March 11, 2024 • 24 mins
PROLONGED GRIEF DISORDER! It’s everywhere - social media, The New York Times, The Washington Post… it’s the hot new medical condition everyone’s talking about. But why is everyone so mad about it?
This week on the show, an overview of this hotly contested “new” human disorder, and what it means for the average person, for healthcare providers, and honestly - for the whole world. This is one medical diagnosis that affects everyone.
In this episode we cover:
- Why anyone should care what the APA thinks about grief
- The actual diagnostic criteria for prolonged grief disorder (translated from psych-jargon into the way real people speak)
- Access to care + funding for research: two of the main reasons people think this diagnosis could be helpful (and why it isn’t)
- The real world impact of the DSM: doubling down on shame and misunderstanding
- One surprise reason this diagnosis *could* be seen as a good thing
We're re-releasing some of our favorite episodes from the first 3 seasons. This episode was originally recorded in 2022
Looking for a creative exploration of grief? Check out the best selling Writing Your Grief course here.
About Megan:
Psychotherapist Megan Devine is one of today’s leading experts on grief, from life-altering losses to the everyday grief that we don’t call grief. Get the best-selling book on grief in over a decade, It’s Ok that You’re Not OK, wherever you get books. Find Megan @refugeingrief
Additional resources:
For an interview with both Megan and the author of the NYT article, Ellen Barry, on WGBH TV Boston, click here.
To read Megan’s more detailed response to the NYT article, check out the original Twitter thread, and the extended thread.
Want to talk with Megan directly? Join our patreon community for live monthly Q&A grief clinics: your questions, answered. Want to speak to her privately? Apply for a 1:1 grief consultation here.
Check out Megan’s best-selling books - It’s OK That You're Not OK and How to Carry What Can’t Be Fixed
Books and resources may contain affiliate links.
See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This is it's okay that you're not okay, and I'm
your host, Megan Divine. This week prolonged grief disorder. Oh
my god, prolonged grief disorder? What is even happening with
this diagnosis? Why are there articles about it? Why do
social media channels sometimes light up over prolonged grief disorder?
This is your me, trying to be brief answer multiple questions.
(00:24):
Overview of this air quotes new human disorder and what
it means for the average person, for therapists, and honestly
for the whole world. Prolonged grief disorder coming up right
after this first break before we get started. Two quick notes. One,
(00:46):
this episode is an encore performance. I am on break
working on a giant new project, so we're releasing a
mix of our favorite episodes from the first three seasons
of the show. This episode is from season one, in
which I answered listener questions, sometimes on my own, sometimes
with a guest. So if you want more of these
Q and A style episodes, you can find the entire
(01:07):
collection from season one wherever you get your podcasts. Second note,
while we cover a lot of emotional relational territory in
our time here together, This show is not a substitute
for skilled support with the license mental health provider or
for professional supervision related to your work. I really want
you to take what you learn here, take your thoughts
and your reflections out into your own world, and talk
(01:30):
about it all. Hey friends, Okay, so I don't know
if you saw it, but The New York Times recently
ran an article with the super unfortunate title how long
should it take to grieve? Psychiatry has come up with
an answer. Okay, something y'all might not know is that
journalists and writers do not usually get to choose the
(01:51):
titles that accompany their pieces. So whoever the journalist is
for this article, sorry they did that to you anyway.
This isn't the first time a major media outlet has
reported on prolonged grief disorder. They usually report on it
with this like deeply alarmist tone. This is the second
article about prolonged grief disorder that The New York Times
(02:12):
has run. Their first one, at least the only one
that I'm aware of, was in late twenty twenty one.
At the end of twenty twenty, Scientific American ran an
article with a headline that proclaimed, quote the whole world
is at risk for the prolonged grief disorder because of
the pandemic. Super not helpful phrasing with a bit of
a better angle. This past fall, the Washington Post ran
(02:33):
an article hoping to educate people about what the diagnosis means,
why it's recently been added to the DSM. The DSM
is the Diagnostic Statistical Manual. It's basically a big old
catalog of things that go wrong or get dicey during
the course of being a live human being. We're going
to get into the DSM, what it is and how
it's used a little later in the show. But back
(02:54):
to the New York Times article about prolonged grief disorder.
There was such a huge uproar surrounding that article, including
full disclosure my own Twitter rant that has so far,
so far spanned several days. We figured that a show
at least starting a conversation about prolonged grief disorder should
(03:14):
get moved to the top of the production queue. Articles
like this raise so many questions. To be honest, everybody,
I have avoided a show about prolonged grief disorder. It
is a super complicated, super messy issue. When it hits
all of my outrage buttons. So I have just tried
to grumble about it a little bit when it pops
(03:36):
up in my media feeds, and then just like go
distract myself with something else for a bit. But I
can't keep doing that. This whole disorder lens on grief
does such damage not only to people who identify as grieving,
but also to the friends, family, clinicians, and medical providers
that come across grief in their social and professional worlds.
