There is a problem with rigid medical definitions. There is a huge difference between the author of this, a young pregnant woman losing her husband, and say, something like a middle aged person losing an elderly parent (as I did earlier this year). Of course it will take her far longer to recover (if at all).
I would guess her grief is not "disordered" though. As she says she functions - she works, she looks after her child, she looks after herself.
> We medicalize grief because we fear it.
Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
I think that's backwards. I think the problem is that we, the general populace, fear medicalization. The medicalization of grief specifically or other emotional issues generally is unrelated.
These sorts of diagnosis criteria are created for a reason. I highly doubt psychiatric medical practitioners are developing them to pack people up into bins so that they can be marginalized. They create these criteria to be able to have a shared language to speak about issues and try to develop treatment regimens.
And it's not their fault that the lay population takes it out of context and screams, "NO NO NO! I'M NOT BROKEN!" It's that reaction that is the problem. That reaction that, "someone who fits this criteria is by-definition broken", with "and broken people are irredemable" followed closely behind. It belies a belief that they feel this way about other people, too.
The truth is, everyone deals with issues that would fit some criteria in the DSM-5. It's just part of the human condition. Some people are able to manage these issues on their own and some people are not, and that doesn't make them broken anymore than the fact that some people can dunk a basketball and some cannot. But, if you're 5'9" and had a job to put a ball in a basket 10 feet off the ground, wouldn't you want to focus on learning to shoot rather than try techniques you've observed 6'9" people use with ease?
> Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
Someone always rocks up to say this in these threads, and then never actually offers any suggestions of what they think an alternative should look like.
It's in the same vein as people who complain no one ever talks about serious subjects, and I'm just wondering why they think I want to get into discussing the meaning of life in the workplace cafeteria.
Seriously, what is the alternative meant to be? A celebration of death? Constantly reminding people that everyone will die and you'll be forgotten completely in about 3 generations? Why focus on the inevitable rather then actually living?
I'm so sorry for your loss. I agree with what you say about "disordered", the language is hostile.
In a less morbid area, I feel the same way about ADHD - "attention-deficit/hyperactivity disorder". For some people this is problematic, but others can function fine and happily with this.
In those cases, why is it a "disorder"? Why can't it just be "how some people are"?
>> For some people this is problematic, but others can function fine and happily with this.
In that case I would say it’s not ADHD, which as its name suggests is disordered. If the ADH part isn’t negatively impacting your life why would it require a diagnosis?
The DSM-5 defines ADHD as "A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or
development". If you're functioning fine, then by definition you don't have ADHD.
>a young pregnant woman losing her husband, and say, something like a middle aged person losing an elderly parent
This isn’t really your point, but this person lost their husband at 40. By some definitions, that is middle aged. In the general view of things, not young.
That doesn’t really change much, but I was thinking of a mid-twenties before I realized who it was.
> There is a certain cowardice in how we deal with death in the contemporary west.
It's because we have a dearth of true elders right now.
Not in age, but in temperament and learning.
I got interested in story telling during COVID and managed to find a great author (K.M. Weiland) that went in deep on the archetypes of story.
Her hook was essentially: "What happens after the Hero's Journey/happily ever after?" And then she got real deep on her idea of the 6 phases of life. Her work is properly about how to write a plot, but man does it apply more broadly.
The pertinent one here is the 'Crone' stage of life [0]. You're no longer the 'King' of your little fief, you had to give up the power and make way for the next generation. But now what?
The journey of the Crone is essentially learning that Death is a part of Life, that Death is not Evil, Death is a Friend.
K.M. Weiland admits that less and less people ever make it through the stages as you go along.
But, I think right now in the West, we have a lot of boomers that never really progressed past the Hero stage, let alone the Queen or King stages. There should be more Crone and Mage people around, but the boomers were retarded in their development. Just look at RBG, Feinstein and Pelosi (to name but a few), grappling on to power like the Tyrants or Sorceresses (strong shadow archetypes of the Queen and King) and never letting go, to the classical harm of the kingdom/hearth that such stories tell.
