Recently, “Prolonged grief disorder” was added to the DSM 5—the diagnosing psychotherapist’s “bible.” The timeline of six months is often regarded as a turning point in grief; if symptoms strongly persist, a diagnosis of depression may be considered. The prolonged grief diagnosis stretches the normalcy of persistent symptoms to a year. Nevertheless, the diagnosis is somewhat controversial. The question is when does grief become a “disorder” and how long are grief symptoms considered to be a part of the normal healing process rather than becoming a “disorder” or mental illness.
In practice and in experience I have come to see grief as an adjustment to a change that shakes one to the core. In profound losses, a kind of anesthetic shock can seem like a numbness protecting the mind while reality begins to seep into full consciousness. This brief period allows us to make decisions that must be made in the moment and to do the next necessary thing. Some are misjudged as “not feeling” because there may be no tears at this point. It is like having a major body injury and at first not even feeling it.
As the reality of loss begins to reveal itself in a myriad of ways, the mind begins the process of understanding and questioning and finding meaning. An energy that looks like anger distracts as we try to make some sense of what has happened while it makes no sense to us. The next season seems more identifiable as tears and sorrow melt into our consciousness, like a giant iceberg in the chest. This is the season that looks like clinical depression. There may be difficulty in making decisions, little energy or motivation, difficulty sleeping, isolation, and irritability. Like a bodily injury healing, the mind and body and spirit begin the first stages of knitting our lives back together. This takes as long as it takes.
These days as we witness the Ukrainian tragedy, we share in the experience of their grief and observe them moving through unimaginable loss. All of the stages are playing out for the world to see. We send support as we are able, and know at the same time, that it will take a very long time for them to put their lives back together in some way again. It is not measurable in months. There is no timeline for grief other than waiting for the coming of hope and those who encourage us that in time winter lets go and gives way year after year into spring.