Showing posts with label grief. Show all posts
Showing posts with label grief. Show all posts

Monday, September 30, 2013

Virginia Morell - Mournful Creatures (Animals and Grief)


From the current issue of Lapham's Quarterly, Virgina Morell has written an excellent, captivating, and extensive article on the experience of grief among animals, human and (mostly) otherwise. Brilliant writing and content that reminds me we are simply one animal among many, and little about our experience of life is unique.

Morell mentions two recent books in this section of the article: How Animals Grieve, by anthropologist Barbara J. King, and The Bonobo and the Atheist: In Search of Humanism Among the Primates, by primatologist Frans de Waal. Of the two, de Waal is the author I would most trust to get this topic correct.

~ Virginia Morell, a contributor to National Geographic, Science, and Smithsonian, is the author of the books Ancestral Passions: The Leakey Family and the Quest for Humankind's Beginnings (1996) and Blue Nile: Ethiopia's River of Magic and Mystery (2002). Her most recent book is Animal Wise: The Thoughts and Emotions of Our Fellow Creatures (2013). She blogs at Animal Wise at Psychology Today.

Mournful Creatures


Virginia Morell | Lapham's Quarterly


Animals have a great advantage over man: they never hear the clock strike, however intelligent they may be; they die without any idea of death; they have no theologians to instruct them…Their last moments are not disturbed by unwelcome and often objectionable ceremonies; it costs them nothing to be buried; no one starts lawsuits over their wills. — Voltaire

Who can say what cows feel, when they surround and stare intently on a dying or dead companion? — Charles Darwin

It is often said that our understanding and knowledge of death separates the human animal from all other animals. We alone know that we will die—that one day, suddenly or slowly, our life, our loves, our dreams will end. Surely this awareness sets us apart from the rest of the animal kingdom, we say, pointing to some of our greatest art, music, and literature—all inspired by what we know: that death awaits every living being. And yet, how very odd it is that we should be the only animal to know what life ultimately has in store for us. We share biological histories and physiologies DNA, eyes, muscles, nerves, neurons, hormones—with other animals, and these may lead to similar behaviors, thought processes, and emotions—even about death.

Take the case of Thomas, a nine-year-old chimpanzee who died in 2010 at the Chimfunshi Wildlife Orphanage Trust in Zambia, home to more than one hundred chimps. Research scientists filmed the reactions of one community of forty-three chimpanzees to Thomas’ corpse; thirty-eight of them gathered around and stayed by his side for almost twenty minutes. During that time, some of the chimps gently touched his body, smelled and studied him closely. One of those visitors was Masya, a mother carrying her dead infant (at the time, there was an outbreak of a respiratory illness among the chimps). A few days earlier, Masya had been seen placing her dead child in a grassy, sunlit patch and retreating to the shade, where she sat watching, her eyes rarely straying from her infant. Every few minutes, she strode back to the clearing to inspect her baby’s body. At times she did so hurriedly, jumping up and rushing forward as if she thought she’d detected a stirring. She studied her child’s face intently, peered into her gaping mouth and wide eyes, and brushed away the flies. Finally, she placed her knuckles softly against her infant’s neck—hoping, it seems, for any sign of life.

The chimpanzees gathered at Thomas’ side also appeared to be trying to come to grips with what had happened. One female smacked his body, hard—while the others paid close attention, looking, perhaps, for a reaction. Their faces were serious, their manner subdued. One adult male appeared even more distraught than the others; the researchers say this chimp had cared for Thomas for over four years and “had a very strong social relationship” with the dead chimp. He left and returned several times to view the body, as if unable to believe what he was seeing. Finally, he stepped between the others to get as close as possible. He scrutinized the body and erupted in frantic screams while walking rapidly over the cadaver.

Was this a chimpanzee wail of grief? Had the male friend and other chimpanzees come together to mourn Thomas? The scientists who recorded these events prefer not to use such words. Yet the chimpanzees’ behaviors—which mirror many of our own when we lose a loved one—suggest that, like us, they have trouble accepting death when it comes to one of their own. As with most emotions in animals, we do not yet understand their reactions with total clarity—but, as Charles Darwin wisely observed, they may very well have meaning. Perhaps we are the only animals with foreknowledge of death, but when it comes to grieving, we are not so unique.

The study of animal grief is a young field, largely because studies of any animal behaviors that one might think of as “human” were ignored for much of the twentieth century. It was commonly held that nonhuman animals were only reactive beings, lacking thoughts and emotions, and responding to stimuli as unthinking, unfeeling robots. Scientists were cautioned about being anthropomorphic, that is, regarding animals as they are often depicted in naive films and storybooks—as if they were people dressed up in fur or feathers. Researchers who thought they detected animal emotions—especially those that we think of as uniquely human, such as love, joy, or grief—were considered to be sentimentalists. And their reports (such as Darwin’s about the grieving cows) were dismissed as anecdotal.

In the last few decades, though, wildlife biologists have amassed so many firsthand accounts of animals caring for and mourning their dead that the idea of animal grief is no longer as suspect as it once was. Two recent books, both published in March of this year, explore the subject. How Animals Grieve, by anthropologist Barbara J. King, collects anecdotal and scientific data on grief in many kinds of animals, even some that most researchers ignore, such as rabbits, goats, and turtles. In The Bonobo and the Atheist: In Search of Humanism Among the Primates, primatologist Frans de Waal examines the biological roots of religion and morality. Since our awareness of death is often cited as the reason we developed religion, de Waal investigates whether other animals have a similar sense of their ultimate end. While King doubts that even our close chimpanzee relatives are “aware that death is coming,” de Waal suggests that older apes or elephants may have experienced enough of life to comprehend that they, too, will die. “When an old ape notices that trees are harder and harder to get into or an elephant has ever more trouble keeping up with the herd, might these individuals not apply what they have learned about life and death to their own bodies?” de Waal asks. “It’s hard to know, yet impossible to rule out.”

Scientists grappling with animal grief must find some way of framing their questions into hypotheses they can test. So far, none of them have figured out how to set up an experiment to address de Waal’s question. But they are getting closer to answering what once seemed an equally daunting problem: why do animals grieve? As King points out in her book, there are enough examples of grief in species as varied as goats, baboons, and gorillas that the emotion may be an experience shared by many species. If so, then it must have an evolutionary history and confer some benefit—that is, it must be advantageous in some way, enabling the mourner to survive long enough to reproduce and pass his or her genes to the next generation. Otherwise, natural selection would have weeded out grief long ago.

From a study of twenty-two wild-baboon females who had lost either an infant or other close relative to a predator, scientists know that the animals’ stress hormones flare for four weeks after the attack. They typically act in a “bereaved” manner, too, the researchers say, sitting apart from other baboons and not seeking out grooming (a behavior that has both social and hygienic benefits). In time, the baboons’ stress hormones subside, and they again spend time with their fellows. At first glance, it would seem that grieving would leave baboons—or other mourning animals—at great risk of either falling ill or being taken by a predator themselves. But another study, by neuroscientists Karen Wager-Smith and Athina Markou, which King discusses at length, suggests that the mourning period is actually a neurobiological necessity, particularly for any animal that forms close bonds with another individual. The researchers note that stress can inflict “microdamage” in key areas of the brain, such as the hippocampus and prefrontal cortex, both of which are concerned with memory, emotions, personality, and planning. But the brain is not a static organ; it responds dynamically to life’s events by pruning away neurons that are no longer needed and sprouting new ones. Rewiring takes time and energy, and so a period of mourning—of sleeping longer, minimizing social contact, eating less—can ultimately prove beneficial. And, indeed, all of the baboons eventually recovered from their grief, made new friends, or gave birth to new children. Grief for them can have an “adaptive value,” as evolutionary biologists are fond of saying; it enables an animal to recover from what is essentially minor brain trauma and carry on with the purpose of life—reproducing.