Facing Death is hard, very hard. But is something that we all must do. Realizing that Death is not Evil, but a part of life, and one to be welcomed at times, that is something that very few of us can do.
> Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
This is one of my favourite topics.
I had forgotten to bring "cowardice" to the table when thinking about death (etc) I've mostly thought of it as some kind if vague unspecified fear, thank you for injecting this word and concept into my jumble of thoughts.
I've been using "dignity" to try and make my thoughts more clear, but cowardice clearly has a place at the table too.
When thinking about suicide I have thought of that way to die as potentially needing bravery (as in being able to do something you fear).
The topic of death is dear to me me not only for personal reasons but I also think this relates to quite a few aspects of our societies and not only the obvious ones like how (if we can afford it) seem to overtreat people medically rather than give them proper palliative care and their close ones time and space to be there at this grand moment in life, that death ultimately is :)
It feels weird to use words like: bravery, cowardice, dignity and fear, they feel like from another era, possibly only a fictional era of knights, damsels and dragons.
And somehow I sense that that feeling of weirdness somehow is connected to the medicalisation of "everything" and also our longer work hours and expected increased efficiency. As if we hide and disallow the big important things in life only then will we agree to work the way we do.
But then in the other hand we can cure a lot of disease and I can type this on a tiny screen keyboard and post this to the internet, so...
I don't know, I only know that there is something wrong with death.
Even before finishing the first paragraph, it all sounded familiar to me. Then I looked at the author’s name and remembered, this is the same person who wrote “The Year I Didn’t Survive”.
I experienced a long period of grief as well. I think the grief stayed because I wasn't totally happy with myself.. Then I decided it's time for change and I moved house and changed jobs. That helped me.
I'm still sad sometimes, but I have much more to look forward to now.
Reading Jake's[0] and Bess' posts during his illness was both highly enlightening and also very depressing. The news of his death hurt me more than I expected. I simply cannot imagine the pain Bess has felt.
I wish I was half as articulate as they are and could say something that might provide even a modicum of comfort to her or others struggling with their grief.
There is a practical utility in medicalizing otherwise normal behaviors. Particularly in the US, you need a medical diagnosis in order to take time off work, receive disability benefits or access mental health supports through insurance.
I lost someone, a good friend and lover, when I was young. 27 years ago now.
Grief still occasionally hits me. Not so often these days, it’s a long time in the past, but after some reminders of that time of life on social media a couple of years ago, I felt the unfairness of it all like a knife twisting in my gut again.
All of which is to say I can’t imagine what it must be like to lose a spouse who you had a life and a child and plans with, and I don’t believe that everyone grieves the same, or that it should just be over when someone tells you that’s ‘normal’ or expected of you.
And also, as said in the blog post, if you’re functioning, if your grief isn’t actually stopping you from living your life, then who is to say it is disordered?
I think this is just incorrect. You are not obligated to seek treatment for most medical problems[1]. The point of medicalizing something is to draw a line between situations where it would be too soon for medical professionals to step in and when people enter a situation where they may need external help. One of the diagnostic criteria, which this article mentions, is that your grief is disrupting your life - but despite what this article claims they have misunderstood that criteria. Of course grief changes your routines and life. That change only becomes "disruptive" if you feel the change has somehow gone too far or you are struggling to undo it. This writer is doing neither and therefor does not meet the diagnostic criteria for disordered grief. They are grieving normally and the medical literate supports that understanding.
There are of course medical professionals who use diagnostic criteria as cudgels. Trying to force people to become patients in order to enforce their idea of what someone "should" want. This is a problem but it is a problem that the official diagnostic guidelines try to avoid. For those who are interested in this kind of problem with our medical system might look into the professional philosophy of doctors (generally arrayed around identifying and curing disease) and nursing (generally arrayed around making the patient comfortable as possible). I tend to think the nursing model is the more useful and sensible of the two - even though, of course, if one wants to cure a disease a doctor is helpful.