(03:58):
This is a good time to remind you that that
little description that I just gave applies to pretty much everyone.
Everyone is grieving. It doesn't matter if it's from death
or illness, or job loss or a loss of the
sense of the world as a good, orderly, reasonably safe place.
(04:19):
Grief is everywhere. So this week on the show, I'm
going to do my best to do a rapid fire
Q and a whistle stop tour of prolonged grief disorder,
what it is, how the diagnosis is used in both
the perfect world and the real world, why people are
so mad about it, and hopefully maybe why you should
(04:41):
maybe be mad about it too. We will definitely have
more shows addressing different issues related to the diagnosis of
prolonged grief disorder. So consider this just like part one
of I don't know how many parts. Let's get rolling.
I'm gonna do my best here, folks who not kidding
when I say that, I get hot about this? All right?
Really quickly? A short orientation to prolonged grief disorder. This
(05:05):
is a diagnosis that's been under debate, and I mean
hot debate for the last ten years or so, with
people fighting ferociously on both sides. The official entry of
the diagnosis or the disorder into the Diagnostic Statistical Manual
that DSMI mentioned, that's already happened. It is already in there.
So the period for debate about whether that diagnosis is
(05:26):
in or out over the fight about it, or more precisely,
the fight against it, is ongoing. Okay, so what is it?
Prolonged grief disorder is a new diagnosis created by the
American Psychiatric Association that describes a quote maladaptive response to loss.
Usually that's a low due to death. In order to
(05:48):
receive the diagnosis, somebody must be at least six months
past the initiating event a death, and they must be
quote experiencing persistent and pervasive longing for the deceased and
or persistent and pervasive cognitive preoccupation with the deceased combined
with any of ten additional grief reactions indicative of intense
(06:09):
emotional pain again for at least six months after bereavement,
also known as the loss. Okay, who let's define some
terms here, because that is some jargon. Pervasive cognitive preoccupation
literally means you are thinking of the person who died
pretty regularly since they died. Persistent and pervasive longing part
(06:32):
two of the diagnostic criteria. Persistent and pervasive longing for
the person is psychiatry speak for you miss them and
you wish they were still here. So in addition to
one or both of those two things, you just need
one more, as they say, grief reaction indicative of intense
emotional pain to qualify for this prolonged grief disorder diagnosis.
(06:54):
So things on the list of those ten additional grief
reactions in dayative of intense emotional pain. I am not
making this up, everybody, I'm reading it off of the
official dignostic criteria. So these ten things include sadness, guilt, anger,
denial like having a hard time reconciling that this death
(07:15):
is real, like difficulty accepting the death, feeling like you've
lost part of yourself in this loss, an inability to
experience a positive mood, emotional numbness, and difficulty engaging with
social or other activities. So, according to this new diagnosis
in a manual that goes out to all clinicians and
(07:35):
all medical providers, if you're still sad about somebody's death
six months after they've died, you really really miss them,
You think about them all the time, and you're having
a tough time bouncing back to your happy, positive party
pre death self. You have a disorder. You can probably
hear it, but I have a really hard time controlling
(07:58):
my fury even just reading those criteria. I am going
to try to keep it contained for the purposes of
our show at least today, and get through this general
overview with some questions, but I do gotta note that
it is hard hard for me to keep it together.
I want to address why anybody should care what the
(08:20):
APA or the DSM thinks about grief. I mean, realistically speaking, here,
no governing body can tell you how to feel or
mandate required emotions for anything. But here's the thing, the
way the medical industry talks about grief has a direct
impact on the quality of care and support a grieving
person receives, and the opinions or the edicts of the
(08:44):
psychiatric industry actually trickle down to the wider public understanding
of grief. If the medical industry says that missing your person,
still missing your person, still feeling sad, still talking about
them six months after they've died. If the medical industry
says that that's a problem, then the general population believes
it's a problem. If the medical industry officially says that
(09:08):
grief is a disorder, then we all believe it's a disorder.
There's sort of this like trickle down pathology that happens
from the medical world into popular culture. So when a
major medical industry releases their quote Prolonged Grief Disorder diagnostic criteria,
and then major media outlets report on that diagnostic criteria,
(09:29):
that all feeds into this belief we still have in
Western culture that grief is a problem to be solved,
that sadness is unhealthy, and that bouncing back to a productive, happy,
positive outlook is the only healthy response to loss. I mean,
this is the whole reason I do the work that
I do right. Friends, This is the whole reason for
(09:50):
the podcast, in the books, and the education and the
training in all of it is to kick over those
outdated ideas about what it means to be human, because
those beliefs that being human is somehow faulty is like
the whole problem. There might be a lot of nuance
to the diagnosis, which we're totally going to touch on
(10:11):
in a minute, but basically, if your doctor says grief
as a disorder, then the best thing we can do
for people going through hard times is listen to the
medical profession and cheer people up, get them to be
less sad, and probably suggest that they quote get help
for their disordered emotional responses. I mean, that's not just
like me overreacting to things. We can back up all
(10:32):
of this with recent real world experience. Over the last
three days, I've received hundreds of messages from people saying
that well meaning friends and family actually sent them a
link to that New York Times article on prolonged grief disorder,
often accompanied with messages saying things like I knew you
shouldn't be sad after all this time read this article.
