March 20, 2023 • 24 mins
We’re on break, creating all new episodes for season 3. In the meantime, here’s one of our favorite episodes from the past year. See you soon.
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.
Want your questions answered on the show? Submit your questions at megandevine.co
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
- Why launching new rules about how long it’s ok to grieve is more than a bit problematic while we’re still in the middle of a mass death and mass disabling event (aka the pandemic)
- One surprise reason this diagnosis *could* be seen as a good thing
Click here for the episode webpage
Notable quotes:
“Grief makes you less productive, and what we value above all else is productivity.” - Megan Devine
Questions to Carry with you:
Read up on the unfolding public conversation about prolonged grief disorder - how do *you* feel about it? Let us know! Visit megandevine.co
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, including tweet-by-tweet takedowns of most of the major “pro disorder” points, check out the original Twitter thread, and the extended thread. Versions of these threads are also on the blog.
Want to read even more about our culture’s deep avoidance of human emotion, and all the ways that messes with day to day life? Maybe more important, want to know what’s actually normal inside grief? Check out Megan’s best-selling book, It’s OK that You’re Not OK, and follow @refugeingrief on IG/FB/TW
We recommend you check out the Perfectly Normal campaign, serving up just the validation you need when you’re feeling like the only person in the world doing that “weird” thing you do.
Therapist, clinician, or other healthcare provider? Be sure to check out upcoming trainings that address PGD and re-humanizing grief. Follow Megan Devine on LinkedIn, too.
Other articles on prolonged grief disorder include Medicalizing Grief May Threaten Our Ability to Mourn
Get in touch:
Thanks for listening to this week’s episode of Here After with Megan Devine. Tune in, subscribe, leave a review, send in your questions, and share the show with everyone you know. Together, we can make things better, even when they can’t be made right.
To submit your questions visit megandevine.co
For more information, including clinical training and consulting, visit us at www.Megandevine.co
For grief support & education, follow us at @refugeingrief on Instagram, Facebook, Twitter, and TikTok
Check out Megan’s best-selling books - It’s OK That You’re N
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This is here After, and I'm your host, Megan Divine.
Each week we tackled big questions from educators, nurses, and
other helpful folks that let us explore how to show
up after life goes horribly wrong. This week prolonged grief disorder. Oh,
my god's prolonged grief disorder? What is even happening? Why
is the media talking about it? Why are all of
(00:22):
our social media channels lit up over prolonged grief disorder?
This is your I am trying to be brief answer
multiple questions overview of this new new and error quotes
human disorder and what it means for the average person,
for healthcare providers, and honestly for the whole world. Coming
right up after this first break, before we get started,
(00:51):
one quick note. While we cover a lot of emotional
relational territory in each and every episode, this show is
not a substitute for skilled support with a licensed mental
health provider or for professionals supervision related to your work.
And one more note. Hereafter with Megan Divine is currently
on break between seasons. We'll be back before you know
(01:12):
it with a whole new season with even more incredible
guests in the meantime, here's one of our most loved
episodes we'll season. 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
(01:33):
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 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
(01:54):
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 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
(02:15):
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 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 bagel catalog of things that
(02:35):
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 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
(02:56):
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 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
(03:17):
prolonged grief disorder. It is a super complicated, super messy
issue and it hits all of my outrage buttons. So
I have just tried to grumble about it a little
bit when it pops 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
(03:39):
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. This is a good time to remind
you that that little description that I just gave applies
to pretty much everyone one is grieving. It doesn't matter
(04:03):
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. 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,
(04:27):
why people are so mad about it, and hopefully maybe
why you should 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 going to do my best here.
Folks who not kidding when I say that, I get
(04:50):
hot about this stuff, all right, really quickly. A short
orientation to prolonged grief disorder. This 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 DSM I mentioned,
(05:13):
that's already happened. It is already in there. So the
period for debate about whether that diagnosis is 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 lass.