[1] There are very few diseases, such as tuberculosis, where you can be forced to treat the disease.
Further: by defining the criteria under which a condition becomes medically treatable, other parts of the healthcare system, such as insurance (private or government-funded), treatment protocols, and the like, come into play. Individuals should they choose to seek treatment are then able to do so within a much larger system.
By making the criteria reasonably loose and readily met, such a definition also minimises the number of individuals who would benefit from treatment who are excluded from being able to do so. This would include those who are very much unable to function or face larger grief-related risks.
We medicalise grief not because we fear it, but because there are genuinely useful therapies which may be of use to some, and denying them that merely compounds suffering.
And yes, absolutely, grief ultimately is a lifelong experience. You never stop missing that which you've lost, so long as you have the capacities of memory, reason, and feeling. That is not what the clinical definition is about.
A piece of paper from a medical professional stating that you have some medical need is extremely powerful against the cold machine of corporate and state bureaucracy. You may want to handle grief through general compassion or something but lawyers and managers don't run on that fuel, but medical documents work on them like garlic on Dracula. That's just how it is.
Having experienced a few hard losses this year (My dad to ALS, and my cat suddenly a week after my dad), the thing that has surprised me the most is how they show up in my dreams. In some dreams, I'm like "I thought you were dead? What am I going to do with all these death certificates now?", in others we're just hanging out at the pool. I never dreamed about my dad before he died. But in these dreams he's just there, and healthier looking than I had seen him in years. My cat shows up too, and many times I remember petting her in her bed, not realizing it was a dream, only to wake up surprised she wasn't still there next to me. In my waking life I fully know they're gone, but at least part of my brain really doesn't want to accept it's true.
I have been through two very painful deaths, first by brother then my father and both had very similar transitions from shock to acceptance to
grief and finally to the new normal. Both cases took years to heal. I stopped dreaming about my brother after about 10 years of his death. It has been 5 years since my dad passed and I still have very vivid dreams that upset me very much, but they are much less common now than say two years ago and I know at some point, like the dreams about my brother, they will stop. Everything succumbs to time, including grief.
I'm pretty sure my dad has chronic grief. My mom passed away from cancer when I was 11. I didn't know how unusual their marriage was until I saw others' marriages. It became particularly clear when I started dating and got married myself.
They never fought at all. There was zero conflict. It wasn't that they just "hid it from the kids"—there was simply nothing to fight about. They were truly each other's very best friend, and intensely so. My dad tried dating again a few years after her death, but I think he soon realized there was no way anyone could capture the kind of companionship he had with my mom. Some people are able to love more than one partner over the course of their life; I think he decided he could not.
He's a very private person, but I know he constantly thinks about her every day, and I suspect he's pushing off retirement because he doesn't want to be at home without her. They would have just hit their 40th anniversary if she were still alive.
She has very clearly articulated what we have lost as a culture as we attempt to eliminate any discomfort or inconvenience in our lives because of death. This book really changed my perspective:
> There’s no modern cultural framework for dealing with death.
Indeed. We used to have religion to help us deal with it. In our modern world driven by science, death is just the absence of life. Since all (physical, chemical) reactions have ceased, science has nothing more to say about it. In trying to deal with the ills of organized religion, we may have also disposed of its benefits.
One of my best friends died 12 years ago in our late 20s. I know he is dead, and yet a couple times a month I think, "Oh, I haven't talked to him in a while, I should text him!" before my logical brain kicks in and lets me know the deal.
There is a dumb part of me that wants to believe, "Oh, he probably faked his death to get out of debt." He was such a schemer, if anyone would, he would. It was an open casket funeral. I know he is dead.
It's not a disorder. I just have mental pathways built that lead to a person who was integral to my life for many years, a person who does not exist on this plane anymore. I want him back in my life. Death is just difficult.
He was a genuine source of both encouragement and constructive criticism the likes I have had not had before or since. I miss you, Meka.