(10:54):
Maybe you should go get some help weaponizing grief disorder
to shame, judge, advise and correct people going through the
hardest times of their lives under the guise of medical
advice and a return to health. So while it can
(11:15):
seem like a diagnostic code used in a manual by
clinicians has no actual real world impact, I am here
to tell you wholly everything, everybody, It has so much impact.
Now the impact of diagnoses on the general world is
a totally other, big topic for another day, because I
want to, as briefly as I can, remind you that
(11:37):
no matter what anybody says, grief is a healthy, reasonable
response to loss. It's not going to be over in
six months or a year or eighteen months. Grief lasts
as long as love lasts, and there's nothing wrong with that.
On that note, we are going to take a very
(11:57):
quick break. I'm going to drink some wine. Hydration is
important when you're feeling outraged, and we'll be right back.
Welcome back, everybody, Okay, Continuing with our quick fly over
(12:19):
drive by orientation to prolong grief disorder. Why do we
even have the disorder? That in itself is a major topic,
And as I've said, a number of times. We will
get into that in other shows, but for now, calling
grief a disorder is an outgrowth of our grief averse
emotions are bad get back to work as soon as
you possibly can culture, which is to say that prolonged
(12:43):
grief disorder as a diagnosis is an extension of capitalism.
Grief makes you less productive, and what we value above
all else is productivity. As you know from listening to
previous shows, we have a long history of avoiding emotion pain,
so that actually underlies a lot of capitalism, or it's
at least like the twin of capitalism avoiding all human
(13:07):
things so that we can be more productive. Like that,
you know who capitalism should actually be in the DSM.
But that is also a subject for another day. Ooh,
I can already see the Twitter responses. I'm going to
get for that one anyway. The DSM that manual we've
all been talking about is written for the insurance industry.
(13:27):
Little known fact that you might not know if you're
outside of the medical industry. It's a collection of conditions
that insurance companies will or will not pay for, meaning
they'll pay your therapist or your doctor to treat a
condition as long as it is detailed in the DSM.
With the current US healthcare system, you actually can't get
help from a doctor or therapist for something like depression
(13:49):
or anxiety. You can't get help within the US healthcare
system if you weren't broken broken in our quotes. So
we need there to be something broken in you that
we can fix. This leads us to pushback number one,
where people say, like actually having grief an official diagnosis
or disorder in the DSM is a good thing. If
(14:10):
we normalize this very normal human experience, if we say
it's not a disorder, this is a normal thing. If
we say that, then insurance companies won't want to pay
for treatment or support or therapy, because remember what I
just said, in the current US healthcare system and in
some other healthcare systems around the world, you can't get support, treatment,
(14:31):
therapy if there isn't something wrong with you. So we
need to say there's something wrong in order for you
to access care. If you don't get a diagnosis inside
your grief, it means that some people won't be able
to access care if they aren't labeled with the disorder.
So this is one reason, as I said, that people
are in favor of the prolonged grief disorder diagnosis. They
(14:51):
say it's going to let people gain access to therapy
and other support. So when a couple of people yell
at me for not supporting the brief disorder diagnosis, they're
saying that people need it in order to access services.
Now my response here is like, yeah, that is in
many cases true. That is the function of the capitalistic
(15:12):
insurance based system where you need to have a disorder
in order to access care. But I would much rather
we focus on getting insurance companies to reimburse for therapy
and support just because being human is hard. Sometimes not
you only get paid to go to therapy because being
human is a disorder, you know what I mean. In
(15:33):
the meantime, we do have the system that we have,
so that means we do need a diagnosis very often
in order to unlock access to therapy and other supportive resources.
But we do have other, less shame based diagnoses we
can give people in order to unlock that care. We
really didn't need yet another way to shame and deride
the human experience. Actually, somebody on Twitter had a really
(15:56):
good point. They were like, this diagnosis or this new
disord is just one step closer to making the human
experience as a whole a pathology. Yeah, that is where
we're going the robot army approaches. Okay, what about the
Family Medical Leave Act? Doesn't getting a prolonged grief disorder
diagnosis get you that Family Medical Leve Act protection? Now
(16:18):
I am not an expert in the Family and Medical
Leave Act, but I can say that fmla Family Medical
Leave Act, it doesn't typically cover bereavement. You can often
get family medical leave while you are caring for a
terminally ill family member, but once that person dies, family
medical leave stops. They figure you're going to rely on
your company's bereavement policies, which is a problem since there
(16:42):
is no law saying that your company has to give
you bereavement leave, and many of those company policies are
for very specific family members. So if you've been tending
to your best friend in their late stage cancer and
then they've died, like forget about it, you're not covered
by anybody. Even if you have a good bereavement leave
policy and you're company, those things typically just cover a
couple of days off three five. Some people might even
(17:07):
get a week. Now you can use family medically for
some mental health conditions. So technically a prolonged grief disorder
diagnosis might unlock family medical leave in some situations. But
I want to point out something really really important here.