But discerning whatever adaptive value or evolutionary benefit grief might confer doesn’t answer another important question: how do animals experience grief? Is it at all like the sorrow we feel when a loved one dies? Can it be so all-consuming that one never recovers?

Apparently so. How else to explain the behavior of Flint, a male chimpanzee whom Jane Goodall observed at Gombe Stream National Park in Tanzania for the eight and a half years of his short life. Flint could not express in words what he felt about his mother’s death, but no one could misinterpret his actions. Flint’s mother, Flo, was in her early forties when she gave birth to her son. That’s close to old age for chimpanzees, and it may explain why Flo wasn’t the strict mother she’d been to her younger children. For whatever reason, she let Flint do whatever he pleased, nursing at her breast long past the age (four or so) when he should have been weaned, and riding on his old mother’s back until he was eight, an age when he should have been walking everywhere on his own. The pair was inseparable, and then Flo died.

“It seemed,” Goodall wrote in Through a Window, a memoir of her thirty years of chimpanzee research at Gombe, “that [Flint] had no will to survive without her Never shall I forget watching as, three days after Flo’s death, Flint climbed slowly into a tall tree near the stream [where she had died]. He walked along one of the branches, then stopped and stood motionless, staring down at an empty nest. After about two minutes he turned away and, with the movements of an old man, climbed down, walked a few steps, then lay, wide eyes staring ahead. The nest was one which he and Flo had shared a short while before Flo died.”

Flint never recovered from his loss. He grew lethargic, refused food that the researchers set out for him, and fell sick. The last time Goodall saw him alive, he was “hollow-eyed, gaunt, and utterly depressed, huddled in the vegetation close to where Flo had died…The last short journey he made, pausing to rest every few feet, was to the very place where Flo’s body had lain. There he stayed for several hours, sometimes staring and staring into the water. He struggled on a little farther, then curled up—and never moved again.”

Flint’s response was entirely maladaptive. It did not help one whit in terms of fitness; he never reproduced, his genes were not passed to the next generation. So profound was Flint’s love for his mother and his sorrow at her death that he simply gave up the will to live.
Read the whole captivating and lengthy article.

Sunday, August 11, 2013

Mark Epstein - The Trauma of Being Alive (New York Times)


In anticipation of his new book, The Trauma of Everyday Life, being released this week (Aug. 15), Mark Epstein had an interesting column in the New York Times a week ago. His point here, and I would assume in the book, as well, is that being alive entails the experience of trauma in some form or another (whether big T traumas like death, natural disasters, rape, being a refugee, and so on; or small t traumas such as neglect, bullying, social isolation, and so on).
An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune. Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it.
I suppose there is truth in this - and a little wisdom. On the other hand, I can see some people becoming frozen in their fear of the next traumatic experience. I see two solutions to this awareness: (1) Allow our brains to do what they do well, keep such awareness below the threshold of consciousness, or (2) Embrace the knowledge that any moment could be our last and carpe diem.

The Trauma of Being Alive

By MARK EPSTEIN
Published: August 3, 2013

TALKING with my 88-year-old mother, four and a half years after my father died from a brain tumor, I was surprised to hear her questioning herself. “You’d think I would be over it by now,” she said, speaking of the pain of losing my father, her husband of almost 60 years. “It’s been more than four years, and I’m still upset.”

Balint Zsako

I’m not sure if I became a psychiatrist because my mother liked to talk to me in this way when I was young or if she talks to me this way now because I became a psychiatrist, but I was pleased to have this conversation with her. Grief needs to be talked about. When it is held too privately it tends to eat away at its own support.

“Trauma never goes away completely,” I responded. “It changes perhaps, softens some with time, but never completely goes away. What makes you think you should be completely over it? I don’t think it works that way.” There was a palpable sense of relief as my mother considered my opinion.

“I don’t have to feel guilty that I’m not over it?” she asked. “It took 10 years after my first husband died,” she remembered suddenly, thinking back to her college sweetheart, to his sudden death from a heart condition when she was in her mid-20s, a few years before she met my father. “I guess I could give myself a break.”

I never knew about my mother’s first husband until I was playing Scrabble one day when I was 10 or 11 and opened her weather-beaten copy of Webster’s Dictionary to look up a word. There, on the inside of the front cover, in her handwriting, was her name inscribed in black ink. Only it wasn’t her current name (and it wasn’t her maiden name). It was another, unfamiliar name, not Sherrie Epstein but Sherrie Steinbach: an alternative version of my mother at once entirely familiar (in her distinctive hand) and utterly alien.

“What’s this?” I remember asking her, holding up the faded blue dictionary, and the story came tumbling out. It was rarely spoken of thereafter, at least until my father died half a century later, at which point my mother began to bring it up, this time of her own volition. I’m not sure that the trauma of her first husband’s death had ever completely disappeared; it seemed to be surfacing again in the context of my father’s death.

Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune. Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it.

My response to my mother — that trauma never goes away completely — points to something I have learned through my years as a psychiatrist. In resisting trauma and in defending ourselves from feeling its full impact, we deprive ourselves of its truth. As a therapist, I can testify to how difficult it can be to acknowledge one’s distress and to admit one’s vulnerability. My mother’s knee-jerk reaction, “Shouldn’t I be over this by now?” is very common. There is a rush to normal in many of us that closes us off, not only to the depth of our own suffering but also, as a consequence, to the suffering of others.

When disasters strike we may have an immediate empathic response, but underneath we are often conditioned to believe that “normal” is where we all should be. The victims of the Boston Marathon bombings will take years to recover. Soldiers returning from war carry their battlefield experiences within. Can we, as a community, keep these people in our hearts for years? Or will we move on, expecting them to move on, the way the father of one of my friends expected his 4-year-old son — my friend — to move on after his mother killed herself, telling him one morning that she was gone and never mentioning her again?

IN 1969, after working with terminally ill patients, the Swiss psychiatrist Elisabeth Kübler-Ross brought the trauma of death out of the closet with the publication of her groundbreaking work, “On Death and Dying.” She outlined a five-stage model of grief: denial, anger, bargaining, depression, acceptance. Her work was radical at the time. It made death a normal topic of conversation, but had the inadvertent effect of making people feel, as my mother did, that grief was something to do right.

Mourning, however, has no timetable. Grief is not the same for everyone. And it does not always go away. The closest one can find to a consensus about it among today’s therapists is the conviction that the healthiest way to deal with trauma is to lean into it, rather than try to keep it at bay. The reflexive rush to normal is counterproductive. In the attempt to fit in, to be normal, the traumatized person (and this is most of us) feels estranged.

While we are accustomed to thinking of trauma as the inevitable result of a major cataclysm, daily life is filled with endless little traumas. Things break. People hurt our feelings. Ticks carry Lyme disease. Pets die. Friends get sick and even die.

“They’re shooting at our regiment now,” a 60-year-old friend said the other day as he recounted the various illnesses of his closest acquaintances. “We’re the ones coming over the hill.” He was right, but the traumatic underpinnings of life are not specific to any generation. The first day of school and the first day in an assisted-living facility are remarkably similar. Separation and loss touch everyone.

I was surprised when my mother mentioned that it had taken her 10 years to recover from her first husband’s death. That would have made me 6 or 7, I thought to myself, by the time she began to feel better. My father, while a compassionate physician, had not wanted to deal with that aspect of my mother’s history. When she married him, she gave her previous wedding’s photographs to her sister to hold for her. I never knew about them or thought to ask about them, but after my father died, my mother was suddenly very open about this hidden period in her life. It had been lying in wait, rarely spoken of, for 60 years.

My mother was putting herself under the same pressure in dealing with my father’s death as she had when her first husband died. The earlier trauma was conditioning the later one, and the difficulties were only getting compounded. I was glad to be a psychiatrist and grateful for my Buddhist inclinations when speaking with her. I could offer her something beyond the blandishments of the rush to normal.

