Stop Measuring Grief at the Six Month Mark
This article was first published on Medium. Follow me and subscribe to email updates on Medium to be notified when I publish a new article.
Two people I love were recently diagnosed with cancer. One received a diagnosis that was relatively straightforward. She was treated quickly and today, her life goes on without much complication. The other friend received a more complicated diagnosis. He sees many specialists, his treatment is intense and aggressive, and his daily life is riddled with medical interventions. Everyone in his circle — from his doctors to his family to his friends — understand that this will be a long, hard process. My first friend’s diagnosis is a part of her life and a part of her future; society would probably tell the story that she “bounced back quickly.” Her experience lies in direct contrast to my second friend whose treatment is ongoing. Yet both people received the same diagnosis: cancer.
Each of my friends was diagnosed with the same disease, but it’s easy to understand that cancer is not a generic diagnosis. It can be simple or complex, slow-moving or aggressive, common or rare, easy to treat or difficult to contain. Society does not treat all people with cancer the same, nor do we expect them all to have the same recovery experience. There is a broad range of what a cancer diagnosis entails. Cancer is allowed to mean many things and it is understood that cancer is as unique as the person diagnosed with it.
This distinction is so obvious, but somehow we fail to embrace this truth when it comes to grief. Society has never been spectacular at helping grievers cope with their losses, but now, with the creation and adoption of a new diagnosis called “Persistent Complex Bereavement Disorder (PCBD)” in the DSM-5, I suspect that the stigma surrounding grief will become even worse.
The problem with this new diagnosis begins with the fact that all losses are lumped together under the general label of “grief.” Whether a person has suffered the murder of a child or the expected death of an elderly parent, the diagnostic criteria for PCBD is the same.
Within six months of a loss taking place, a griever can be diagnosed with PCBD based on the following symptoms:
Intense yearning for their loved one
Preoccupation with thinking about the person who died
Feeling empty or lonely
Having thoughts that life is hopeless or meaningless
Thinking about wanting to die
In addition to presenting with the previous symptoms, a grieving person diagnosed with PCBD must have two of the following symptoms for at least one month:
Feeling shocked or numb
Having feelings of disbelief about the loss happening
Ruminating about death
Feeling angry or bitter about the loss
Experiencing the same physical pain that their loved one experienced
Hearing or seeing the deceased
Trouble trust or caring about others
Intense reaction to or avoiding reminders of the person who died
Seeking out reminders in order to feel closer to their loved one
If you’re thinking that six months is a wildly short amount of time to begin diagnosing grief as a disorder, you’re right.
These symptoms describe almost all grievers who have dealt with a significant loss. While some grievers may follow the six month timeline for societally-deemed “normal” grief recovery, the majority of others do not. I have yet to speak to a parent who lost a child or someone who faced a traumatic loss involving violence, overdose, or an accident who is good to go at six months, let alone one year after their loss. Even with a phenomenal support system, learning to integrate loss can take years.
The problem with PCBD continues in the diagnosis’s failure to acknowledge all of the ways that grief can be complicated; in other words, its definition of grief and expectations for grievers are very narrow. The inclusion of PCBD in the DSM-5 could’ve been a unique and welcome opportunity to expand the scope and depth of grief; instead, it reduced all of grief’s nuance to a one-size-fits all diagnosis based on one measure: time.
Additionally, there is an undertone of judgment surrounding PCBD that we do not see in medical diagnoses. For instance, if a grieving person dealing with traumatic loss is taking too long, feeling too devastated, or not conforming to arbitrary clinical guidelines, then the subtle — and sometimes overt — message underneath their receiving a PCBD diagnosis is that there is something wrong with them. There is little, if any, understanding that grief for some is a long, hard process. There is no elaboration on how a griever arrives at a PCBD diagnosis; it is simply caused by “grief.” It fails to include that the nature of the loss — not some weakness or failing in the griever — determines how and when they recover from it. It simply points to a person who is still deeply mourning after six months and says, “That’s wrong.”
The PCBD diagnosis could be helpful if it acknowledged the reality that there are many factors that complicate grief and influence how — and when — a person comes back from a loss. Just as a person with a stage IV cancer diagnosis generally requires greater and longer intervention than a person diagnosed with stage I cancer, a person grieving a sudden or traumatic loss generally requires greater and longer help to recover than someone facing an expected loss that they’ve had time and resources to process.
My friend with the more complicated cancer diagnosis doesn’t have to explain why his treatment is taking a long time, or why more specialized, frequent interventions are necessary for him to heal. Society largely understands that a more severe cancer diagnosis requires a lengthy and complex road to recovery. Compare that to the experience of grieving people who — at least through the lens of a PCBD diagnosis — are herded along a singular, narrow path. Their health and success — regardless of their relationship to the person who died and ignorant of any additional factors that may complicate their emotional landscape — is measured by how they’re doing after six months.
If the PCBD diagnosis came with a collective, compassionate understanding that some losses require a longer journey and that some losses require more and different kinds of support, it would serve a truly helpful purpose to practitioners and the grievers they treat. Unfortunately, as it stands, the diagnosis serves to pathologize grief and grievers while simultaneously offering no further assistance. It sticks grieving people into a disordered category based on the arbitrary measure of time without including all of the other factors that influence grievers’ ability to return to life after someone in their life dies.
It’s like that popular quote goes:
“Everyone is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”
Said another way:
“Everybody can recover from loss. But if you judge a griever by their ability to heal in six months, they will live their whole life believing they are broken.”
We need to do better. If you are a provider, I urge you to learn about what grief looks like in the real world — beyond the textbook’s restricted and inadequate definition. Push back on this unrealistic timeline of healing. If you are a friend to someone who’s grieving, do not judge them by the DSM-5’s narrow, unattainable standards. Big, tragic losses change people. Trauma can take years to absorb, digest, and integrate. That’s normal.
Provided enough time, enough compassion and enough support, most grieving people learn to navigate life after loss and build a life they feel is worth living. This is made all the more possible when they aren’t pathologized for their pain.