A diagnosis of prolonged grief disorder can't happen without that
(17:28):
prolonged bit. By definition, you can't get a diagnosis of
prolonged grief disorder until at least six months' post loss,
which means even family medical leave wouldn't come into effect
in the early days and weeks after somebody dies, which
is often when people need grief support the most. So
(17:50):
that argument that we need the diagnosis or the disorder
of prolonged grief disorder in order to unlock family medical
leave absolutely not relevant. It can't even happen until six
months after the death. And then, just to throw one
last complicating wrench into the works, I just want to
show you how truly complicated this entire thing is. I'm
(18:10):
going to give you an argument for prolonged grief disorder
showing up in the DSM. Just messing with the world here.
This is precisely because we live in such a grief
a verse culture where grieving people find it really hard
to get support and understanding from the people around them.
I've heard from a lot of people who feel like
they need to have this official medical diagnosis in order
(18:35):
to prove to their family and friends that they have
a right to their grief. It's like they need the
official diagnosis as a way to legitimize their feelings and
their experience. And that is important. If you feel like
everybody around you is telling you to get over it
move on, then having a legit medical diagnosis gives you
(18:59):
some power. You can always push back at the people
around you and say no, no, no, this isn't like
normal grief. It's an actual medical condition. That official diagnosis
is like your shield and your defense. So you basically
have to agree that you're doing grief wrong in order
to legitimize your experience. I mean, how screwed up is
(19:21):
that everybody that in order to have your very normal,
very messy, very difficult, very complex response emotional response to
the death or loss of somebody you care about, in
order to have that honored and acknowledged and supported, you
have to give yourself a disorder just to make the
(19:44):
people around you take it seriously. So this is what
I mean, friends, Addressing the issue of prolonged grief disorder
is a whole cauldron of interrelated problems that go far
beyond grief itself. It is a symptom of the machinery
of capitalism and grief. It involves access to care, so
that means issues of race and class, and gender and immigration.
(20:07):
It also brings into place centuries and centuries of people
being scared of big emotions. Who there's a reason why
we're gonna need a lot of shows to talk about
this one. I hope that what you've gained from this
show today so far is one, of course, the sense
of my outrage, because honestly, you know, outrage is sometimes
(20:29):
useful to share to start you having these conversations, but
also like you're gonna hear a lot of conversation about it,
and I want you to be equipped with some basic
knowledge so that you can enter into some conversations or
some outrage Twitter threads with a little bit more than
what the headlines give you. We'll be right back with
questions to carry with you. You know they're gonna be
(20:51):
related to prolonged grief disorder. We'll be right back friends.
Each week, I leave you with some questions to carry
with you until we meet again. It's part of this
whole awkward stuff gets easier with practice thing this week.
(21:13):
Maybe it's the outrage stuff gets easier with practice thing.
If you haven't yet, go check out the media coverage
of prolonged grief disorder. Read up on it, Read my
Twitter rant about it. We'll link it in the show notes.
Read discussions about it for and against the complex, middle
messy part of people who somehow, like I just did
(21:35):
at the end of the show, come out somehow for
something I don't believe in. Rant about it, speak about it,
ask questions about it. No matter what, I bet that
you will have some thoughts and feelings about it. This
isn't just a siloed only applies to certain people issue.
It is a whole, big, messy human thing. So for
your homework, your questions to carry with you this week.
(21:57):
Go check it out, friends, and send me your questions,
either about prolonged grief disorder or anything else. This show
is nothing without your questions. It is literally a Q
and a show. You can ask me anything you'd like,
Bring me your clinical questions, your I'm trying really hard
to be a good friend, but I'm getting mixed messages
from everywhere. Bring me your questions about the things that
(22:18):
scare you. How to handle that one thing that always
leaves you feeling with a deer in the headlights and
you really need a script for it. Let's talk it out.
We want to hear from you. I want to hear
from you. This show, this world needs your questions. Together,
we can make things better even when we can't make
(22:39):
them right. You know how most people are going to
scan through their podcast app looking for a new thing
to listen to, and then they're going to see the
show description for Hereafter and think, I don't want to
talk about that stuff. Things are hard enough. This is
where you come in your reviews. Let people know it
really isn't all that bad. In here. We talk heavy stuff,
(23:00):
but it's in the service of making things better for everyone.