I say this with respect and love to the author: it does not sound like you’re handling this just fine. I think you’re right that there’s no way to handle this just fine, and you’re right that you’ve got a very good reason for not being just fine, and it’s in fact very normal and expected for you to not be handling this just fine, but it is also the case that you’re not handling this just fine.
I think we tend to react to being told there’s a diagnosis name for the thing we’re currently doing, but there are situations in which it is both absolutely normal, understandable, and expected that we behave in a way with the hallmarks of a particular pathology and also we are still behaving in that way and could probably use some support.
(On a more bureaucratic note, the other reason to have an actual DSM-recognized diagnosis is because the ghouls running insurance companies won’t cover counseling without it. Giving your therapist a DSM approved name to apply to your deep, life-impacting, and completely understandable grief means they have a better shot at convincing the claims department you actually do need help right now.)
In my grief training, it was made pretty clear that typical grieving of a loss takes 3 to 5 years to somehow find to a new normal and start living again, and lasts forever, with phases of varying intensity. It is important to allow all the phases and encourage emotional release so it doesn’t get stuck and somatized. Stuck, unprocessed grief can kill you.
It is common for the first full year to be more in numbness and survival than in strong emotions. The psyche does not want to accept the loss so it pretends it is not real. Anniversaries and such serve as a slow and painful reminder that the person is in fact not there and will never return.
Swinging between emotional denial and waves of anger and intense pain over many years is totally normal, and should be encouraged and supported. Go with your friends into the intensity of their pain. Ask about their loss. Sit with it. Don’t say stuff like “it will pass“. They will love you for it.
The way the author captures grief (not as a pathology, but as a form of learning, unlearning, and continuing to love) is so raw and honest it almost feels invasive to read. The line "grief is a terrible kind of learning" hit me like a freight train. There's such a deep humanity here, and also a quiet indictment of our culture's need to classify, contain, and "resolve" grief like it's a software bug. We talk a lot about resilience, but rarely about the kind that means simply keeping going while carrying a pain that doesn't lessen, only changes shape.
The depth of grief the author feels drove me to tears. I think I’d feel like this if I lost my spouse. But I worry wouldn’t be able to express my feelings as well as she has here, so people wouldn’t know how much she meant to me. What a silly thing to worry about.
54 comments
[ 4.8 ms ] story [ 77.3 ms ] threadI would guess her grief is not "disordered" though. As she says she functions - she works, she looks after her child, she looks after herself.
> We medicalize grief because we fear it.
Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
I think that's backwards. I think the problem is that we, the general populace, fear medicalization. The medicalization of grief specifically or other emotional issues generally is unrelated.
These sorts of diagnosis criteria are created for a reason. I highly doubt psychiatric medical practitioners are developing them to pack people up into bins so that they can be marginalized. They create these criteria to be able to have a shared language to speak about issues and try to develop treatment regimens.
And it's not their fault that the lay population takes it out of context and screams, "NO NO NO! I'M NOT BROKEN!" It's that reaction that is the problem. That reaction that, "someone who fits this criteria is by-definition broken", with "and broken people are irredemable" followed closely behind. It belies a belief that they feel this way about other people, too.
The truth is, everyone deals with issues that would fit some criteria in the DSM-5. It's just part of the human condition. Some people are able to manage these issues on their own and some people are not, and that doesn't make them broken anymore than the fact that some people can dunk a basketball and some cannot. But, if you're 5'9" and had a job to put a ball in a basket 10 feet off the ground, wouldn't you want to focus on learning to shoot rather than try techniques you've observed 6'9" people use with ease?
Someone always rocks up to say this in these threads, and then never actually offers any suggestions of what they think an alternative should look like.
It's in the same vein as people who complain no one ever talks about serious subjects, and I'm just wondering why they think I want to get into discussing the meaning of life in the workplace cafeteria.
Seriously, what is the alternative meant to be? A celebration of death? Constantly reminding people that everyone will die and you'll be forgotten completely in about 3 generations? Why focus on the inevitable rather then actually living?
In a less morbid area, I feel the same way about ADHD - "attention-deficit/hyperactivity disorder". For some people this is problematic, but others can function fine and happily with this.