(05:36):
Usually that's a lawsue to death. In order to 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
(05:57):
any of ten additional grief reactions indicative of intense 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 jargain. Pervasive cognitive preoccupation literally means
you are thinking of the person who died pretty regularly
(06:19):
since they died. Persistent and pervasive longing part 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
(06:42):
to qualify for this prolonged grief disorder diagnosis. So things
on the list of those ten additional grief reactions indicative
of intense emotional pain. I am not making this up, everybody,
I'm reading it off of the official diagnostic criteria. So
these ten things include sadness, guilt, anger, denial like having
(07:04):
a hard time reconciling that this death 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
(07:25):
out to all clinicians and 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
(07:48):
a really hard time controlling my fury even just reading
those criteria. I am going to try to keep it
contained for the purposiness of our show at least today,
and get through this general overview with some questions, but
I do gott to note that it is hard for
me to keep it together. I want to address why
(08:09):
anybody should care what the 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
(08:33):
the opinions or the edicts of the 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.
(08:58):
If the medical industry officially says that 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, that all
(09:21):
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, is the whole reason for the
(09:42):
podcast and the books and the education and the training
and 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 in
(10:02):
a minute, but basically, if your doctors as 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 of this
(10:24):
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. Maybe
(10:46):
you should go get some help. Weaponizing prolonged 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
(11:06):
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,
(11:28):
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
(11:49):
quick break. I'm going to drink some water. Hydration is
important when you're feeling outraged, and we'll be right back.
Welcome back, everybody, okay, Continuing with our quick fly over
(12:10):
drive by orientation to prolonged 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
(12:35):
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 emotional pain,
so that actually underlies a lot of capitalism, or it's
at least like the twin of capitalism, avoiding all human
(12:59):
things so that we can be more productive like that.
You know, Oh, capitalism should actually be in the DSM,
but that is also a subject for another day. Oh,
I can already see that 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.
(13:19):
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 DSU.
With the current US healthcare system, you actually can't get
help from a doctor or therapist for something like depression
(13:41):
or anxiety. You can't get help within the US healthcare
system if you weren't broken broken in air 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
(14:01):
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,
(14:22):
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 a disorder.
So this is one reason, as I said, that people
are in favor of the prolonged grief disorder diagnosis. They
(14:43):
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 grief 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
(15:03):
insurance based system where you need to have a disorder
in order to access care. But I would much rather
refocus 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 the meantime,
(15:25):
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 good
(15:48):
point there were like, this diagnosis or this new disorder
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 leav Act protection. Now, I
(16:10):
am not an expert in the Family 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,
(16:31):
which is a problem since there is no law saying
that your company has to give you bereavement leave, and
many of those company policies are four 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 in your company, those
(16:52):
things typically just cover a couple of days off three five.
Some people might even get a week. Now, you can
use family medical leaf 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
(17:13):
something really, really important here. A diagnosis of prolonged grief
disorder can't happen without that 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
(17:33):
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 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,
(17:55):
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 going to give you an argument
for prolonged grief disorders 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
(18:17):
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 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.
(18:44):
If you feel like everybody around you is telling you
to get over it, move on, then having a legit
medical diagnosis gives you 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.
Official diagnosis is like your shield and your defense. So
(19:04):
you basically have to agree that you're doing grief wrong
in order to legitimize your experience. I mean, how screwed
up is 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,
(19:27):
in order to have that honored and acknowledged and supported,
you have to give yourself a disorder just to make
the 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
(19:49):
machinery of capitalism and greed. It involves access to care,
so that means issues of race and class, and gender
and immigration. It also brings into play centuries and centuries
of people being scared of big emotions. There's a reason
why we're going to need a lot of shows to
(20:10):
talk about this one. I hope that what you've gained
from this show today so far is one, of course,
a sense of my outrage, because honestly, you know, outrage
is sometimes useful to share to start you having these conversations,
but also like you're going to hear a lot of
conversation about it, and I want you to be equipped
with some basic knowledge so that you can enter into
(20:31):
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 going to be related to prolonged grief disorder. We'll
be right back, friends. Each week, I leave you with
(20:56):
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, 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
(21:18):
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 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
(21:40):
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, go check it out, friends,
and then 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.