So everyone needs to listen. Spread the word in your workplaces,
in your social world on social media, and click through
to leave a review. Subscribe to the show, download episodes,
send in your questions. Want more Hereafter? Brief education doesn't
just belong to end of life issues. Life is full
(23:23):
of losses, from everyday disappointments to events that clearly divide
life into before and after. Learning how to talk about
all that without cliches or platitudes or simplistic think positive
posters is an important skill for everyone. Find trainings, workshops,
books and resources for every human trying to make their
way in the world after something Goes horribly wrong at
(23:45):
Megandivine dot Co. Hereafter with Megan Divine is written at
produced by me Megan Divine. Executive producer is Amy Brown
and Elizabeth Fozzio, Edited by Houston Tilley. Music provided by
Wave Crush Ey
This is it's okay that you're not okay, and I'm
your host, Megan Divine. This week prolonged grief disorder. Oh
my god, prolonged grief disorder? What is even happening with
this diagnosis? Why are there articles about it? Why do
social media channels sometimes light up over prolonged grief disorder?
This is your me, trying to be brief answer multiple questions.
(00:24):
Overview of this air quotes new human disorder and what
it means for the average person, for therapists, and honestly
for the whole world. Prolonged grief disorder coming up right
after this first break before we get started. Two quick notes. One,
(00:46):
this episode is an encore performance. I am on break
working on a giant new project, so we're releasing a
mix of our favorite episodes from the first three seasons
of the show. This episode is from season one, in
which I answered listener questions, sometimes on my own, sometimes
with a guest. So if you want more of these
Q and A style episodes, you can find the entire
(01:07):
collection from season one wherever you get your podcasts. Second note,
while we cover a lot of emotional relational territory in
our time here together, This show is not a substitute
for skilled support with the license mental health provider or
for professional supervision related to your work. I really want
you to take what you learn here, take your thoughts
and your reflections out into your own world, and talk
(01:30):
about it all. Hey friends, Okay, so I don't know
if you saw it, but The New York Times recently
ran an article with the super unfortunate title how long
should it take to grieve? Psychiatry has come up with
an answer. Okay, something y'all might not know is that
journalists and writers do not usually get to choose the
(01:51):
titles that accompany their pieces. So whoever the journalist is
for this article, sorry they did that to you anyway.
This isn't the first time a major media outlet has
reported on prolonged grief disorder. They usually report on it
with this like deeply alarmist tone. This is the second
article about prolonged grief disorder that The New York Times
(02:12):
has run. Their first one, at least the only one
that I'm aware of, was in late twenty twenty one.
At the end of twenty twenty, Scientific American ran an
article with a headline that proclaimed, quote the whole world
is at risk for the prolonged grief disorder because of
the pandemic. Super not helpful phrasing with a bit of
a better angle. This past fall, the Washington Post ran
(02:33):
an article hoping to educate people about what the diagnosis means,
why it's recently been added to the DSM. The DSM
is the Diagnostic Statistical Manual. It's basically a big old
catalog of things that go wrong or get dicey during
the course of being a live human being. We're going
to get into the DSM, what it is and how
it's used a little later in the show. But back
(02:54):
to the New York Times article about prolonged grief disorder.
There was such a huge uproar surrounding that article, including
full disclosure my own Twitter rant that has so far,
so far spanned several days. We figured that a show
at least starting a conversation about prolonged grief disorder should
(03:14):
get moved to the top of the production queue. Articles
like this raise so many questions. To be honest, everybody,
I have avoided a show about prolonged grief disorder. It
is a super complicated, super messy issue. When it hits
all of my outrage buttons. So I have just tried
to grumble about it a little bit when it pops
(03:36):
up in my media feeds, and then just like go
distract myself with something else for a bit. But I
can't keep doing that. This whole disorder lens on grief
does such damage not only to people who identify as grieving,
but also to the friends, family, clinicians, and medical providers
that come across grief in their social and professional worlds.
(03:58):
This is a good time to remind you that that
little description that I just gave applies to pretty much everyone.
Everyone is grieving. It doesn't matter if it's from death
or illness, or job loss or a loss of the
sense of the world as a good, orderly, reasonably safe place.
(04:19):
Grief is everywhere. So this week on the show, I'm
going to do my best to do a rapid fire
Q and a whistle stop tour of prolonged grief disorder,
what it is, how the diagnosis is used in both
the perfect world and the real world, why people are
so mad about it, and hopefully maybe why you should
(04:41):
maybe be mad about it too. We will definitely have
more shows addressing different issues related to the diagnosis of
prolonged grief disorder. So consider this just like part one
of I don't know how many parts. Let's get rolling.
I'm gonna do my best here, folks who not kidding
when I say that, I get hot about this? All right?