The willingness to face traumas — be they large, small, primitive or fresh — is the key to healing from them. They may never disappear in the way we think they should, but maybe they don’t need to. Trauma is an ineradicable aspect of life. We are human as a result of it, not in spite of it.


~ Mark Epstein is a psychiatrist and the author, most recently, of the forthcoming book “The Trauma of Everyday Life.”

Thursday, June 27, 2013

Bob Holmes - Tracing the Roots of Human Morality in Animals

Over at New Scientist, Bob Holmes recently (well, okay, in May) reviewed new books from Frans de Waal and Barbara King on morality in animals and on how animals grieve. While Holmes enjoyed de Waal's scientific approach to understanding how morality develops in animals (especially primates), he much less keen on King's anecdotal account of greiving in animals.

The books under review are The Bonobo and the Atheist: In search of humanism among the primates by Frans de Waal and How Animals Grieve by Barbara J. King.

Tracing the roots of human morality in animals

21 May 2013 by Bob Holmes
Magazine issue 2917

The Bonobo and the Atheist and How Animals Grieve show that we must be careful when studying animals to learn about the origins of human traits and behaviours

Bonobos are more likely than chimps to have concern for each other 
(Image: ZSSD/Minden Pictures/FLPA)

Book information

The Bonobo and the Atheist: In search of humanism among the primates by Frans de WaalPublished by: NortonPrice: $27.95  ($20.15 at Amazon)
How Animals Grieve by Barbara J. KingPublished by: University of Chicago PressPrice: $25.00 ($18.14 at Amazon)

WHERE does morality come from? Throughout the history of Western civilisation, thinkers have usually answered either that it comes from God, or else through the application of reason.

But in The Bonobo and the Atheist, primatologist Frans de Waal argues that there's another answer that fits the data better: morality comes from our evolutionary past as a social primate. Like our closest relatives the apes, humans evolved in small, tightly knit, cooperative groups. As a result, again like the apes, we are exquisitely sensitive to one another's moods, needs and intentions.

This well-developed empathy provided the trellis on which morality later flowered. De Waal, who is based at Emory University in Atlanta, Georgia, has been making this case eloquently for many years and over several books, notably in Good Natured back in 1997, and in Primates and Philosophers, 12 years later.

In his new work, he bolsters the argument by drawing on a lot of new research, carefully footnoted for those who want to dig deeper. De Waal distinguishes two degrees of morality. The first he calls "one-on-one morality", which governs how an individual can expect to be treated, and the second "community concern", a larger, more abstract concept that extends to the harmony of the group as a whole.

Chimps and bonobos certainly have the former – they respect ownership, for example, and expect to be treated according to their place in the hierarchy. But de Waal presents several examples – such as a chimp stepping in to stop a fight between two others – that suggest that they also have a rudimentary form of the latter.

The book's title, incidentally, draws on bonobos because they are more likely than chimps to behave morally, to have concern for each other, to value harmony and so on. This, imagines, de Waal, is something morally inclined atheists would want to emulate.

If humans inherited morality from our ancestors, though, what are we to make of religion? Here de Waal moves into territory he has not explored before. Clearly, religion must do something important, since every human culture has it. But instead of religion giving us morality, de Waal turns the tables. Morality, he argues, probably gave us religion as a way of reinforcing the pre-existing community concern.

If he's right, then there may be no absolute code of right and wrong out there to be discovered. Instead, each individual's evolved sense of empathy and concern for the group may help shape the group's consensus on what kind of behaviour is appropriate. In short, says de Waal, morality may be something we all have to work out together. It's a persuasive argument, and de Waal's cautious and evidence-based approach is one that many New Scientist readers are sure to find congenial.

That careful approach is less evident in another book covering some of the same ground. In How Animals Grieve, anthropologist Barbara King sets out to explore the question of whether non-human animals grieve for their dead. It's an intriguing question, but unfortunately King's book is largely a succession of anecdotes: the cat who roams the house, crying, in search of its dead litter mate; the dog who waits daily at the train station for its dead master; a dolphin trying to keep her dead calf afloat for days.

Some of these stories make a persuasive case for some animals – especially apes, elephants and cetaceans – sometimes grieving. No surprises there: I suspect most readers would have conceded that ground right from the start.

But King makes little effort to dig any deeper by exploring, for example, the neural machinery and cognitive skills an animal needs in order to be capable of grief. After all, solitary species such as cats have less need for empathy – and its corollary, grief – than social animals, and small-brained creatures such as turtles may simply lack the brainpower or not form lasting pair bonds.

To his credit, de Waal takes full note of such distinctions; King, not so much.

This article appeared in print under the headline "The making of morality"

Saturday, April 13, 2013

Barbara J King - When Animals Mourn: Seeing That Grief Is Not Uniquely Human

From NPR's 13.7 Cosmos and Culture blog, Barbara J. King does a little self-promotion for her new book, How Animals GrieveThis looks like a fascinating book, especially for any hard-core animal lovers, or those who do not believe that many mammals and some birds experience a sense of self/other and have emotional lives.

When Animals Mourn: Seeing That Grief Is Not Uniquely Human

by BARBARA J. KING


April 11, 2013


An elephant at the Emmen, Netherlands, zoo stands at the edge of a ditch in 2009, a day after another elephant fell into the ditch and died. Olaf Kraak/AFP/Getty Images

Eleanor was the matriarch of an elephant family called the First Ladies. One day, elephant researchers in Kenya's Samburu National Reserve saw that Eleanor was bruised and dragging her trunk on the ground. Soon, she collapsed.

Within minutes, Grace, the matriarch of another elephant family, came near. Using her trunk, she pushed Eleanor back up to a standing position. When Eleanor, greatly weakened now, thudded once again to the ground, Grace became visibly distressed: she vocalized, pushed at the body and refused to leave Eleanor's side.



When Eleanor died, a female called Maui, from a third elephant family, hovered over her body, pulling on and rocking over it. During the next week, elephants from five different families came to the body. Some individuals seemed motivated only by curiosity. But the behavior of others, including Grace and Maui, clearly involved grief.

The breadth and depth of animal grief is the topic of my book How Animals Grieve, just published. Writing this book often moved me profoundly; through reading the science literature and conducting interviews with experienced animal caretakers, I came to understand at a new, visceral level just how extensively animals feel their lives. Elephants grieve. Great apes (think chimpanzees, bonobos) and cetaceans (such as dolphins) grieve. So do horses and rabbits, cats and dogs, even some birds.

Here at 13.7, I often write about science books. So it's gratifying to write now about my own, especially this week when it's the focal point of a story in Time Magazine called "The Mystery of Animal Grief."

The Time article includes the story of Eleanor. It mentions also the keening grief of the Siamese cat Willa for her sister Carson, which I described in one of my first posts for 13.7, back in 2011.

In my work, I define grief as some visible response to death that goes beyond curiosity or exploration to include altered daily routines plus signs of emotional distress. Horses who merely nudge or sniff at the body of a dead companion, for example, can't be said to be grieving. Horses who stand vigil in a hushed circle, for many hours, at the fresh grave of a lost friend may well be grieving. A horse who refuses food and companionship, becomes listless and won't follow normal routines for days when her friend dies? Why wouldn't we see this as grief? (These examples are explained in detail in the book.)

As I've mentioned, it's not only the big-brained "usual suspects" — the apes, elephants and dolphins — who grieve. In this brief video produced at The College of William and Mary (where I teach), I describe what happened when one duck named Harper, rescued by and living contentedly at Farm Sanctuary, witnesses the necessary euthanasia of his best duck friend Kohl. Emotionally, Harper simply cannot recover from his loss.



In our own lives, when it hits hard, grief can be a wild and terrible force. In another post to come, I will outline some ways in which I think human mourning and thinking about death differs from the grief of other animals.