(22:03):
You're I'm trying really hard to be a good friend,
but I'm getting mixed messages from everywhere. Bring me your
questions above the things that 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. Call us at three
two three six four three three seven six eight and
leave a voicemail. If you missed it, you can find
(22:25):
the number in the show notes or visit Megan divine
dot co. If you'd rather send an email, you can
do that too, right on the website Megan Divine dot co.
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
(22:48):
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 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 year, we talk about heavy stuff,
(23:09):
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. Grief education doesn't
just belong to end of life issues. Life is full
(23:31):
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
(23:53):
Megan Divine dot Co. Hereafter with Megan Divine is written
and produced by Aggin Divine Executive producer is Andy Brown
and Elizabeth Fasio, edited by Houston Tilly, and studio support
by Chris Uren. Music provided by Wave Crush.
This is here After, and I'm your host, Megan Divine.
Each week we tackled big questions from educators, nurses, and
other helpful folks that let us explore how to show
up after life goes horribly wrong. This week prolonged grief disorder. Oh,
my god's prolonged grief disorder? What is even happening? Why
is the media talking about it? Why are all of
(00:22):
our social media channels lit up over prolonged grief disorder?
This is your I am trying to be brief answer
multiple questions overview of this new new and error quotes
human disorder and what it means for the average person,
for healthcare providers, and honestly for the whole world. Coming
right up after this first break, before we get started,
(00:51):
one quick note. While we cover a lot of emotional
relational territory in each and every episode, this show is
not a substitute for skilled support with a licensed mental
health provider or for professionals supervision related to your work.
And one more note. Hereafter with Megan Divine is currently
on break between seasons. We'll be back before you know
(01:12):
it with a whole new season with even more incredible
guests in the meantime, here's one of our most loved
episodes we'll season. 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
(01:33):
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 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
(01:54):
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 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
(02:15):
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 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 bagel catalog of things that
(02:35):
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 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
(02:56):
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 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
(03:17):
prolonged grief disorder. It is a super complicated, super messy
issue and it hits all of my outrage buttons. So
I have just tried to grumble about it a little
bit when it pops 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
(03:39):
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. This is a good time to remind
you that that little description that I just gave applies
to pretty much everyone one is grieving. It doesn't matter
(04:03):
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. 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,
(04:27):
why people are so mad about it, and hopefully maybe
why you should 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 going to do my best here.
Folks who not kidding when I say that, I get
(04:50):
hot about this stuff, all right, really quickly. A short
orientation to prolonged grief disorder. This 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 DSM I mentioned,
(05:13):
that's already happened. It is already in there. So the
period for debate about whether that diagnosis is 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 lass.
(05:36):
Usually that's a lawsue to death. In order to 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
(05:57):
any of ten additional grief reactions indicative of intense 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 jargain. Pervasive cognitive preoccupation literally means
you are thinking of the person who died pretty regularly
(06:19):
since they died. Persistent and pervasive longing part 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
(06:42):
to qualify for this prolonged grief disorder diagnosis. So things
on the list of those ten additional grief reactions indicative
of intense emotional pain. I am not making this up, everybody,
I'm reading it off of the official diagnostic criteria. So
these ten things include sadness, guilt, anger, denial like having
(07:04):
a hard time reconciling that this death 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
(07:25):
out to all clinicians and 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
(07:48):
a really hard time controlling my fury even just reading
those criteria. I am going to try to keep it
contained for the purposiness of our show at least today,
and get through this general overview with some questions, but
I do gott to note that it is hard for
me to keep it together. I want to address why
(08:09):
anybody should care what the 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
(08:33):
the opinions or the edicts of the 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.