Really quickly? A short orientation to prolonged grief disorder. This
(05:05):
is a diagnosis that's been under debate, and I mean
hot debate for the last ten years or so, with
people fighting ferociously on both sides. The official entry of
the diagnosis or the disorder into the Diagnostic Statistical Manual
that DSMI mentioned, that's already happened. It is already in there.
So the period for debate about whether that diagnosis is
(05:26):
in or out over the fight about it, or more precisely,
the fight against it, is ongoing. Okay, so what is it?
Prolonged grief disorder is a new diagnosis created by the
American Psychiatric Association that describes a quote maladaptive response to loss.
Usually that's a low due to death. In order to
(05:48):
receive the diagnosis, somebody must be at least six months
past the initiating event a death, and they must be
quote experiencing persistent and pervasive longing for the deceased and
or persistent and pervasive cognitive preoccupation with the deceased combined
with any of ten additional grief reactions indicative of intense
(06:09):
emotional pain again for at least six months after bereavement,
also known as the loss. Okay, who let's define some
terms here, because that is some jargon. Pervasive cognitive preoccupation
literally means you are thinking of the person who died
pretty regularly since they died. Persistent and pervasive longing part
(06:32):
two of the diagnostic criteria. Persistent and pervasive longing for
the person is psychiatry speak for you miss them and
you wish they were still here. So in addition to
one or both of those two things, you just need
one more, as they say, grief reaction indicative of intense
emotional pain to qualify for this prolonged grief disorder diagnosis.
(06:54):
So things on the list of those ten additional grief
reactions in dayative of intense emotional pain. I am not
making this up, everybody, I'm reading it off of the
official dignostic criteria. So these ten things include sadness, guilt, anger,
denial like having a hard time reconciling that this death
(07:15):
is real, like difficulty accepting the death, feeling like you've
lost part of yourself in this loss, an inability to
experience a positive mood, emotional numbness, and difficulty engaging with
social or other activities. So, according to this new diagnosis
in a manual that goes out to all clinicians and
(07:35):
all medical providers, if you're still sad about somebody's death
six months after they've died, you really really miss them,
You think about them all the time, and you're having
a tough time bouncing back to your happy, positive party
pre death self. You have a disorder. You can probably
hear it, but I have a really hard time controlling
(07:58):
my fury even just reading those criteria. I am going
to try to keep it contained for the purposes of
our show at least today, and get through this general
overview with some questions, but I do gotta note that
it is hard hard for me to keep it together.
I want to address why anybody should care what the
(08:20):
APA or the DSM thinks about grief. I mean, realistically speaking, here,
no governing body can tell you how to feel or
mandate required emotions for anything. But here's the thing, the
way the medical industry talks about grief has a direct
impact on the quality of care and support a grieving
person receives, and the opinions or the edicts of the
(08:44):
psychiatric industry actually trickle down to the wider public understanding
of grief. If the medical industry says that missing your person,
still missing your person, still feeling sad, still talking about
them six months after they've died. If the medical industry
says that that's a problem, then the general population believes
it's a problem. If the medical industry officially says that
(09:08):
grief is a disorder, then we all believe it's a disorder.
There's sort of this like trickle down pathology that happens
from the medical world into popular culture. So when a
major medical industry releases their quote Prolonged Grief Disorder diagnostic criteria,
and then major media outlets report on that diagnostic criteria,
(09:29):
that all feeds into this belief we still have in
Western culture that grief is a problem to be solved,
that sadness is unhealthy, and that bouncing back to a productive, happy,
positive outlook is the only healthy response to loss. I mean,
this is the whole reason I do the work that
I do right. Friends, This is the whole reason for
(09:50):
the podcast, in the books, and the education and the
training in all of it is to kick over those
outdated ideas about what it means to be human, because
those beliefs that being human is somehow faulty is like
the whole problem. There might be a lot of nuance
to the diagnosis, which we're totally going to touch on
(10:11):
in a minute, but basically, if your doctor says grief
as a disorder, then the best thing we can do
for people going through hard times is listen to the
medical profession and cheer people up, get them to be
less sad, and probably suggest that they quote get help
for their disordered emotional responses. I mean, that's not just
like me overreacting to things. We can back up all
(10:32):
of this with recent real world experience. Over the last
three days, I've received hundreds of messages from people saying
that well meaning friends and family actually sent them a
link to that New York Times article on prolonged grief disorder,
often accompanied with messages saying things like I knew you
shouldn't be sad after all this time read this article.
(10:54):
Maybe you should go get some help weaponizing grief disorder
to shame, judge, advise and correct people going through the
hardest times of their lives under the guise of medical
advice and a return to health. So while it can
(11:15):
seem like a diagnostic code used in a manual by
clinicians has no actual real world impact, I am here
to tell you wholly everything, everybody, It has so much impact.