For now, I'll conclude with the same words with which I close my book:
It won't ease our deepest grief to know that animals love and grieve too. But when our mourning becomes a little less raw... may it bring genuine comfort to know how much we share with other animals? I find hope and solace in [these] stories. May you find hope and solace in them as well.

Thursday, December 15, 2011

TEDxOjaiWomen - Alana Sheeren - Owning Our Grief

 
The speaker in this TEDx talk is primarily relating a female perspective and experience, but the issue of owning and living with our grief is important for all of us.

On an unrelated note: I have seen several TEDx women conferences, but not a single one for men. That needs to change.

Alana Sheeren - Owning Our Grief




About this talk:
How does grief shape our lives? Does the way we experience it make a difference? Using personal stories, Alana opens up new ways of looking at grief and encourages us to stay open to its gifts and lessons.

Alana Sheeren believes in love, beauty and the transformative power of grief. After the stillbirth of her son she began writing about her personal journey into grief and whole-self healing. A Reiki Master with a MA degree in clinical and community psychology and a BFA in theater, Alana partners with women through the dance of grief, both individually and in healing retreats.

Monday, September 19, 2011

Shrink Rap Radio #279 – Grief, Ritual, and The Soul of the World with Francis Weller


Francis Weller practices something he calls Soul Psychology - sounds like spiritually based therapy, sort of, but he seems to also be skirting the realm of "parts work" and subpersonalities (which some local native healers see as another form of Soul Retrieval). He is the author of Entering The Healing Ground: Grief, Ritual and The Soul of the World.

Shrink Rap Radio #279 – Grief, Ritual, and The Soul of The World with Francis Weller, M.A.




Francis Weller, M.A., MFT is a psychotherapist and author of the 2011 book, Entering The Healing Ground: Grief, Ritual and The Soul of the World. He has been in private practice since 1983. During that time, he developed a style of working with people called Soul-Centered Psychotherapy. Weller says his approach to working with the wounds and challenges we face restores soul as the primary focus. He says he has come to have a deep faith in the way soul/psyche works, its moods and movements, how it speaks through symptoms and images, how it longs for intimacy with the world and its need for beauty. I see this every day in my work with people.


Weller says, we often struggle with the muscular demands of our culture to measure up, perform and be perfect. This leaves little room for those parts of us that do not match these expectations; the vulnerable, weak, inadequate and grieving parts of soul. And yet, it is precisely these parts of who we are that bring us closer to others, to the vitality of life and the world. Bringing these rejected and denied elements of soul-life, “those places where I said no to my life,” back into our daily rhythms is what adds meaning and depth to our days.



Francis weller reports he has worked with many concerns in his practice. He specializes in grief work, shame, addiction, depression, and men’s issues. He works with individuals and couples and he offers groups periodically.
A psychology podcast by David Van Nuys, Ph.D.





Sunday, July 03, 2011

Joan Arehart-Treichel - Mood Disorders May Look Different in DSM-5

Psychiatric News offers another update on the corporate greed that is the DSM-5, this time on apparent changes (nothing is set in stone, yet) to the mood disorders category. Interestingly, it seems they are making some positive decisions, although, again, nothing is final.

If you happen to be a psychiatrist - 75% of who do no therapy and only prescribe drugs - you can leave a comment about these changes at the DSM-5 site (link at the end of the article) and I'm sure they will be glad to hear from you.

If you, like me, are a counselor and actually do therapy with those who have mood disorders, I suspect they could give a rat's ass what you or I think.

Mood Disorders May Look Different in DSM-5

Joan Arehart-Treichel

Questions were raised at the APA annual meeting concerning the classification and description of mood disorders in DSM-5. Much of the discussion focused on lifespan issues.

David Kupfer, M.D., a professor of psychiatry at the University of Pittsburgh, and Darrel Regier, M.D., M.P.H., director of APA's Division of Research and executive director of the American Psychiatric Institute for Research and Education, are the chair and vice chair, respectively, of the DSM-5 Task Force.

To keep psychiatrists and other interested parties informed on the revised manual's development process, they organized a symposium at the APA annual meeting in Honolulu in May on “Mood Disorders Across the Lifespan: Implications for DSM-5.” As Regier explained, “We are trying to focus more on this subject than we did in DSM-IV.

Here are some of the questions that were addressed at the symposium concerning mood disorders and DSM-5, although not all were directly related to lifespan issues.

• Should an Energy Change Constitute a Bipolar Criterion?

Figure

“We are viewing this as a minor change,” said Ellen Frank, Ph.D., regarding energy as a criterion for mood disorders. Credit: David Hathcox

In addition to elation and euphoria, people with bipolar disorder often experience a change in energy, Ellen Frank, Ph.D., reported. Frank, a professor of psychiatry at the University of Pittsburgh, is on the DSM-5 Mood Disorders Work Group. Thus, a change in energy will be included as one of the criteria for bipolar disorder in DSM-5, Frank said. “We are viewing this as a minor change,” she noted, because such energy changes are already implicit in the DSM-IV criteria for bipolar disorder.

The inclusion of a change in energy as a criterion, Frank explained, should make the diagnosis of bipolar disorder a little easier than it currently is since people are more likely to recall when they had an energy change than when they had a mood change.

• Should the Bereavement Exclusion for Major Depression Remain?

If, for example, a 63-year-old man is despondent for three to four weeks, is his diagnosis major depressive disorder? Perhaps. But suppose his despondency is due to his wife dying. DSM-IV would say that he is bereaved, not depressed, Sidney Zisook, M.D., a professor of psychiatry at the University of California, San Diego, said.

But what is grief? Zisook asked. It is disbelief and yearning to be with the one who died. Such emotions may occur every day for six months and periodically thereafter. They may also be mixed with other emotions—say, humor or warm recollections. So grief is not depression, he explained.

Yet grief is a stressor that can precipitate a major depression, Zisook asserted, which raises this question: Is grief-triggered depression the same as non-grief-triggered depression? Zisook looked at the evidence, and some studies suggested yes, others no. But most of the studies implied that grief-triggered depression is the same as non-grief-triggered depression. For instance, in one study, antidepressants helped patients who were depressed in the wake of the grieving process without impairing that process.

So, since grief seems to differ from depression, and since grief-triggered depression seems to be the same as major depressive disorder, the bereavement exclusion from major depressive disorder should remain in DSM-5, Zisook concluded.

However, he pointed out, some have proposed that grief that endures longer than six months—often called complicated grief—should be given its own diagnosis in DSM-5. Zisook said this in response to a psychiatrist in the audience who reported that he was experiencing complicated grief in the wake of his wife's death and wondered how complicated grief was going to be handled in DSM-5.

• Should Late-Life Depression Be Added As a Distinct Diagnosis?

Does depression in later life differ from depression in earlier life? It appears that it does, Dan Blazer, M.D., a professor of psychiatry at Duke University and acting chair of the DSM-5 Neurocognitive Work Group, reported.

For instance, a number of studies have shown that people tend to experience less depression later in life than in mid-life, yet, ironically, the symptoms of depression seem to increase in later life. Moreover, it is much more common to see psychotic depression in older people than in middle-aged individuals. And unlike depressed individuals of middle age, older depressed people may not demonstrate outright sadness as a key symptom, but express their depression in the form of aches and pains and a lack of pleasure.

Yet while late-life major depression differs from major depression in middle age in several ways, the differences are not enough to justify including a separate diagnosis for late-life major depression in DSM-5, Blazer stated.

• Should Bipolar Disorder in Children Become a Distinct Diagnosis?

More and more children have been diagnosed with bipolar disorder in recent years, David Shaffer, M.D., a professor of child psychiatry at Columbia University and a member of the DSM-5 Task Force, reported. He hypothesized that in previous years when less was known about bipolar depression in youth, many of them would have been diagnosed with attention-deficit/hyperactivity disorder instead of bipolar disorder, since the two disorders share certain symptoms, for example, disinhibition and irritability.