In those cases, why is it a "disorder"? Why can't it just be "how some people are"?
In that case I would say it’s not ADHD, which as its name suggests is disordered. If the ADH part isn’t negatively impacting your life why would it require a diagnosis?
This isn’t really your point, but this person lost their husband at 40. By some definitions, that is middle aged. In the general view of things, not young. That doesn’t really change much, but I was thinking of a mid-twenties before I realized who it was.
It's because we have a dearth of true elders right now.
Not in age, but in temperament and learning.
I got interested in story telling during COVID and managed to find a great author (K.M. Weiland) that went in deep on the archetypes of story.
Her hook was essentially: "What happens after the Hero's Journey/happily ever after?" And then she got real deep on her idea of the 6 phases of life. Her work is properly about how to write a plot, but man does it apply more broadly.
The pertinent one here is the 'Crone' stage of life [0]. You're no longer the 'King' of your little fief, you had to give up the power and make way for the next generation. But now what?
The journey of the Crone is essentially learning that Death is a part of Life, that Death is not Evil, Death is a Friend.
K.M. Weiland admits that less and less people ever make it through the stages as you go along.
But, I think right now in the West, we have a lot of boomers that never really progressed past the Hero stage, let alone the Queen or King stages. There should be more Crone and Mage people around, but the boomers were retarded in their development. Just look at RBG, Feinstein and Pelosi (to name but a few), grappling on to power like the Tyrants or Sorceresses (strong shadow archetypes of the Queen and King) and never letting go, to the classical harm of the kingdom/hearth that such stories tell.
Facing Death is hard, very hard. But is something that we all must do. Realizing that Death is not Evil, but a part of life, and one to be welcomed at times, that is something that very few of us can do.
[0] https://www.helpingwritersbecomeauthors.com/archetypal-chara...
> Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
This is one of my favourite topics.
I had forgotten to bring "cowardice" to the table when thinking about death (etc) I've mostly thought of it as some kind if vague unspecified fear, thank you for injecting this word and concept into my jumble of thoughts.
I've been using "dignity" to try and make my thoughts more clear, but cowardice clearly has a place at the table too.
When thinking about suicide I have thought of that way to die as potentially needing bravery (as in being able to do something you fear).
The topic of death is dear to me me not only for personal reasons but I also think this relates to quite a few aspects of our societies and not only the obvious ones like how (if we can afford it) seem to overtreat people medically rather than give them proper palliative care and their close ones time and space to be there at this grand moment in life, that death ultimately is :)
It feels weird to use words like: bravery, cowardice, dignity and fear, they feel like from another era, possibly only a fictional era of knights, damsels and dragons.
And somehow I sense that that feeling of weirdness somehow is connected to the medicalisation of "everything" and also our longer work hours and expected increased efficiency. As if we hide and disallow the big important things in life only then will we agree to work the way we do.
But then in the other hand we can cure a lot of disease and I can type this on a tiny screen keyboard and post this to the internet, so...
I don't know, I only know that there is something wrong with death.
https://news.ycombinator.com/item?id=43020983 949 points | 7 months ago | 266 comments
I'm still sad sometimes, but I have much more to look forward to now.
I wish I was half as articulate as they are and could say something that might provide even a modicum of comfort to her or others struggling with their grief.
https://news.ycombinator.com/user?id=jseliger
Grief still occasionally hits me. Not so often these days, it’s a long time in the past, but after some reminders of that time of life on social media a couple of years ago, I felt the unfairness of it all like a knife twisting in my gut again.
All of which is to say I can’t imagine what it must be like to lose a spouse who you had a life and a child and plans with, and I don’t believe that everyone grieves the same, or that it should just be over when someone tells you that’s ‘normal’ or expected of you.
And also, as said in the blog post, if you’re functioning, if your grief isn’t actually stopping you from living your life, then who is to say it is disordered?
I should not cry at work but damn, I want to.