Now the impact of diagnoses on the general world is
a totally other, big topic for another day, because I
want to, as briefly as I can, remind you that
(11:37):
no matter what anybody says, grief is a healthy, reasonable
response to loss. It's not going to be over in
six months or a year or eighteen months. Grief lasts
as long as love lasts, and there's nothing wrong with that.
On that note, we are going to take a very
(11:57):
quick break. I'm going to drink some wine. Hydration is
important when you're feeling outraged, and we'll be right back.
Welcome back, everybody, Okay, Continuing with our quick fly over
(12:19):
drive by orientation to prolong grief disorder. Why do we
even have the disorder? That in itself is a major topic,
And as I've said, a number of times. We will
get into that in other shows, but for now, calling
grief a disorder is an outgrowth of our grief averse
emotions are bad get back to work as soon as
you possibly can culture, which is to say that prolonged
(12:43):
grief disorder as a diagnosis is an extension of capitalism.
Grief makes you less productive, and what we value above
all else is productivity. As you know from listening to
previous shows, we have a long history of avoiding emotion pain,
so that actually underlies a lot of capitalism, or it's
at least like the twin of capitalism avoiding all human
(13:07):
things so that we can be more productive. Like that,
you know who capitalism should actually be in the DSM.
But that is also a subject for another day. Ooh,
I can already see the Twitter responses. I'm going to
get for that one anyway. The DSM that manual we've
all been talking about is written for the insurance industry.
(13:27):
Little known fact that you might not know if you're
outside of the medical industry. It's a collection of conditions
that insurance companies will or will not pay for, meaning
they'll pay your therapist or your doctor to treat a
condition as long as it is detailed in the DSM.
With the current US healthcare system, you actually can't get
help from a doctor or therapist for something like depression
(13:49):
or anxiety. You can't get help within the US healthcare
system if you weren't broken broken in our quotes. So
we need there to be something broken in you that
we can fix. This leads us to pushback number one,
where people say, like actually having grief an official diagnosis
or disorder in the DSM is a good thing. If
(14:10):
we normalize this very normal human experience, if we say
it's not a disorder, this is a normal thing. If
we say that, then insurance companies won't want to pay
for treatment or support or therapy, because remember what I
just said, in the current US healthcare system and in
some other healthcare systems around the world, you can't get support, treatment,
(14:31):
therapy if there isn't something wrong with you. So we
need to say there's something wrong in order for you
to access care. If you don't get a diagnosis inside
your grief, it means that some people won't be able
to access care if they aren't labeled with the disorder.
So this is one reason, as I said, that people
are in favor of the prolonged grief disorder diagnosis. They
(14:51):
say it's going to let people gain access to therapy
and other support. So when a couple of people yell
at me for not supporting the brief disorder diagnosis, they're
saying that people need it in order to access services.
Now my response here is like, yeah, that is in
many cases true. That is the function of the capitalistic
(15:12):
insurance based system where you need to have a disorder
in order to access care. But I would much rather
we focus on getting insurance companies to reimburse for therapy
and support just because being human is hard. Sometimes not
you only get paid to go to therapy because being
human is a disorder, you know what I mean. In
(15:33):
the meantime, we do have the system that we have,
so that means we do need a diagnosis very often
in order to unlock access to therapy and other supportive resources.
But we do have other, less shame based diagnoses we
can give people in order to unlock that care. We
really didn't need yet another way to shame and deride
the human experience. Actually, somebody on Twitter had a really
(15:56):
good point. They were like, this diagnosis or this new
disord is just one step closer to making the human
experience as a whole a pathology. Yeah, that is where
we're going the robot army approaches. Okay, what about the
Family Medical Leave Act? Doesn't getting a prolonged grief disorder
diagnosis get you that Family Medical Leve Act protection? Now
(16:18):
I am not an expert in the Family and Medical
Leave Act, but I can say that fmla Family Medical
Leave Act, it doesn't typically cover bereavement. You can often
get family medical leave while you are caring for a
terminally ill family member, but once that person dies, family
medical leave stops. They figure you're going to rely on
your company's bereavement policies, which is a problem since there
(16:42):
is no law saying that your company has to give
you bereavement leave, and many of those company policies are
for very specific family members. So if you've been tending
to your best friend in their late stage cancer and
then they've died, like forget about it, you're not covered
by anybody. Even if you have a good bereavement leave
policy and you're company, those things typically just cover a
couple of days off three five. Some people might even
(17:07):
get a week. Now you can use family medically for
some mental health conditions. So technically a prolonged grief disorder
diagnosis might unlock family medical leave in some situations. But
I want to point out something really really important here.