Shaffer did not, however, express an opinion on whether in DSM-5 childhood bipolar disorder should be considered a distinct diagnosis or continue to be classified under the rubric of “Bipolar Disorder Not Otherwise Specified.”

Kupfer indicated that he, Regier, and the other experts involved in the DSM-5 development process welcome input from psychiatrists on the subject of mood disorders across the lifespan. Psychiatrists can post their comments on the DSM-5 Web site.
Psychiatric News July 1, 2011
Volume 46 Number 13 Page 10
© American Psychiatric Association


Friday, January 14, 2011

Free Support Group for those affected by the Tucson Tragedy

I know the therapists who are doing this - great people!



Free Support Group for those affected by the Tucson Tragedy

Time:
Saturday, January 29 · 9:30am - 11:00am
Location: Tucson Center for Counseling and Psychotherapy
2230 E. Speedway Blvd., Suite #140 * Tucson, AZ

Created By: Tucson Center for Counseling and Psychotherapy

More Info: The Tucson community was affected by the tragic incident on Saturday January 8, 2011. These support groups are intended to allow community members a safe place to share and support each other through this tough time. Each group is limited to 10 participants and are free of charge. Please help spread the the love by spreading the word.

Call to register: 520-318-4227

Please note that these are support groups facilitated by the staff at TCCP. They are not therapy groups.

Thursday, January 13, 2011

Barack Obama's Speech in Tucson Last Night

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Full text here -and here is the video for those (like me) who did not/could not see it last night. It was certainly one of his best speeches - as one commenter below noted, he matched and easily transcended the speeches given by Reagan (the Challenger disaster) and Clinton (Oklahoma City bombing).



Andrew Sullivan's Daily Dish collected responses to Obama's speech, which is far as I can tell have been largely favorable, even from conservatives - here is what he posted earlier this morning.

Adam Serwer tweets:

This speech reminds me that the criticism I find most incomprehensible is the idea that the president does not love his country.

Fallows:

The standard comparisons of the past four days have been to Ronald Reagan after the Challenger disaster and Bill Clinton after Oklahoma City. [Yesterday's] speech matched those as a demonstration of "head of state" presence, and far exceeded them as oratory -- while being completely different in tone and nature. They, in retrospect, were mainly -- and effectively -- designed to note tragic loss. Obama turned this into a celebration -- of the people who were killed, of the values they lived by, and of the way their example could bring out the better in all of us and in our country.

First Read:

While Obama tried to uplift, Palin tried to settle scores. While the president called for more civility, the former Alaska governor talked about duels and 'blood libel.' And while Obama's message was, well, presidential, Palin's was not. We'll say this: If Palin has ambitions for the White House -- and we're still not sure she does -- then her tone, message, and timing from her eight-minute video was a serious miscalculation.

Amy Davidson:

We do need civility, and one hopes we get more of that, and less scorn. We also need politics. And true civility can be disruptive—it is not civil, for example, to abandon the unpopular or unfairly treated. There are times when smiling blandly is far more cynical than raising one’s voice would be—when politeness is uncivil—just as there are times when cheering at a memorial is a profound act of mourning.

Allahpundit:

Note the rhetorical move at the end: Civil rhetoric may be a virtue but that doesn’t mean it’s a lesson of the shooting. He’s obviously aiming this at the left, although naturally they’ll conclude that that can’t possibly be the case. Ace heard a different speech than I did, I guess, but for what it’s worth, this is playing remarkably well thus far among righties on Twitter: Rich Lowry, Jonah Goldberg, Jim Geraghty, Andy Levy, S.E. Cupp, Philip Klein, and Ace’s own co-bloggers Drew and Gabe all thought it was rock solid.

Jonathan Bernstein:

It's an easy speech because everyone watching wants the president to succeed. It's an easy speech because that's how representation works, at its best. He's not only Barack Obama speaking; he's speaking on behalf of the American people.

Noam Scheiber:

I found myself reacting well to the speech emotionally even if it didn’t always hang together for me intellectually. Still, by nodding at the ways the Tucson tragedy might nudge us toward self-improvement, then not following through, Obama’s otherwise eloquent speech left me a bit unsatisfied.

Josh Green:

My own impression is that he provided what had so far been missing from this tragedy: a response that dignified the memories of the victims and properly placed them at the forefront of public attention.

Ed Morrissey:

Some of my friends may criticize Obama for not defending Palin specifically, or for waiting until the memorial to have rebuked those attempting to exploit the deaths for political gain. On the first point, though, this was a memorial service and it wouldn’t have been appropriate to name other names than the dead, the wounded, and the heros who helped save lives. The second point may be germane criticism of the previous couple of days, but even if it came late, Obama stepped up and led last night.


Tucson Recovers - Upcoming Events

http://www.latimes.com/media/photo/2011-01/58687085.JPG

As Tucson and its people begin to recover from last week's tragic events, the community is coming together in various events - I will post some of them as I become aware of them - if you know of events that I have missed, please drop me a note.

There are still people gathering and leaving candles, prayers, pictures, offerings and tears at University Medical Center and at Gabriel Giffords' office. The above picture is from UMC.

In an effort to avoid negative impact on private funerals, the Tucson Memorial Project and Wingspan (the LGBT support and community group) have organized this first event - today at 12-2 pm.
Peace and Solidarity Gathering

If you don't want to fight traffic, parking, shuttles, and deal with crowds, there is an alternative venue that is gathering. We highly encourage that everyone considers attending alternate venues to alleviate the impact of the funeral on the community, area businesses, and residences. See below for more information. Thank you, and please spread the word.

Time: Thursday, January 13 · 12:00pm - 2:00pm
Location: Demeester Band Shell - Reid Park, Country Club and 22nd St.
Tucson, AZ

Created By: Wingspan

More Info: In collaboration with the "Angel Project," Wingspan AVP has organized a peace and solidarity gathering for community members to come together and promote non-violence and healing.

Please join friends and neighbors as we challenge acts of violence with kindness and community.

Bring messages of hope and well wishes to the families of those affected by this week's tragedy.

Gain strength and mend hearts through kinship.

If you are interested in helping with the event as a peacekeeper, please contact Oscar Jimenez at ojimenez@wingspan.org
For the Buddhist community here (and anyone else who like to attend), which is quite large and diverse, the Tucson Shambhala Meditation Group is offering a tonglen and loving-kindness event on Saturday.
Tonglen & Loving-Kindness Practice Opportunity For Sangha and Friends



When: Saturday, January 15, 2011 at 10:00 A.M.


Tucson Shambhala Meditation Group would like to invite everyone who is interested to gather at the Center this coming Saturday at 10:00 a.m. for the opportunity to practice tonglen and loving-kindness together for all those people involved with and connected to this week's sad events in our city.

There will also be a chance to practice tonglen on Sunday at the regular 9:00 a.m. practice period, which will be followed at 10:00 a.m. by a Community Meeting as previously announced.

Tucson Shambhala Meditation Group
3250 N. Tucson Blvd.
Tucson, AZ 85716

Wednesday, January 12, 2011

Barack Obama's Memorial in Tucson

Full text here - here is a piece that moved me.

barack obama
We are grateful for Daniel Hernandez, a volunteer in Gabby's office who ran through the chaos to minister to his boss, tending to her wounds to keep her alive. We are grateful for the men who tackled the gunman as he stopped to reload. We are grateful for a petite 61 year-old, Patricia Maisch, who wrestled away the killer's ammunition, undoubtedly saving some lives. And we are grateful for the doctors and nurses and emergency medics who worked wonders to heal those who'd been hurt.

