There is now a disorder for ‘prolonged’ grief. But what does ‘normal’ grief look like?

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Anakana Schofield’s most recent novel is Bina: A Novel in Warnings.

Recently, after conversing over a bowl of noodles with my son about a very ill relative, I noticed adverts for urns popping up on my phone. A coincidence perhaps: but what was conspicuous about these urns promoting themselves was how rarely ads target us for death-related inventory. Seldom am I reminded I will die, and urns are waiting to welcome me. Instead, the algorithm informs me hourly, my nearest and dearest are never going to be able to tolerate me if I don’t immediately lose weight and pack my facial features and butt cheeks with fish goo or substances akin to cement.

This has not been the only discourse targeting the living about the dead: The American Psychiatric Association recently updated and added Prolonged Grief Disorder to the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders). The press release described it excitedly as a “new disorder.” And who has this disorder? The Centre for Prolonged Grief cite approximately 10 per cent to 15 per cent of the bereaved. Such mourners “may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month.” According to the APA, “in the case of prolonged grief disorder, the duration of the person’s bereavement exceeds expected social, cultural or religious norms.”

Strangely our endurance for hearing about the prospect or failure of romantic love or marital discord knows no such time limits. Nobody is diagnosed with excessive heartbreak or told they must cease discussing or thinking about a marital breakdown within a 12-month period or they’ll be assessed for Excessive Ranting, Complaining and Wanting Revenge Disorder.

The addition of this new disorder is intended to help clinicians and patients recognize what “normal grief” looks like versus “a long-term problem,” but, practically speaking, the addition means that insurance companies can be billed for services related to the diagnosis.

This distinction of “normal grief” is deeply puzzling. It suggests that like booze, mind-altering substances or diving out of planes over large cactuses, you can now overconsume or be addicted to grief. You can grieve to excess. To an abnormal degree. Do normal grievers have some regulated 10,000-tears system that automatically turns off when reached? Exactly who can determine precisely what normal grief ever is? We do know that grief, like much of the human condition, is complicated and it accumulates. Thus, we are often mourning retroactively, possibly more than one person in our grieving.

I’ve been thinking a lot about how exactly you are to measure what constitutes “normal grief” to a parent who loses a child? There’s nothing normal about your child dying before you at any age. I’ve had conversations with a 93-year-old devastated by the loss of her 65-year-old son. And what is “normal grief” for a child who loses a parent and can’t yet even comprehend the concept of dying? They are suspended between either waiting for the parent to come back or reaching an age where they finally register the dead do not return. Now, by the measure of the DSM5, a child who experiences persistent difficulties beyond six months could be diagnosed as having prolonged grief disorder. An adult is afforded an extravagant 12 months before being potentially diagnosed “mentally disordered.” No matter that they may have lived with the person for 20, 30, 50 years. No matter that it takes nine months to even grow a human. You’ve got one year to recover from the death of a loved one. What a world!

In 2018 when the World Health Organization approved a new diagnosis of prolonged grief disorder it would have been more useful if they’d proposed that, rather than limiting it to 12 months, we should anticipate that it will last a lifetime. Rather than approving a new disorder, they could have mandated a new understanding of grief and urged the adoption of some simple protocols in daily life that would facilitate people to process it collectively. Rather than problematizing and medicalizing the 10 per cent to 15 per cent who are affected, perhaps it would be healthier to ask how the larger percentage of the population are able to move on so rapidly? In fact, it’s very likely they are suffering quietly in ways that are neither vocalized nor exhibited and will meet up with or even surpass the 10 per cent to 15 per cent at a later date.

All this addition to the DSM 5 provides is billing procedures. Help is available, reads the press release. This help continues to remainder people alone and lock grief away as the solvable jurisdiction of a billable professional. Yet the bereaved person must still exit after an hour to live in a world that reflects that it’s inconvenient and inefficient if they mourn too long.

What’s needed instead is a manifesto on grief and dying to make it the focus of our daily lives. People die in the night and go into a box in the ground and are barely spoken of again. This remains deeply perplexing to me. Dying and grief should become as common a conversation as food and exercise. We will stop being surprised when we die. Any extended interrogation of grief by the living would be met with engagement and curiosity rather than avoidance, diagnosis and the demand the bereaved hurry up and get over it. We will come to know the dead, even if we never met them alive. We will recognize that each of us are made up of a long line of people who noticed, spent time and cared about us and we understand that if we are benefiting from the person standing before us, it’s reasonable to appreciate the people who delivered them to this point. And in the same way we can, if necessary, recognize the negative elements of the dead person and why they were the devil incarnate and congratulate the person on having survived them.

I propose the integration of the expression of grief in the workplace and daily life. Each day, we start by remembering the dead. This way significant anniversaries for the bereaved aren’t endured in silent isolation, while colleagues demand outstanding tasks, better sales and that e-mail they owe them.

We recognize that we are all made up of those we have lost and everything they taught us or the ways in which they ruined us. The way we were loved or equally not loved. Just as people announce their birthdays, wedding, sobriety, illness survival anniversaries, we invite people to share their loved ones verbally with us on the anniversaries of their deaths. The comfort of talk and remembrance need not only be reserved for the church pew and the psychiatrist’s office.

Surprisingly, the NBA is one of the few places I’ve observed a remarkable public acknowledgment of grief, especially among rookies. I can tell you which player’s mother died of COVID-19, father shot himself, mother died when he was a baby, father was murdered, father died suddenly in a car crash, lost his mother and his grandmother, and sibling was killed by completely random gun violence.

On draft night, deceased parents, grandparents, siblings, mentors are actively remembered, while stories of their tragic loss are often reflected upon in films about the athlete’s life. And they aren’t just talking for themselves; they are sometimes acknowledging the pain of the communities they come from. They model much healthier attitudes: They endorse that grief can be a force not only for remembrance, but for affirmation and progress. They even demonstrate a measurement of the scale of grief, since in every game they testify to the absence of the loved one(s) who can never witness them play.

This is likely the truth of all grief; it is rooted in what our dead loved ones are missing. The ordinary conversations of the day, the things they saw us struggle with for years that have finally come to fruition, the children they never saw become adults, the babies they can never meet, funny anecdotes we cannot tell them or a shared reaction to a beautiful day or a piece of pie.

When we remember the dead and allow people their very reasonable continuing grief, we concurrently remind the living that they matter. We are saying: Live because you can live, whereas your loved one cannot. We are saying: Your loved one wants you to live. We are saying: They are here with you because I am asking about them. There is nothing disordered about this.

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