Grief or Depression? How to Tell When Grieving Goes Too Far. Part 1

by on Aug.24, 2011, under Grief & Coping

Grief brings pain. Pain, an experience we usually try to avoid or escape, suggests that something is wrong with the body or mind. But most psychiatrists and psychotherapists consider the pain of grief a normal, in fact necessary, response to loss, not a symptom of mental illness.

Drawing parallels between emotional and physical symptoms risks serious errors involved with different levels of logical discourse.

Still, consider how physical pain can represent an important adaptive response of the body to injury. As part of the process of inflammation, it represents an aspect of added protection during healing.

People may suffer loss of pain sensation in a part of the body. The neuropathy, or nerve damage, often associated with diabetes offers one of many possible examples. Such people live at risk of far worse than an occasional bruise to that part.

Perhaps the inability to experience emotional pain carries similar risks. The critical capacity to attach oneself to others seems irremediably entwined with the capacity suffering of their loss. When John Donne (“Devotions Upon Emergent Occasions,” 1624) observed, “any man’s death diminishes me, because I am involved in Mankind,” he set a standard of compassion that many might emulate but few attain. Still, to the extent that we can experience the loss of another as more than just another’s loss, we ourselves become less like “islands” and more a part of the human “continent” to which the poet refers.

Accordingly, while we can find “Bereavement” listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, it resides in a category-and receives a “V” diagnostic code–distinct from that of mental disorders. The nonspecific category it falls under is that of “Other Conditions That May Be a Focus of Clinical Attention;” this includes such other non-diagnoses as “Religious or Spiritual Problem” and “Academic Problem.”

Note the phrase “Clinical Attention,” as suggesting something different from the “Treatment” accorded actual mental and emotional disorders. The Manual does not attempt to specify what diagnosis needs or justifies which treatment-but it does represent the collective appraisal of some experienced and eminent clinicians as to the kind of conditions that may indicate a need for diagnosis and treatment.

Many therapists believe that failure to grieve a loss leads to later, more severe emotional consequences than the pain of grieving. Although psychodynamic thinking has fallen out of favor with the current breed of biological psychiatrists (one of whom I must confess myself to be), it remains credible to me that a person who loses someone very important will hold on all the more tightly to that part of the other person remaining within the self of the survivor.

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