These men and women remind us that heroism is found not only on the fields of battle. They remind us that heroism does not require special training or physical strength. Heroism is here, all around us, in the hearts of so many of our fellow citizens, just waiting to be summoned - as it was on Saturday morning.

Their actions, their selflessness, also pose a challenge to each of us. It raises the question of what, beyond the prayers and expressions of concern, is required of us going forward. How can we honor the fallen? How can we be true to their memory?

You see, when a tragedy like this strikes, it is part of our nature to demand explanations - to try to impose some order on the chaos, and make sense out of that which seems senseless. Already we've seen a national conversation commence, not only about the motivations behind these killings, but about everything from the merits of gun safety laws to the adequacy of our mental health systems. Much of this process, of debating what might be done to prevent such tragedies in the future, is an essential ingredient in our exercise of self-government.

But at a time when our discourse has become so sharply polarized - at a time when we are far too eager to lay the blame for all that ails the world at the feet of those who think differently than we do - it's important for us to pause for a moment and make sure that we are talking with each other in a way that heals, not a way that wounds.

Scripture tells us that there is evil in the world, and that terrible things happen for reasons that defy human understanding. In the words of Job, "when I looked for light, then came darkness." Bad things happen, and we must guard against simple explanations in the aftermath.

For the truth is that none of us can know exactly what triggered this vicious attack. None of us can know with any certainty what might have stopped those shots from being fired, or what thoughts lurked in the inner recesses of a violent man's mind.

Monday, October 18, 2010

New Poem: Sitting Shiva



I borrowed the title of this poem from the Jewish tradition of a seven-day mourning period following a loved one's death.

We lost Maggie, our beautiful Great Dane, this weekend (I wrote about it at The Masculine Heart). More so than even the deaths of immediate family members, I feel a need to observe a mourning, to hold her loss in my awareness and feel it with as much embodiment as I can muster.

As is generally the case with these things, it is not a good poem, but it is one I need to write, maybe one of many.


Sitting Shiva

we stumble through this silence -
autumn wind howling through the hole
of her sudden absence

we've collected her toys,
keeping only her favorite -
the squeaky sheep

mornings are the worst,
the daily ritual disrupted -
no wet kisses and bad breath
waking us to the sunrise,
never again the wagging tail
nor the "woooo" of her joy
in having all of us awake

now there is only the silence,
the empty space where was her bed,
useless food and water bowls

and it's the silence
piercing our hearts
binding our tongues
leaving us gasping
wondering who
we are without her

and how to take
the next breath
and the next
the next


Wednesday, August 04, 2010

NPR - Is Emotional Pain Necessary? by Alix Spiegel

This story from NPR's Morning Edition poses some issues for me. I think grief is a good and necessary emotion - and I think that how grief expresses itself is unique to each person and each circumstance - not to mention each culture.

The move in the DSM-5 to put so many things on a spectrum is being pushed bu Big Pharma to loosen the diagnoses for various mental illness so that more of them can be treated with their magic pills (they want to remove "bereavement exclusion" from the major depression diagnosis so that they can medicate perfectly normal grief). This is rather than add the more needed complex grief diagnosis to the DSM-5 (see below).

In the winter of 1992, Theresa Smith took her 14-month-old daughter, Scarlett, to Arizona for an extended visit with family. One night, as they headed to bed, Theresa's mother made a declaration: She would watch the baby the next morning. Theresa should take the day for herself.

We know relatively little about whether the pain that follows a loss is necessary.
iStockphoto.com

We know relatively little about whether the pain that follows a loss is, in a health sense, necessary.

The following morning, Theresa kissed her mother and child goodbye and headed off for a rare day of leisure. This was the era before cell phones, and Theresa wasn't able to call home. So it wasn't until later that afternoon when Theresa learned that her baby daughter had died — she had fallen into the pool in her mother's backyard and drowned shortly after Theresa pulled out of her mother's driveway.

Scarlett was Theresa's only child, the center of her life, and so the months that followed were close to unbearable. Theresa cried every day. She considered suicide. She could not sleep. And, though she went back to graduate school, she found it hard to focus.

The nights were the worst. Theresa would go to the cemetery and sit, banging her head against Scarlett's headstone until her face was covered with blood. Eventually, the husband of a good friend started coming to retrieve her after he closed his restaurant for the night. He would take her back to her apartment, a place no safer from pain.

"At one point," Theresa says, "I wanted to smell Scarlett. And I looked and I went around the apartment, and I looked for her fingerprints, little spots where she had spit up milk. I just looked for her everywhere. She was all I wanted."

Today, Theresa is doing well. And she looks on this period of her life, the months of incredible pain and suffering, with a kind of distant pragmatism.

"It's a normal process of letting go of your child," she says. "You've got to go through all of this."

More On Grieving

But is what Theresa went through a normal part of grieving, or did the death of her child bring on a mental disorder — major depression — that could have been, perhaps should have been, aggressively treated?

Change In Guidelines

Earlier this year, the American Psychiatric Association released a rough draft of its new Diagnostic and Statistical Manual of Mental Disorders, or DSM. It's a big book that lists all the mental disorders doctors can use to diagnose mental illness. One of the changes they're proposing is causing controversy.

Traditionally, the manual has warned doctors away from diagnosing major depression in people who have just lost a loved one in what's called "bereavement exclusion." The idea was that feelings of intense pain were normal, so they shouldn't be labeled as a mental disorder.

But the new DSM changes this. Buried in the pages is a small but potentially potent alteration that has implications not only for people like Theresa, but ultimately for the way that we think about and understand the emotion of pain.

The DSM committee removed the bereavement exclusion — a small, almost footnote at the bottom of the section that describes the symptoms of major depression — from the manual.

The Difference

Dr. Kenneth Kendler, who is on the committee that decided to make this change, says it's not that the committee feels everyone who has a loss should immediately be diagnosed with depression. For Kendler, there is a clear, bright line between normal grief and clinical depression. Grief is OK — depression is not. Depression, by definition, is dangerous and should be treated. Grief is normal and should not.

So how, exactly, does Kendler define grief?

"Typically, modest amounts of upset are fairly common — sometimes difficulty sleeping, crying over memories of the loved one," Kendler says.

According to Kendler, people in grief also often lack concentration. They frequently lose sleep, lose appetite, lose energy.

The Diagnostic and Statistical Manual of Mental Disorders
Ellen Webber/NPR

The Diagnostic and Statistical Manual of Mental Disorders, or DSM, is the book that lists all the mental disorders doctors can use to diagnose mental illness.

Now technically, these are also symptoms of depression. So what's the difference between grief and depression in Kendler's view? Kendler says that in grief, the symptoms are less severe, and also, the acute pain doesn't last as long.

"Usually for days at a time. Not for weeks," Kendler says. There are "a few days of acute upset and then a much longer period of the longing, the tearfulness. But typically sleep, appetite, energy, concentration come back to normal more quickly than that."

In fact, in the new manual, if symptoms like these persist for more than two weeks, the bereaved person will be considered to have a mental disorder: major depression. And treatment, either therapy or medication, is recommended.

Now according to Kendler, this change will affect a small number of people — less than 30 percent of the bereaved. But Holly Prigerson, a researcher at Harvard University who studies bereavement, says that while there's no good research on what percentage of people will meet the criteria for depression after a loss, it's clear that most experience depressive symptoms far beyond two weeks.

What underlies a lot of this discussion is: Is it harmful to interrupt a normal grief process by medicating?

"What we found," Prigerson says, "is that when you follow people — for example, between zero and six months post-loss — their depression symptom levels actually increase over time and peak at about six months post-loss."

Because grief and depression look so much alike, Prigerson says, she worries that people who are suffering from normal grief will be told that they are sick when they are not, and encouraged to treat their symptoms when they don't need to.

That is potentially a problem, Prigerson says, because we don't know whether the pain of normal grief actually helps people to process their loss.

