Follow Up: Grief as a Mental Illness?

After my recent post about whether and when grief can be considered a mental illness, I received an email that had some poignant thoughts from someone with some firsthand knowledge of what it means to live with grief.  Sonya, a law school friend of mine (whose husband performed my marriage ceremony with Brian), shared her thoughts on the topic.  What she wrote was wise, heartfelt, and cuts to the core of what grief is.  She agreed to let me share those words with you:

I lost my father to liver cancer last month. It was stressful, as well as an emotional crisis and roller coaster. I didn’t know grief could be so painful. Grief is a human and normal response to the death of a loved one. It can be a mental disorder if it becomes debilitating, I agree. Mourning is personal and may last for months or years. I feel it is important for us to express our feelings either to loved ones or in a diary (or blog) to help us deal with our emotions.

 

Grief does not have to do with an illness caused by biochemicals in your brains that doctors can just treat. It has to do with your soul, compassion, remembrance, and empathy. I had a lifetime of shared experiences with my Dad. My heart is broken. He passed away on a Friday. While other people are happy on Fridays and looking forward to the weekend, I wear black and mourn the loss of my dear father and visit his grave. The harder part is to watch my mom experience the emptiness in her house and in her heart.

While real suffering is involved in grief, it can help you gain experience and perspective. We know that life in this side of the world is not forever, so we learn to accept that life is for the living. It takes effort to begin living in the present. Grief can make you stronger, more resilient. I try not to take things for granted. I am more gentle towards others.

Be patient, my friend. You are not crazy. You are human.

Pick-Me-Up

A few weeks ago, I was in Austin for a night.  I didn't call any of my friends, didn't let anyone know I was in town.  It was a rainy day, and I had a task at hand -- I was cleaning out my condo so it would be renter-ready.  I packed up all my books (including a small library on grieving and widowhood), my photographs (including some of Brian), my clothes (pretty much a bikini, cover-up and flip-flops), my food, toiletries, and other personal items.  I took care of a few fixer-upper items on the list -- hanging a key rack, putting a towel hook on the bathroom door, changing my internet password, making copies of keys, etc.  That night, as I often do when I find myself alone for an evening, I did some thinking and some writing.  Then, I slept in the condo, alone, one last night.  

When the morning came, it was time to pack up and get out.  I loaded all the boxes and my overnight bag into my car.  I washed bedsheets while I took a shower, and then did some cleaning of surfaces and floors.  I took out the trash and recycling.  I put the fresh sheets and bedding back on the bed.  I left a note for my tenant.  I had two things left to do before locking up and driving away -- cleaning out the fridge and replacing bags in each of the two trash cans, kitchen and bathroom.

While knocking these tasks off my rental-readiness to-do list, the condo started to look a little less like my place and more like a sweet rental pad.  Don't get me wrong -- the Frida Kahlo artwork, kelly green shag rug, and a cardboard poster of Kenny Rogers as "The Gambler" overlooking the dining set keep things from looking too boring or neutral.  But still, it was starting to feel like it could be anyone's place, not just mine.  That was good -- that's how I wanted and needed it to look -- but it was bittersweet, knowing what I was giving up, at least for the next few months.

What I am giving up, you see, is not just a rockin' pad - it is a phase of my life.  Austin is where I came to heal and find myself.  It's where I re-connected with myself and nature.  It's where I learned to navigate a new place and a new life on my own.  It's where I took refuge, where I cried, where I started blogging, where I journaled my way through incredible pain, where I started to start over.  It's a city where I have many fond memories of Brian, and also where I opened my heart to fall in love again.  As long as I had my condo there, I had all that at my fingertips -- any time I wanted, I could go up for a night, whether I needed a fun diversion in the form of a wild night out, deep conversation with one or two kindred spirit friends, or a night of solitude and reflection.  Now, I'm letting go of that option, at least temporarily, and focusing on my life at hand in San Antonio.

I started thinking about all this while I was packing away all my books, photos, journals, jewelry, and miscellaneous other things.  And it was bittersweet.  In that last few minutes, it started hitting home, and I started to well up a bit.  I am good enough now at working through emotion, so I continued to putter around, keeping busy with my hands in spite of my wandering mind.  Just as I was started to get pools collecting in my eyes, I reached under the sink into a canvas holder to get a plastic bag (to use as the bathroom trash can liner)...and I encountered something unexpected that made me laugh, something I took to be a sign that I taking a step in the right direction and that all would be well in my world.  Inside the plastic grocery bag I grabbed was one of Brian's guitar picks.  I have NO idea how it got into that plastic bag, which was jammed along with dozens of others into this bag-holder (which, incidentally, is made from a cat-print fabric and was given to me by an elderly woman at Brian's visition by a woman who knew his parents and who had read in his obituary that we had two cats).  When I saw it, I laughed and said, "Thank you, Brian.  I needed that. You're right -- I'll be okay."