A diagnosis of prolonged grief disorder can't happen without that
(17:28):
prolonged bit. By definition, you can't get a diagnosis of
prolonged grief disorder until at least six months' post loss,
which means even family medical leave wouldn't come into effect
in the early days and weeks after somebody dies, which
is often when people need grief support the most. So
(17:50):
that argument that we need the diagnosis or the disorder
of prolonged grief disorder in order to unlock family medical
leave absolutely not relevant. It can't even happen until six
months after the death. And then, just to throw one
last complicating wrench into the works, I just want to
show you how truly complicated this entire thing is. I'm
(18:10):
going to give you an argument for prolonged grief disorder
showing up in the DSM. Just messing with the world here.
This is precisely because we live in such a grief
a verse culture where grieving people find it really hard
to get support and understanding from the people around them.
I've heard from a lot of people who feel like
they need to have this official medical diagnosis in order
(18:35):
to prove to their family and friends that they have
a right to their grief. It's like they need the
official diagnosis as a way to legitimize their feelings and
their experience. And that is important. If you feel like
everybody around you is telling you to get over it
move on, then having a legit medical diagnosis gives you
(18:59):
some power. You can always push back at the people
around you and say no, no, no, this isn't like
normal grief. It's an actual medical condition. That official diagnosis
is like your shield and your defense. So you basically
have to agree that you're doing grief wrong in order
to legitimize your experience. I mean, how screwed up is
(19:21):
that everybody that in order to have your very normal,
very messy, very difficult, very complex response emotional response to
the death or loss of somebody you care about, in
order to have that honored and acknowledged and supported, you
have to give yourself a disorder just to make the
(19:44):
people around you take it seriously. So this is what
I mean, friends, Addressing the issue of prolonged grief disorder
is a whole cauldron of interrelated problems that go far
beyond grief itself. It is a symptom of the machinery
of capitalism and grief. It involves access to care, so
that means issues of race and class, and gender and immigration.
(20:07):
It also brings into place centuries and centuries of people
being scared of big emotions. Who there's a reason why
we're gonna need a lot of shows to talk about
this one. I hope that what you've gained from this
show today so far is one, of course, the sense
of my outrage, because honestly, you know, outrage is sometimes
(20:29):
useful to share to start you having these conversations, but
also like you're gonna hear a lot of conversation about it,
and I want you to be equipped with some basic
knowledge so that you can enter into some conversations or
some outrage Twitter threads with a little bit more than
what the headlines give you. We'll be right back with
questions to carry with you. You know they're gonna be
(20:51):
related to prolonged grief disorder. We'll be right back friends.
Each week, I leave you with some questions to carry
with you until we meet again. It's part of this
whole awkward stuff gets easier with practice thing this week.
(21:13):
Maybe it's the outrage stuff gets easier with practice thing.
If you haven't yet, go check out the media coverage
of prolonged grief disorder. Read up on it, Read my
Twitter rant about it. We'll link it in the show notes.
Read discussions about it for and against the complex, middle
messy part of people who somehow, like I just did
(21:35):
at the end of the show, come out somehow for
something I don't believe in. Rant about it, speak about it,
ask questions about it. No matter what, I bet that
you will have some thoughts and feelings about it. This
isn't just a siloed only applies to certain people issue.
It is a whole, big, messy human thing. So for
your homework, your questions to carry with you this week.
(21:57):
Go check it out, friends, and send me your questions,
either about prolonged grief disorder or anything else. This show
is nothing without your questions. It is literally a Q
and a show. You can ask me anything you'd like,
Bring me your clinical questions, your I'm trying really hard
to be a good friend, but I'm getting mixed messages
from everywhere. Bring me your questions about the things that
(22:18):
scare you. How to handle that one thing that always
leaves you feeling with a deer in the headlights and
you really need a script for it. Let's talk it out.
We want to hear from you. I want to hear
from you. This show, this world needs your questions. Together,
we can make things better even when we can't make
(22:39):
them right. You know how most people are going to
scan through their podcast app looking for a new thing
to listen to, and then they're going to see the
show description for Hereafter and think, I don't want to
talk about that stuff. Things are hard enough. This is
where you come in your reviews. Let people know it
really isn't all that bad. In here. We talk heavy stuff,
(23:00):
but it's in the service of making things better for everyone.
So everyone needs to listen. Spread the word in your workplaces,
in your social world on social media, and click through
to leave a review. Subscribe to the show, download episodes,
send in your questions. Want more Hereafter? Brief education doesn't
just belong to end of life issues. Life is full
(23:23):
of losses, from everyday disappointments to events that clearly divide
life into before and after. Learning how to talk about
all that without cliches or platitudes or simplistic think positive
posters is an important skill for everyone. Find trainings, workshops,
books and resources for every human trying to make their
way in the world after something Goes horribly wrong at
(23:45):
Megandivine dot Co. Hereafter with Megan Divine is written at
produced by me Megan Divine. Executive producer is Amy Brown
and Elizabeth Fozzio, Edited by Houston Tilley. Music provided by
Wave Crush Ey
Host
Megan Devine
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