What We Don't Know

In some ways, it is shocking what we don't know about grief. Every day in America people die, leaving loved ones behind to struggle with the consequences. Yet we know relatively little about whether the pain that follows a loss is, in a health sense, necessary.

As Prigerson says, "What underlies a lot of this discussion is: Is it harmful to interrupt a normal grief process by medicating?"

I'd rather make the mistake of calling someone depressed who may not be depressed than missing the diagnosis of depression, not treating it, and having that person kill themselves.

That is, does going through intense emotional pain make you emotionally healthier later by allowing you to emotionally process your loss?

Kendler says no.

"Early on, there used to be the thought that there was this grief work, and that if you did not demonstrate lots of upset acutely after someone died, that later on there would be more distress," Kendler says. "But research has shown clearly that that concept is false."

Kendler points to research showing that people who are doing well two weeks after a loss also seem to be doing well one year later.

But Prigerson and several other researchers don't agree that the research is clear. They argue that at this point, we just don't know whether emotional pain in the wake of death allows you to come to terms with your loss, or if you can be just fine without it.

While Normal, Grief Is Treatable

But to Dr. Sid Zisook, one of the psychiatrists who has argued for removal of the bereavement exclusion, this academic question doesn't matter. The dangers of depression, he says, are perfectly clear.

"I'd rather make the mistake of calling someone depressed who may not be depressed, than missing the diagnosis of depression, not treating it, and having that person kill themselves," Zisook says.

And just because pain after loss is normal, Zisook says, doesn't mean you shouldn't treat it.

"I mean, [pain] is a normal consequence of breaking a bone. But that doesn't mean that we don't treat the pain. We treat the pain vigorously," Zisook says.

Medicalizing Our Experiences

But for some people, the real issue raised by the bereavement exclusion is philosophical — or maybe the better word is existential. Dr. Allen Frances, the famous psychiatrist and a former editor of the DSM, says that more and more, psychiatry is medicalizing our experiences. That is, it is turning emotions that are perfectly normal into something pathological.

Over the course of time, we've become looser in applying the term 'mental disorder' to the expectable aches and pains and sufferings of everyday life.

"Over the course of time, we've become looser in applying the term 'mental disorder' to the expectable aches and pains and sufferings of everyday life," Frances says. "And always, we think about a medication treatment for each and every problem."

From Frances' perspective, if you can't feel intense emotional pain in the wake of the death of your child without it being categorized as a mental disorder, then when in the course of human experience are you allowed to feel intense emotional pain for more than two weeks?

This perspective is also shared by Theresa Smith, the woman who lost her daughter 20 years ago.

"I grieved her just as hard as I loved her," Smith says. "I had to. It wouldn't have meant anything if I hadn't."

Related NPR Stories

OK, then, since 1997 (at least, probably longer) there has been and effort to get a new category called complex grief into the DSM - then it was the DSM-IV-TR. But surprise, surprise, it has not made it into the DSM, and it won't make it into the DSM-5, despite another paper in 2009 - see below.

Diagnostic criteria for complicated grief disorder

MJ Horowitz, B Siegel, A Holen, GA Bonanno, C Milbrath and CH Stinson
Langley Porter Psychiatric Institute, University of California, San Francisco 94143-0984, USA.
Am J Psychiatry 1997; 154:904-910

OBJECTIVE: Some prolonged and turbulent grief reactions include symptoms that differ from the DSM-IV criteria for major depressive disorder. The authors investigated a new diagnosis that would include these symptoms. METHOD: They developed observer-based definitions of 30 symptoms noted clinically in previous longitudinal interviews of bereaved persons and then designed a plan to investigate whether any combination of these would serve as criteria for a possible new diagnosis of complicated grief disorder. Using a structured diagnostic interview, they assessed 70 subjects whose spouses had died. Latent class model analyses and signal detection procedures were used to calibrate the data against global clinical ratings and self-report measures of grief-specific distress. RESULTS: Complicated grief disorder was found to be characterized by a smaller set of the assessed symptoms. Subjects elected by an algorithm for these symptoms patterns did not significantly overlap with subjects who received a diagnosis of major depressive disorder. CONCLUSIONS: A new diagnosis of complicated grief disorder may be indicated. Its criteria would include the current experience (more than a year after a loss) of intense intrusive thoughts, pangs of severe emotion, distressing yearnings, feeling excessively alone and empty, excessively avoiding tasks reminiscent of the deceased, unusual sleep disturbances, and maladaptive levels of loss of interest in personal activities.

Emphasis added.

Here is the most recent article I can find in Google - from last year, that defines some of the diagnostic criteria for complex grief. In reality, many therapists already treat this disorder - and not being psychiatrists, they do it without drugs (since they don't seem to help anyway).

Zisook, S & Shear, K. (2009). Grief and bereavement: what psychiatrists need to know. World Psychiatry. June; 8(2): 67–74.

COMPLICATED GRIEF
Complicated grief, a syndrome that occurs in about 10% of bereaved people, results from the failure to transition from acute to integrated grief. As a result, acute grief is prolonged, perhaps indefinitely. Symptoms include separation distress (recurrent pangs of painful emotions, with intense yearning and longing for the deceased, and preoccupation with thoughts of the loved one) and traumatic distress (sense of disbelief regarding the death, anger and bitterness, distressing, intrusive thoughts related to the death, and pronounced avoidance of reminders of the painful loss) 10. Characteristically, individuals experiencing complicated grief have difficulty accepting the death, and the intense separation and traumatic distress may last well beyond six months 1, 4. Bereaved individuals with complicated grief find themselves in a repetitive loop of intense yearning and longing that becomes the major focus of their lives, albeit accompanied by inevitable sadness, frustration, and anxiety. Complicated grievers may perceive their grief as frightening, shameful, and strange. They may believe that their life is over and that the intense pain they constantly endure will never cease. Alternatively, there are grievers who do not want the grief to end, as they feel it is all that is left of the relationship with their loved one. Sometimes, people think that, by enjoying their life, they are betraying their lost loved one. Maladaptive behaviors consist of over-involvement in activities related to the deceased, on the one hand, and excessive avoidance on the other. Preoccupation with the deceased may include daydreaming, sitting at the cemetery, or rearranging belongings. At the same time, the bereaved person may avoid activities and situations that remind them that the loved one is gone, or of the good times they spent with the deceased. Frequently, people with complicated grief feel estranged from others, including people that used to be close.

Risk factors for complicated grief have not been well studied. However, individuals who have a history of difficult early relationships and lose a person with whom they had a deeply satisfying relationship seem to be at risk. Additionally, those with a history of mood or anxiety disorders, those who have experienced multiple important losses, have a history of adverse life events and whose poor health, lack of social supports, or concurrent life stresses have overwhelmed their capacity to cope, may be at risk for complicated grief 8, 10. An interesting unanswered question is why one person develops complicated grief, while another suffers from major depression or post-traumatic stress disorder in the wake of a loss.
Complicated grief can be reliably identified using the Inventory of Complicated Grief (ICG, 14). It is indicated by a score ≥ 30 on the ICG at least six months after the death. It is associated with significant distress, impairment, and negative health consequences 14, 15. Studies have documented chronic sleep disturbance 16, 17 and disruption in daily routine 18. People with complicated grief have been found to be at increased risk for cancer, cardiac disease, hypertension, substance abuse, and suicidality 19. Among bereaved spouses over the age of 50, 57% of those with complicated grief had suicidal ideation compared to the remaining 24% who did not endorse. Among adolescent friends of adolescent suicides, young adults with complicated grief were 4.12 times more likely to endorse suicidal thoughts, controlling for syndromal depression, than subjects who did not have syndromal level complicated grief 20. In studies of clinical populations, complicated grief was associated with a high rate of suicidal ideation, a history of suicide attempts and indirect suicidal behavior, not explained by co-occurring major depression 19, and with elevated rates of lifetime suicide attempts in bipolar patients 21. Once established, complicated grief tends to be chronic and unremitting. Clearly, complicated grief must be taken seriously and treated appropriately.