Good Grief! Am I Crazy?

The American Psychiatric Association will be issuing a new Diagnostic and Statistical Manual of Mental Disorders (DSM) next year.  There is, apparently, a movement to add complicated grief to the manual. 

I just read this fascinating piece on Slate: http://www.slate.com/articles/life/grieving/2012/03/complicated_grief_and_the_dsm_the_wrongheaded_movement_to_list_mourning_as_a_mental_disorder_.html

The heart of the article is expressed in this excerpt: 

"Grief, even the ostensibly extreme variety that the DSM might include, is a universal and normal human reaction to the loss of a loved one. Unlike most disorders in the manual, it is a condition we will all experience. It is not a disease and it has no place in a book dedicated to listing mental disorders. In a culture that has largely turned grief into a private experience rather than a communal one, the decision to include grief in the DSM risks doing more harm than good, making it easier than ever to view those who are simply experiencing a painful rite of passage as abnormal."

I thought the Slate piece had some great points.  On the other hand, I also think there is some point where grief goes beyond "normal" and might be a psychological problem.  The proponents of including grief in the DSM-V, at least according to the article, would base this on the length of one's grief.  To some extent, this may be valid, though I (a person with no formal psychological training, educated in grief only through firsthand knowledge, self-help books, support group experience, grief counseling, and scouring online resources) think this oversimplifies things. I believe -- and I know a lot of others, including so-called grief "experts" believe -- that grief never ends.  You don't "get over it."  Sure, you might start to "feel normal," as participants in a Slate research study on grief eluded to, but you don't stop feeling it for good.  I will never get to the point where I can say, "I'm done missing Brian.  I'll never yearn for him, nor feel nostalgic for what we shared again." I don't see that happening.  I know I'll never be the same person -- does that make me clinically mentally ill?  That could be how I'd be classified if the wrong definition of grief was used in the manual.

I would classify problematic grief as that which, after some amount of time (which would vary depending on the loss), continues to be all-consuming.  Grief that lasts a long time -- even forever -- isn't a psychiatric problem.  Grief that lasts a long time and keeps you from enjoying life probably is.

What are your thoughts?

So the Saying Goes

"Live each day like it's your last."
"What would you do if you knew this was the last day of your life?"
"Live/love/run/sing/dance/[insert verb here] like there's no tomorrow."
"Live for today."

How on earth are we supposed to take the lessons of those expressions -- a lesson deeply compounded in one's psyche after a sudden loss, like Brian's death at age 31 -- and balance that with some degree of planning for the future and building a better tomorrow?  How do I balance enjoying life right now and building toward what I want for my big-picture goals?  It's something I am struggling with right now as I get my new career in real estate going.  It is hard to choose between birthday parties, weddings, etc., and open houses and community-relationship building on weekends.  On the one hand, I know all too well that a wedding or a birthday party might be the last one I get to spend with someone I love.  On the other, I have to commit to my future if I'm going to have the kind of life I want.  I can't have it all.

I think I've also come to the realization that I've spent a lot of the past couple years living for the moment, trying to take each day as it came.  My future ambitions and larger goals were, quite simply, things I couldn't see through the fog.  I think, subconsciously, I was so afraid to think about my future --wondering what the point of it all was, maybe somewhat expecting I would die young as well, and most of all, dreading the thought of actually living a long life and having to spend so many more decades on this earth without Brian.  Of course I didn't have a clear vision of what I wanted to do with my life at that point, as a new widow.

Sometimes I still feel lost.  I'm a bit scared, to be honest, to be starting up in a new career.  I am just hoping that this works out, that once I've built up a bit of a client base and I have appointments, showings, and closings every week, that it will be a career that leaves me happy and fulfilled.  Most of all, in starting this career, a lot of real estate results in the future are based on what you do today -- the person you call today might give you a lead that turns into business (and a commission check) three months down the road, the person you meet while door-knocking to promote an open house might want to sell their home with you three years down the road.  I am in the beginning phases not of a new job, but a new career.  By virtue of this fact, I am being forced to think about and plan for the future.  I'm having to think long-term, to imagine what I want the rest of my decades of life to look like.

While I'm anxious about this, I am also relieved.  It feels good to realize that I'm looking at life the way it is meant to be seen again.  I finally am thinking about a future, and excited about what it might hold.  I finally believe again that there is value in setting goals, working to achieve them, and thinking long-term.