Complicated Grief or Unacceptable Grief?

In recent years, there’s been much discussion about the concept of ‘complicated grief’ and whether it should be viewed as a psychiatric disorder, which has brought the idea into the popular consciousness. As explored in a psychiatric and psychological sense, it refers to extreme symptoms like numbness, difficulty with daily tasks, pining, agitation, depression, and lack of trust occurring in people more than six months after losing a loved one. These symptoms can become so intense that they make it impossible for the bereaved to function, and psychiatric treatment like medications, counseling, and other options can help people address their grief and other underlying issues to get into recovery.

I don’t dispute that complicated grief is a very real issue. And I also agree with the medical community: it’s actually quite rare.

More public awareness of complicated grief as a concept has created a situation where people mistakenly label grieving as ‘complicated’ because they don’t fully understand this diagnosis. And that’s harmful to bereaved people, as well as setting a bad precedent just in general, creating a world where totally normal responses to loss are suddenly pathologised by the world around you. That’s more likely to make people feel even worse than they already do, and to make people very reluctant to reach out for counseling and help if they do feel they are experiencing problems and might benefit from some professional assistance.

Grief takes many different forms and there are no specific right or wrong ways to grieve. For many people, it can include depression and a whole host of emotions and behaviours that may arise while they work through their loss. Survivor’s guilt, for example, or the desire to question everything surrounding the death. The need to know exactly what happened and why, if it could have been prevented, to find someone or something to blame. Distrust of people, and concerns about the real motivations of people offering condolences and support. Agitation, irritability, and mood swings.

These don’t necessarily occur in all people; you aren’t failing at grieving if you don’t feel numb, for example, or if you aren’t constantly preoccupied with thoughts of someone you lost. But they do occur in many people, and they are totally normal. Loss is huge and complex and scary, and each loss is very different, so it’s hard to predict how grief will affect people. Whether expected or not, loss can still knock the wind out of you and leave you unsure as to which way is up and where to proceed from there, especially in cases where the deceased occupied a huge and important role in your life, and it’s hard to imagine surviving and getting on without that person there by your side.

Complicated grief happens when these issues persist more than six months after the death, and last more than a month. As with other psychiatric conditions, a patient needs to be carefully evaluated to make a determination; while there is a set of diagnostic criteria to be used, the patient actually needs to see a counselor and talk. Several meetings may be required to determine if something else is going on, like underlying major depression that was triggered by the death, and an individual determination needs to be made. Which means it’s not as simple as ‘okay, the calendar shows it’s six months later, all grieving after this point is clearly the result of complicated grief, which means you’re broken and need to be fixed.’

Many people aren’t even aware that most psychiatric professionals agree that it’s not unreasonable for people to experience severe emotional disruption for up to half a year after a death. Attacks on the bereaved can start within days of a death as people want that person to ‘get over it’ and ‘shape up’ and ‘rejoin the world.’ Their grief, and however it manifests, is inconvenient and not enjoyable, and unfortunately, some are seizing on the concept of ‘complicated grief’ to pathologise it and shame people for experiencing emotions in the wake of a loss.

Having true complicated grief is nothing to be ashamed of, just like with any other mental health condition. It’s a thing that happens, it requires management and treatment, and it’s also unpredictable, although there are some risk factors in terms of who is more likely to experience it. Traumatic death and long terminal illness, for example, can increases the chances of complicated grief. People who think they need help, or who identify issues of concern in someone they love, shouldn’t be afraid to seek it and should be supported as they work through the death and process the emotions that come up.

But telling someone who is experiencing a loss that they have a mental health condition simply because you don’t like the way their grief manifests is a really dreadful thing to do. It contributes to the stigma of mental health conditions, and it contributes to the stigma against grief in society. Mourners are supposed to be quiet and well-behaved, to get their business done quickly and quietly, and to return to regular operations as quickly as possible. They are not supposed to openly express or experience grief, let alone spend several months processing a loss. And thus, a legitimate medical condition has become something to beat people with to make them feel bad for not processing a death in the way the people around them want them to.

People seem to have difficulty grasping that grief looks different for everyone. That there is no right or wrong way to be bereaved. And there is nothing to be ashamed of if your grief is more complicated than you expected.