Psychotropic medications and standard grief-focused supportive psychotherapies appear to have little impact on this syndrome. By contrast, a targeted intervention, complicated grief treatment (CGT), has demonstrated significantly better outcomes than standard psychotherapy in treating this syndrome 21. CGT combines cognitive behavioral techniques with aspects of interpersonal psycho-therapy and motivational interviewing. The treatment includes a dual focus on coming to terms with the loss and on finding a pathway to restoration. It includes a structured exercise focused on repeatedly revisiting the time of the death as well as gradual re-engagement in activities and situations that have been avoided. Personal goals are addressed and discussed. A randomized controlled trial comparing CGT to standard interpersonal psychotherapy showed that the former performed better 22. Participants were permitted to enter the trial on medication that had been prescribed for more than 3 months if they still met criteria for complicated grief. Compared to those not already taking medication, previously treated individuals appeared to derive modest benefits from the addition of psychotherapy and proved to be more likely to complete a full course of CGT. Given these findings and the frequent occurrence of lifetime mood and anxiety disorders in individuals with complicated grief, it appears likely that combination treatment, including antidepressant medication and targeted psychotherapy, may be the most effective treatment approach 23. Prospective randomized controlled trials examining the role of pharmacotherapy for the treatment of complicated grief with and without concomitant psychotherapy are indicated.
___

CONCLUSIONS
After completing their education and formal training, psychiatrists may not be fully prepared to handle some of the most common clinical challenges they will face in practice. Diagnosing and treating complicated grief and bereavement related major depression will undoubtedly rank high on the list of such challenges. Both conditions overlap with symptoms found in ordinary, uncomplicated grief, and often are written off as “normal” with the assumption that time, strength of character and the natural support system will heal.

It is important to realize that, while each individual grief process is unique, there is a form of grief that is disabling, interfering with function and quality of life. This prolonged, complicated grief response tends to be chronic and persistent in the absence of targeted interventions, and may be life threatening. Complicated grief usually responds well to a specific psychotherapy, perhaps best when administered in combination with antidepressant medication. In addition, with patient suicides being a commonplace occupational risk for psychiatrists, it is essential for them to recognize their own vulnerabilities to the personal assaults that often accompany such losses, not only for their own mental health and well-being, but also to provide the most sensitive and enlightened care to their patients.
Emphasis added.

Work has been done to verify this diagnosis as well, so there is a metric for identifying it in those 10% who are likely to experience this form of grief.

Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, et al. (2009) Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11. PLoS Med 6(8): e1000121. doi:10.1371/journal.pmed.1000121

Assessment of Symptoms of PGD

Symptoms of PGD were assessed with the rater version of the Inventory of Complicated Grief—Revised (ICG-R) [34][36],[40],[41],[45],[59], a structured interview designed to assess a wide variety of potential PGD symptoms, using five-point scales to represent increasing levels of symptom severity. The ICG-R is a modification of the Inventory of Complicated Grief (ICG) [15] that includes all the symptoms proposed by the consensus panel [23] and additional symptoms enabling the testing of alternative diagnostic algorithms [22]. The ICG-R and the original ICG have both proven highly reliable (e.g., [15],[25],[36],[41]) (e.g., Cronbach's α>0.90; test-retest reliability coefficient = 0.80 [15]) and to possess criterion validity [15],[21],[24],[25],[45]. Based on prior work [23],[59], a symptom was considered present if rated 4 or 5, and absent if rated 1, 2, or 3, on its five-point scale. Interviewers were trained by project investigators (HGP, SJC) to provide a separate evaluation of whether or not the participant represented a current “case” of PGD.

And their proposed diagnostic criteria based on several rounds of refinement:

The ultimate consensus criteria set for PGD proposed for DSM-V and ICD-11 appears in Table 3. Diagnoses of PDG based on these criteria demonstrated convergent validity with respect to the diagnostic algorithm proposed by Horowitz et al. [22] (κ = 0.69) and the rater diagnosis of PGD (κ = 0.52), and discriminant validity with respect to other mood and anxiety disorders (Φ with MDD = 0.48; PTSD = 0.23; GAD = 0.21).

You can view Table 3 because it's too small to read it I post it here. This last bit comes from the discussion:

Our results indicate that PGD meets DSM criteria for inclusion as a distinct mental disorder on the grounds that it is a clinically significant form of psychological distress associated with substantial disability. Findings from this field trial of consensus criteria for PGD confirm prior work demonstrating the distinctiveness of the symptoms of PGD (e.g., [15],[18][20],[22],[26],[27],[29][31]). The proposed diagnostic algorithm for PGD has quite incomplete overlap with established mental disorders commonly occurring among recently bereaved individuals (MDD, PTSD). Further, our results indicate that in the absence of mental disorders found in DSM-IV (e.g., MDD), the proposed algorithm for PGD predicts substantial dysfunction—impairment missed by the current psychiatric diagnostic system. Because standard treatments for depression have not always proven effective for the reduction of PGD [49][52], whereas psychotherapies designed specifically to ameliorate symptoms of PGD have demonstrated efficacy [53],[54], there exists a need for the accurate detection and specialized treatment of PGD.

Although the YBS data may appear unrepresentative of the general US population, a comparison with US Census 2005 [48],[69],[70] data reveals similarities with the US widowed population. For example, the YBS sample was 73.7% female compared with 80.7% of the US widowed population and 95.3% white compared with 80.2% of the US widowed population. Like the population of US widowed individuals, the YBS sample is disproportionately female, white, and elderly. Compared with the US widowed population, however, the study participants were somewhat younger, more likely to be male, and a higher proportion was white and better educated. Future research should replicate the analyses in older, nonwhite, less-educated widowed samples.

Although there is a need to confirm the results in nonwidowed bereaved persons, we consider widowhood following an older spouse's death from natural causes to be the prototypical case of bereavement. In the US, 84% of all deaths occur among individuals who are 65 y and over [71], and less than 7% of deaths are from unnatural causes (e.g., unintentional injuries, assault, suicide) [72]. Given that in later life one's spouse/partner is the person most likely to be adversely affected by the death, a sample of older widowed persons surviving the death of a spouse from natural causes provides an important sample in which to develop and test criteria for a bereavement-related mental disorder. In addition, the symptoms retained were only those proven to be invariant across gender, time from loss, and kinship groups (e.g., IRT DIF analysis removed items that performed differently based on whether or not the deceased was a spouse) and a distinct advantage of IRT is that it produces generalizable results regardless of sample characteristics [66]. Thus, the results are expected to be generalizable to most bereaved individuals. The generalizability of the results reported here is not intended to deny the value in further confirmation of the findings in nonwidowed, more traumatically bereaved, younger, less-educated, more male, and ethnically and geographically diverse samples, and the need to examine longer-term bereavement outcomes (e.g., 3, 5, and 10 y post-loss).

Although the sample size may appear modest, the study was designed and appropriately powered to evaluate a wide range of potential diagnostic criteria (i.e., the first phases of the analyses used the full sample [n = 291]). The YBS PGD prevalence rate was obtained in a resilient community sample in which rates of mental illness were lower than those that have been reported in other bereavement studies (e.g., 9% for MDD compared with 22% in the first year of widowhood) [73]. The only analyses limited by statistical power would have been the predictive validity analyses. Here, we found large, statistically significant effects suggesting the conservative nature of our estimates of functional impairment associated with PGD.

You can read the whole article at PubMed.

In my opinion, we would do much better to be correct as possible and accurate as science will allow in our diagnostic criteria, and not be influenced by Big Pharma to make all grief treatable with an antidepressant - that is stupid and criminal in my opinion.