Skip to main content

Verified by Psychology Today

Grief

Living With Prolonged Grief Disorder

A Personal Perspective: There is no clock for grief.

Key points

  • Collective grief fades but individual grief, particularly for those who have lost children or loved ones to violence, can intensify over time.
  • There is a social stigma associated with grieving for "too long."
  • Unrecognized long-term grief means missed opportunities to intervene.
  • Acknowledging that grief doesn't have a set timetable is the best thing we can do for those experiencing profound loss.
Carol Smith
A lily blooms above dark water
Source: Carol Smith

Their faces fill my screen. Expressions of hope and expectation on their 10-year-old faces. I stare into their bright eyes until my hands begin to shake. I have to look away to get a breath. It’s been one week since 19 children and two teachers were killed at Robb Elementary School in Uvalde, TX, two days before classes were to let out for summer.

Little more than a week earlier, 10 people going about their business at a Tops Grocery store in Buffalo, NY, were shot dead in a racist rampage. And prior to that, a string of other mass shootings, nine so far this year, claimed victims in churches, subways, and shopping malls.

It's hard to recall the details of each of those shootings now; they come and go with fierce regularity. With each, we go into collective mourning, rapid cycling between rage and anguish. We light candles and make speeches. We hug strangers. We cry and whisper our despair. It’s too much sadness. Too much, we say. And then our sadness, the sadness of strangers, begins to fade as it always fades. This is how collective grief works. Over time, the faces blur. The tragedies, too, bleed into one another.

It takes only a week for that to happen. According to research published in the Proceedings of the National Academy of Sciences about the effect of mass tragedies on daily emotions, “the impact of mass shootings (even in the most extreme incidents) is close to zero within roughly one week of the event.” One week.

Public Versus Private Grieving

There’s a difference, though, between collective and individual grief.

Collective grief provides catharsis, allows us to purge our feelings. We move on for self-preservation, and so the business of schools and churches, and grocery stores can keep going.

For the loved ones of the victims, there is no catharsis. Not yet. For some, not ever. When the public mourning period ends, the private one is just beginning. Maybe it’s this disconnect between the experience of public and private mourning that has given rise to one of the more damaging myths surrounding grief—that it should end after a year, and if it doesn’t, there must be something wrong with you.

I lost my only child more than 20 years ago, and I still think about him most days. For years, though, I couldn't admit that.

I’m fine, I said when people asked how I was doing.

I said this in the first year because I was in shock and didn’t have the words to begin to describe what I felt. My son was 7 when I got the phone call that he’d died unexpectedly while visiting his grandparents. The fact I wasn’t there to hold him in his last hours haunted me.

I said it in the second year because by then I’d instinctively absorbed the message that it’s not culturally acceptable to continue to talk about deep sadness more than a year after a loss. It makes people uncomfortable, as though they should be able to do something; it makes them feel helpless.

I said it year after year to convince others I was okay and to convince myself. It worked, for the most part. Three years after my son’s death, I went back to my job as a journalist for The Seattle Post-Intelligencer. To the outside world, it looked as though I were “over it.” In reality, I was living in my own private snow globe — watching the rest of the world pass by without engaging. I avoided relationships, both old ones and new so I didn’t have to talk about it.

No, I don’t have children, I said for years if strangers asked. This would later send me into a spiral of shame and agony. No, felt like denying he had ever lived. My giggly little boy with eyes the color of maple syrup, who loved trains, and T-ball, and “101 Dalmatians.” My son, who was deaf and helped me see both language and the world around me in a brand new way. My son, who pressed his hand to mine when we signed, I love you, and whose hugs I sometimes still feel in my dreams. Yes, forced me to explain he was dead and brought up memories that were still too painful to face.

These lies kept me frozen for many years.

Prolonged Grief Disorder

It wasn’t until more than two decades later that I learned there was a name for what I likely experienced: Prolonged Grief Disorder.

Recently, the American Psychiatric Association officially included the diagnosis in its Diagnostic and Statistical Manual for Mental Disorders (DSM-5). It refers to intense emotional pain that persists more than a year after a loss. Some of the criteria include numbness, withdrawal, and inability to rejoin the normal stream of life. Those who lose children are at particular risk, as are those who lose a loved one to violence, natural disasters, and other tragedies. Those without support systems or who have other significant life stressors are also at risk.

The official inclusion of the diagnosis caps years of debate over whether labeling something Prolonged Grief Disorder amounts to pathologizing grief. None of us escapes without losing something or someone we love dearly. The process of grieving a loved one is as individual and idiosyncratic as the person who has died. Critics of labeling long-term grief a disorder argue that to suggest otherwise is to indicate that a normal process is a disease. But lost in all this heated discussion is what it’s like to live with deep grief year after year.

We are taught to suck it up. We are taught to power through. We get our few days of “bereavement leave” and then we’re supposed to get back to work. There’s not much of a grace period when it comes to grief. And because of that, long-term grief has been invisible to those who most need to recognize it.

Recognizing Long-Term Grief

During the pandemic, I attended a virtual conference for families who have lost children. One of the other bereaved moms gave a presentation about complicated grief. She ticked through some of the signs and symptoms: intense yearning that interferes with normal life more than a year after the death, numbness, disbelief, avoidance of social contact, and difficulties moving on. It was as though she were describing my life in the 10 years that followed my son’s death. For the first time, I didn’t feel inadequate for the difficulties I had adjusting to the loss of my only child. I felt seen.

I was never officially diagnosed back then because such a diagnosis didn’t exist. At the time, I didn’t even associate many of my behaviors with grief. Neither, apparently, did those around me.

No one back then suggested that my growing social anxiety, my persistent nightmares, or my general paralysis in life might have been because of grief. And because of that, I never thought to ask for help.

I wish I had. I believe it would have made me feel less alone — less “defective,” not more so. I eventually found my own path forward through my work as a reporter. I immersed myself in stories of hope and transformation, which in turn helped me come to terms with my grief. But I wonder, now, if I could have reached a place of peace with my loss sooner. I don’t think the new diagnosis pathologizes grief so much as makes it visible to those who suffer it and to those in their lives who might be able to help. Maybe the best thing that can come from the new diagnosis is not the view that long grief is disordered or maladaptive, but that it exists for some, is a normal response to an abnormal situation, and deserves our compassion.

We often say to parents who have lost children that they will never be the same. This is necessarily true, as it is for anyone who has suffered a profound loss. But it doesn’t mean that we can’t eventually integrate that loss in such a way that life has meaning and joy again. To get there, though, requires all of us to be more aware. Recognizing when someone’s behaviors might be grief-related, even years later, could encourage more of us to talk about it, might make it okay to say, yes, it still hurts, when someone asks how we are doing. It might make it okay to get a little help. And it might make more of us offer it. That’s the least we can do with our collective grief.

A version of this post also appears in The Washington Post.

advertisement
More from Carol Smith
More from Psychology Today