(08:58):
If the medical industry officially says that 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, that all
(09:21):
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, is the whole reason for the
(09:42):
podcast and the books and the education and the training
and 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 in
(10:02):
a minute, but basically, if your doctors as 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 of this
(10:24):
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. Maybe
(10:46):
you should go get some help. Weaponizing prolonged 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
(11:06):
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,
(11:28):
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
(11:49):
quick break. I'm going to drink some water. Hydration is
important when you're feeling outraged, and we'll be right back.
Welcome back, everybody, okay, Continuing with our quick fly over
(12:10):
drive by orientation to prolonged 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
(12:35):
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 emotional pain,
so that actually underlies a lot of capitalism, or it's
at least like the twin of capitalism, avoiding all human
(12:59):
things so that we can be more productive like that.
You know, Oh, capitalism should actually be in the DSM,
but that is also a subject for another day. Oh,
I can already see that 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.
(13:19):
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 DSU.
With the current US healthcare system, you actually can't get
help from a doctor or therapist for something like depression
(13:41):
or anxiety. You can't get help within the US healthcare
system if you weren't broken broken in air 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
(14:01):
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,
(14:22):
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 a disorder.
So this is one reason, as I said, that people
are in favor of the prolonged grief disorder diagnosis. They
(14:43):
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 grief 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
(15:03):
insurance based system where you need to have a disorder
in order to access care. But I would much rather
refocus 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 the meantime,
(15:25):
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 good
(15:48):
point there were like, this diagnosis or this new disorder
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 leav Act protection. Now, I
(16:10):
am not an expert in the Family 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,
(16:31):
which is a problem since there is no law saying
that your company has to give you bereavement leave, and
many of those company policies are four 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 in your company, those
(16:52):
things typically just cover a couple of days off three five.
Some people might even get a week. Now, you can
use family medical leaf 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
(17:13):
something really, really important here. A diagnosis of prolonged grief
disorder can't happen without that 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
(17:33):
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 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,
(17:55):
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 going to give you an argument
for prolonged grief disorders 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
(18:17):
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 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.
(18:44):
If you feel like everybody around you is telling you
to get over it, move on, then having a legit
medical diagnosis gives you 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.
Official diagnosis is like your shield and your defense. So
(19:04):
you basically have to agree that you're doing grief wrong
in order to legitimize your experience. I mean, how screwed
up is 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,
(19:27):
in order to have that honored and acknowledged and supported,
you have to give yourself a disorder just to make
the 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
(19:49):
machinery of capitalism and greed. It involves access to care,
so that means issues of race and class, and gender
and immigration. It also brings into play centuries and centuries
of people being scared of big emotions. There's a reason
why we're going to need a lot of shows to
(20:10):
talk about this one. I hope that what you've gained
from this show today so far is one, of course,
a sense of my outrage, because honestly, you know, outrage
is sometimes useful to share to start you having these conversations,
but also like you're going to hear a lot of
conversation about it, and I want you to be equipped
with some basic knowledge so that you can enter into
(20:31):
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 going to be related to prolonged grief disorder. We'll
be right back, friends. Each week, I leave you with
(20:56):
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, 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
(21:18):
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 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
(21:40):
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, go check it out, friends,
and then 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.
(22:03):
You're I'm trying really hard to be a good friend,
but I'm getting mixed messages from everywhere. Bring me your
questions above the things that 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. Call us at three
two three six four three three seven six eight and
leave a voicemail. If you missed it, you can find
(22:25):
the number in the show notes or visit Megan divine
dot co. If you'd rather send an email, you can
do that too, right on the website Megan Divine dot co.
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
(22:48):
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 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 year, we talk about heavy stuff,
(23:09):
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. Grief education doesn't
just belong to end of life issues. Life is full
(23:31):
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
(23:53):
Megan Divine dot Co. Hereafter with Megan Divine is written
and produced by Aggin Divine Executive producer is Andy Brown
and Elizabeth Fasio, edited by Houston Tilly, and studio support
by Chris Uren. Music provided by Wave Crush.
Host
Megan Devine
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