I think this is just incorrect. You are not obligated to seek treatment for most medical problems[1]. The point of medicalizing something is to draw a line between situations where it would be too soon for medical professionals to step in and when people enter a situation where they may need external help. One of the diagnostic criteria, which this article mentions, is that your grief is disrupting your life - but despite what this article claims they have misunderstood that criteria. Of course grief changes your routines and life. That change only becomes "disruptive" if you feel the change has somehow gone too far or you are struggling to undo it. This writer is doing neither and therefor does not meet the diagnostic criteria for disordered grief. They are grieving normally and the medical literate supports that understanding.
There are of course medical professionals who use diagnostic criteria as cudgels. Trying to force people to become patients in order to enforce their idea of what someone "should" want. This is a problem but it is a problem that the official diagnostic guidelines try to avoid. For those who are interested in this kind of problem with our medical system might look into the professional philosophy of doctors (generally arrayed around identifying and curing disease) and nursing (generally arrayed around making the patient comfortable as possible). I tend to think the nursing model is the more useful and sensible of the two - even though, of course, if one wants to cure a disease a doctor is helpful.
[1] There are very few diseases, such as tuberculosis, where you can be forced to treat the disease.
By making the criteria reasonably loose and readily met, such a definition also minimises the number of individuals who would benefit from treatment who are excluded from being able to do so. This would include those who are very much unable to function or face larger grief-related risks.
We medicalise grief not because we fear it, but because there are genuinely useful therapies which may be of use to some, and denying them that merely compounds suffering.
And yes, absolutely, grief ultimately is a lifelong experience. You never stop missing that which you've lost, so long as you have the capacities of memory, reason, and feeling. That is not what the clinical definition is about.
They never fought at all. There was zero conflict. It wasn't that they just "hid it from the kids"—there was simply nothing to fight about. They were truly each other's very best friend, and intensely so. My dad tried dating again a few years after her death, but I think he soon realized there was no way anyone could capture the kind of companionship he had with my mom. Some people are able to love more than one partner over the course of their life; I think he decided he could not.
He's a very private person, but I know he constantly thinks about her every day, and I suspect he's pushing off retirement because he doesn't want to be at home without her. They would have just hit their 40th anniversary if she were still alive.
https://orphanwisdom.com/die-wise/
Dying is a skill, both for the person doing it and the people around them.
Indeed. We used to have religion to help us deal with it. In our modern world driven by science, death is just the absence of life. Since all (physical, chemical) reactions have ceased, science has nothing more to say about it. In trying to deal with the ills of organized religion, we may have also disposed of its benefits.
Very sorry for your loss.
There is a dumb part of me that wants to believe, "Oh, he probably faked his death to get out of debt." He was such a schemer, if anyone would, he would. It was an open casket funeral. I know he is dead.
It's not a disorder. I just have mental pathways built that lead to a person who was integral to my life for many years, a person who does not exist on this plane anymore. I want him back in my life. Death is just difficult.
He was a genuine source of both encouragement and constructive criticism the likes I have had not had before or since. I miss you, Meka.
I think we tend to react to being told there’s a diagnosis name for the thing we’re currently doing, but there are situations in which it is both absolutely normal, understandable, and expected that we behave in a way with the hallmarks of a particular pathology and also we are still behaving in that way and could probably use some support.
(On a more bureaucratic note, the other reason to have an actual DSM-recognized diagnosis is because the ghouls running insurance companies won’t cover counseling without it. Giving your therapist a DSM approved name to apply to your deep, life-impacting, and completely understandable grief means they have a better shot at convincing the claims department you actually do need help right now.)
It is common for the first full year to be more in numbness and survival than in strong emotions. The psyche does not want to accept the loss so it pretends it is not real. Anniversaries and such serve as a slow and painful reminder that the person is in fact not there and will never return.
Swinging between emotional denial and waves of anger and intense pain over many years is totally normal, and should be encouraged and supported. Go with your friends into the intensity of their pain. Ask about their loss. Sit with it. Don’t say stuff like “it will pass“. They will love you for it.