Is grief a mental disorder?

Earlier this month, the American Psychological Association (APA) added a new mental health condition to their iconic Diagnostic and Statistical Manual of Mental Health Conditions (Fifth Edition): prolonged grief disorder.

The decision has sparked both praise and concerns from mental health professionals and advocates around the world.

The biggest issue seems to be defining grief as a mental health disorder. Many articles written on the issue point out that grief is a typical part of the human experience.

Then again, the APA’s decision doesn’t cover grief in general, but rather a specific form of it that may affect an estimated 4% of people who experience loss. Prolonged grief disorder (PGD for short) specifically refers to a long period of intense feelings of loss that can totally incapacitate someone. Symptoms of PGD include:

● avoiding reminders that a person has died

● feeling emotionally numb

● feeling as though a part of oneself has died

● trouble returning to a normal way of life, including work, hobbies, and friendships and other relationships

Many of these symptoms might sound familiar to anyone who’s experienced the death of a loved one, but the other notable symptom of PGD is that these feelings continue for over a year in adults or over 6 months in children.

For numerous mental health experts and advocates, adding PGD to the Diagnostic and Statistical Manual of Mental Health Conditions is a positive choice.

For one thing, the DSM is the reference that US insurance companies use to determine whether or not to cover treatment for a mental health condition. Now, people struggling with ongoing grief will be able to afford care.

Its inclusion in the DSM also draws attention to the condition, which means that more research will likely be done on PGD and possible treatments. In fact, one of them, a medication called naltrexone, is currently in the clinical trial stage.

This is where one of the major debates about PGD’s inclusion in the DSM comes into play. For many, grief shouldn’t be medicated, but experienced and treated, if necessary, through psychological means.

Grief expert Dr. Joanne Cacciatore worries that now, many patients may feel pressure to take medication, rather than to work through their feelings.

Cacciatore is one of the major opponents to PGD’s inclusion in the DSM, arguing “When someone who is an ‘expert’ tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions.”

Another issue that some mental health experts have with PGD is that it gives a set time of “normal” grieving. But not everyone is the same, of course, nor are all losses. Cacciatore observes that in her work with parents who’ve lost a child, for instance, symptoms of intense grief are still very common a year later, and can go on, on average, for up to four.

Speaking of a type of loss, psychology professor Hal Herzog, an expert in human and animal relationships, takes umbrage with the wording of PGD’s definition in the DSM: the wording specifically refers to the loss of a person, but what about pets?

Herzog points out that, as with PGD for human losses, studies show that around 4% of pet owners also experience a long period of intense grief after the death of their animal companion. And yet, despite the fact that so many of us have pets and love them dearly, there’s a stigma around talking about feelings of intense grief when it comes to losing a pet.

For Herzog, PGD’s definition only continues to stigmatize this kind of grieving, when for many people, pets play a major role in their lives and are greatly loved.

But maybe wording is what it all comes down to. In our society, people have a tendency to jump to conclusions and take issue with things that might not be such a problem if they looked a little deeper.

PGD is not intended to cover feelings of loss and sadness that still enable the person feeling them to function and live their life in a normal way after a period of intense grieving. The term doesn’t apply to grief in general; rather, its inclusion in the DSM seems motivated by a desire to help to those stuck in grief for an extended period of time.

The DSM is a living document, meaning that it can be constantly edited and added to (upon committee approval). Maybe the points being made about how long and for whom we grieve will catch the right people’s attention and the definition will be changed to reflect these considerations and exceptions.

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