial (this cannot be happening to me),

Then anger (we must blame someone, ourselves, God),

Next is bargaining (if only things get better, I promise that I will do something in return),

Then depression (profoundly glum, do not want to be involved in life, and even have thoughts of suicide), and finally,

Acceptance (understand that death is part of the circle of life and, despite the loss, become peaceful and able to function fully in the community).

With acceptance comes gradual recovery.

Death, like birth, weddings, celebration or illness, is a natural part of life. But whenever death comes, it is always a traumatic and life changing experience for those left behind. Because grief is natural, there has been a backlash against the new recommendation, with many experts believing that a much longer time (six to 12 months or more) is needed before continued grief becomes abnormal, in which case symptoms are similar to any chronic depressive disorder.

So how should we deal with grief or support a grieving person?

Much of the advice often given is incorrect. Becoming distracted, going back to work and ignoring the pain will not necessarily make grieving go away more quickly. Pretending nothing has happened or being “strong” and unemotional will not help. Feeling very sad, vulnerable and lost are natural, and sharing these intimate feelings with those who love you will help the healing process.

Grief is difficult to watch, and a grieving person is particularly difficult to support.Many of us wish to avoid thinking about death at all costs, find it uncomfortable to be around those who are mourning, and tend to stay away - a mistake.

Supporting a person in mourning does not mean continuing with life as normal or reassuring that all willbe better soon. A true friend will simply be there and do nothing but offer support, love and kindness. Let people deal with grief in their own unique way.

Be particularly supportive in the weeks and months after a tragedy, when everyone else has gone home, life has returned to normal, when the mourner is alone and not coping.

As our hearts and thoughts reach out to those most affected by these senseless killings, we should all understand that every life is touched by tragedy, be it a life-threatening illness or the death of a loved one. Having insights into grieving will help make the process understandable and promote eventual healing.

Dr. David Lipschitz is co-director of the Healthy Aging Center at Saline Memorial Hospital. More information is available at: drdavidhealth.com