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Key points
- It's normal for grief to have starts and stops. But sometimes, people can use help moving on.
- Prolonged grief has recently become a diagnosable psychological disorder, with effective treatments.
- If you're still having trouble engaging in life and relationships after a year, there is help.
As a nurse-midwife, birth and its unlikely twin, death, were familiar, renting the fabric between worlds, opposite ends of the spectrum. I’ve studied death, helped mothers and fathers accept death, experienced close, loving deaths. Healthy death, the bereaved recovering and healing.
Recently, my brother Steve, a psychologist, brought up grief. “People in America think grief is supposed to follow a pattern or else they’re doing it wrong, or it’s taking too long, or they’re stuck, not ‘moving on.’ Plus, they feel guilty if they laugh or feel happy when they think they’re ‘supposed’ to be grieving, or think it’s wrong to be angry at the person who died. They need to know they’re OK, all of it’s OK. But if they’re truly not OK, they can reach out, there’s help.”
Prolonged grief is a new entity in the Diagnostic and Statistical Manual, or DSM, the bible of psychiatric diagnoses. Per the DSM, it is sometimes called complicated grief or bereavement. There is no one path for grief, no “right” way. It’s a ziggy, zaggy mess of forward and back, individual in each case, taking what it takes. But it can get complicated. Stuck, if you will. A chronic grind of grief, not life.
The DSM states a person with prolonged grief must have distressing, intense, unremitting yearning for the person who died, and/or be very preoccupied by thoughts of the death, or the person, after at least a year. Three of the following are also required:
- Identity disruption (e.g., feeling as though part of oneself has died) since the death
- A marked sense of disbelief about the death
- Avoidance of reminders that the person is dead (in children and adolescents, this may be characterized by efforts to avoid reminders)
- Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death
- Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with friends, pursuing interests, or planning for the future)
- Emotional numbness (absence or marked reduction of emotional experience) as a result of the death
- Feeling that life is meaningless as a result of the death
- Intense loneliness as a result of the death
Unless someone has three or more of these eight symptoms, and it’s been over a year since their loved one has died, and “the person’s bereavement lasts longer than might be expected based on social, cultural, or religious norms,” plus grieving significantly interferes with life, they don’t have prolonged grief.
This last piece is crucial. If a person is functioning at work, school, with family and friends, they are progressing in their own way and pace through grief. Every symptom of prolonged grief is part of healthy grieving, but not if it is unremitting and extreme after a year. If so, it could actually be dangerous. People with prolonged grief have higher rates of self-harm, suicide, and disability; more depression, anxiety, chronic illness, and trauma; and a decreased quality of life. They are not OK. Ten percent of all mourners are estimated to suffer from prolonged grief.
Death is not a bad secret. Please talk about it. If you lost someone, or someone you love lost someone and it’s been over a year, and every day is spent longing for that person, ruminating, avoiding reminders—such as avoiding driving by the hospital or walking into the room where the person died—if you feel completely, wretchedly alone, like life has no purpose, please think again.
There is so much help available. Reach out to your primary care provider, spiritual leader, or trusted friend. Therapy and grief groups are available, as well as safe medications to help if your grief is complicated by depression, anxiety, insomnia, or trauma.
You can grieve. And you will; that loss will attenuate but never disappear. We are here to surround ourselves with community and life, to return to the world, contributing our part, whatever that may be. We are alive, and while we are, we are empowered to live.
If you or someone you love may have prolonged grief, take a single step and reach out. Everyone in your life misses you and wants you back. I guarantee it. To find support near you, visit the Psychology Today Therapy Directory.
