The psychiatrists’ handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM), has recently added “prolonged grief” to its list of disorders.
It’s definition of the newly recognised PGD is “trauma and stressor-related disorder” characterised by intense and persistent grief following the death of a close person, with symptoms lasting at least 12 months in adults, or 6 months in children and adolescents.
Now, excuse me for saying that but I’ve been affected by bereavement – and other painful losses – and I can tell you that I was far from feeling better 12 months on. I remember being told decades ago that it was a good idea to leave off making major decisions for up to two years after the death of a loved one because one’s mind was not in a good place.
Going back even further than my own long life, let’s look at the Victorians. They had an “official” period of mourning which involved wearing black for the first 12 months and moving into mauve for the second year. As well as being a public acknowledgement that bereaved people suffered, it also allowed others to be aware of that suffering, and perhaps treating them more gently than normal.
So now, if we’re not over it in 12 months, is it right that we have an official disorder? I don’t think so. I think it’s as it’s always been. We’re all different. People grieve and move on in their own time. To stay someone’s “disordered” because they’re not moving on fast enough is surely quite unkind.
I might suggest that the major difference between now and, say, 50 years ago, is that our world has speeded up and I sense an impatience even within the medical profession that our emotions need to catch up and move on.
That presents its own problem. Emotions are a law unto themselves and, speaking as someone who sees clients seeking help with all sorts of different matters, I’d say you can’t force the issue. Sometimes we work with clients who are with us for a limited – time-focused – period but both the therapist and the client knows that we’re not expecting a quick fix at the end of six sessions. If we’re lucky and hard-working, both of us working within the therapy room may be rewarded by seeing the beginning of a change in our client but we know it’ll need more awareness and work if it’s to be permanent.
If we’re privileged enough to be working with a client who does not have a time limit, we will have the opportunity to explore more deeply into what’s going on for them and looking at ways of developing and changing that they can continue long after the therapy has ended.
But what every working therapist will know is that you cannot say that, by this or that point, this or that will have happened. Every individual is different. And every client’s process must be treated with the respect that person deserves.
So it slightly surprises me that an important handbook such as the DSM sounds as if it’s looking to lay down the law over how long someone can be expected to grieve before it becomes a disorder. I can’t help feeling that’s a bit cheeky. Who am I to judge how another person should react when something of such huge importance happens in their life? A simple answer: I couldn’t, and I wouldn’t.
Additionally, there are concerns about the levels of diagnosis happening at present. Health Secretary Wes Streeting blames an “overdiagnosis” of mental health problems for putting further strain on the already overstrained NHS and while others say it is stopping people from going to work.
Official figures released last month declared that 5.8 million people in the UK say they have a mental health problem that affects them so badly they cannot work. That’s a rise of 400,000 in one year.
According to the Office for National Statistics, within people of working age, some 48% said they had a mental health disability, a 9% rise from those who declared a disability in 2018.
Some members of the medical profession agree, with three recently published books arguing that more and more people are either self-diagnosing or being diagnosed as mentally unwell when they shouldn’t be.
Conditions such as ADHD and autism are cited as cases rise to a worrying level.
The charity, Mind, says it’s not surprising that there’s a rise in mental health problems when we look at the world around us.
We seem to be still suffering from a post-Covid feeling of misery that hit not just our mental health but our wallets. There’s a continuing cost of living crisis caused in part by Russia’s invasion of Ukraine, along with a government that tells us there’s no end in sight and now we have the US tariff effect and a fear that the global economy is about to come crashing down around us. Put like that, are there really any reasons to be cheerful?
But such a rise in levels of diagnosis turns the problem into a societal one, rather than a matter for the individual. Is it real, or is it that social media – again – has, as is claimed, given certain groups an opportunity to remove themselves from the workplace on the grounds that it’s damaging their already vulnerable mental health?
Some, including me, would argue work can be a good idea. It can take your mind away from your own internal concerns. It’s hard to overthink when you’re concentrating on the job in hand. Earning money’s helpful too.
I’m not sure I have a definitive answer. Personally, if I’m feeling low, I know I need to have something to occupy me. Otherwise, it would be one long continuous duvet day.
Perhaps a balance of options is good – allowing time for reflection, time to talk (either with generous friends and family) or a professional but we also need to see ourselves as very much part of an integrated society. Maybe that would lead us to finding more “order” and less “disorder” in the shape of our lives.