Deep sorrow, leaning on friends and relatives, pursuing distractions – there is no one correct way to cope with loss and grief. However, many people experience what is known as "Complicated Grief", and simply cannot move on with their lives.
Although the loss of a loved one is an event experienced by everyone at some point throughout their lives, it is also one of the most difficult to cope with. When that moment comes and we have to deal with the void that is left, it is hard not to feel like we're alone in the world.
Each individual’s response is their own: some of us rely on religious faith, or turn to medical or psychological help, we talk with friends and relatives, sometimes pursuing distractions like reading, knitting or diving into work. And there are people who do not cope at all, or who choose to escape and obscure reality behind alcohol and drugs. Professionals can certainly help, but to do so need to differentiate between different distress signals and identify those that require extra attention.
Beyond longing and dealing with the loss, during the mourning period we experience a constant reminder of mortality, and have to deal with the concept of “death” itself, which can have a large impact on our daily lives. And yet, the great majority of us manage to get through it. We are in pain, we cry, we are angry, but in the end we accept the unchangeable and continue with our lives.
A study in 2012 found that a small percentage of the population behave differently, accounting for about 7 percent of the population – a large yet significant minority, who are unable to move beyond it. Instead, they suffer from deep emotional distress and find themselves in a never-ending struggle of unimaginable emotional pain.
Complicated Grief Disorder – CGD
Recently described in the latest version (the fifth in the series) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, is the mourning syndrome disorder (Complicated Grief Disorder, or in short CGD): with a common set of characteristic symptoms experienced by people suffering this ordeal. The syndrome is defined as a period of mourning after a loss event that exceeds six months and is expressed through, among other serious difficulties, everyday functioning, a maladjustment and lack of acceptance of death, social isolation and suicidal tendencies.
To date, the condition is still being investigated because there still hasn’t been much success with effective medical treatments. However, we can help family, friends and loved ones by recognizing the findings collected to date, even if we do not know all the answers yet.
Medical studies focused on the syndrome revealed that the likelihood of developing itis higher among people who have lost a child or a spouse. Bereaved families who have lost a child are at higher risk of suffering for nearly a decade after the loss. Beyond mental symptoms, parents who lost their children were also at higher risk for suffering from many physical ailments.
Another important factor that influences the chances of developing CGD is the circumstances, or ‘how it happened’: a sudden and violent death can severely affect someone compared to a loss that occurred in a less traumatic circumstance. Hence we can understand how much harder and more perilous the situation is for parents who lost their children in war.
Not depression – rather mourning
Before delving into the issue of diagnosis and methods of treatment, we must distinguish between two situations that might appear similar but are actually radically different: mourning and depression. In a state of depression there is a delay in the ability to experience positive emotions. Depressed people see the world as flawed, and therefore lose any hope of enjoyment from life - from their perspective they go into a dark tunnel that moves toward a dead end.
People that mourn, however, are sad and miss the person they have lost. The world seems to be darker momentarily, but are still able to identify joyful situations, enjoying life to a certain degree and understanding the possibility that in the future they will be able to return to live a full and rewarding life. Their ‘tunnel’ is dark, but there is a light at its end.
One must not get confused between the two states, since they have very different treatments – people suffering from depression need professional treatment and sometimes medication. Those mourning primarily need support and encouragement to help them through the difficult period. The normal mourning process comes to an end when the mourner is able to find the exit from the dark tunnel. This means that in fact emotional regulation and learning processes that took place during mourning are helping create a deep connection to the person who was lost, and is inserting them in our long-term memory, based on the acceptance and understanding that life continues.
However, such a scenario does not always occur. Occasionally a disruption in the healing process may cause a worsening of the mourning to a level of grief disorder. Diagnosis of the phenomenon is not simple, since it includes a range of symptoms of varying severity.
Generally, a person who has experienced CGD cannot accept the loss and is sucked into a kind of endless loop of wonder and "what if’s”. Simple everyday activities and innocent situations become wrapped in the framework of negative emotions like jealousy and anger. In a rare situation of experiencing a positive emotion, a feeling of guilt will immediately follow. A mourner chooses to limit their life significantly and will go to great lengths to avoid anything that might remind them of the person they lost. Alternatively, the opposite extreme situation can occur – where the mourner is on a perpetual search for remaining memorabilia to cling to their lost one. This interferes with their normal functioning and may lead to suicidal thoughts.
What we can do and help manage the situation?
Currently there is no proven medical therapy for effective interference, but the search continues. Antidepressants have been tested but so far have failed dramatically. The usual treatment is more similar to the therapy given to people suffering from post-traumatic stress disorder (PTSD), such as those who have "shell shock."
In the absence of a reliable and effective treatment, we must strengthen our ability to recognize and identify the phenomenon. It is also important to be careful not to misdiagnose CGD in a person that is going through a normal mourning process. The most important thing is to just be there for your loved one.
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