Prolonged Grief Disorder

I have always maintained that no one can heal from grief. In fact, grief is a journey that we must all go on in our lives. We all experience it in its varied form, and it can be the cause of tremendous suffering. In contrast, it can also become your greatest teacher and can be the catalyst to spiritual growth if we recognize its benefits. In my last article, ‘The virtues of grief,’ I posited that grief could cause post-traumatic growth as postulated by Taylor.S (2021). That growth can only happen if you allow it. However, if you cannot face your grief from within and find it hard to cope in your daily life, you may be in a condition that goes beyond the expected term of grief. Your suffering can become prolonged, and you could head for severe mental imbalance. In this next article, we will explore the potential of this form of grief, how it can be recognized, and what we can do to protect ourselves against it.

How long Must We Grieve?

There is no set time limit to our grief, and as mentioned previously, no one can heal from grief; it becomes a part of our journey and one of our greatest gifts and spiritual teachers. We should not measure grief in terms of time, unless there is a serious potential of mental imbalance. No one can give a time limit on the grief journey. In modern society, however, there is an expectation on the time one should grieve. Numerous individuals expect someone to get over the grief in a certain period they perceive should be correct. This is made worse by the expectation that the individual “should have gotten over it by now.” That someone who is grieving should just pick up their pack and get on with it as a perception can cause further trauma from the expectations, driven from ignorance. This causes disharmony and discord in the relationship between the griever and those in their circle. This causes severe unbalance. One who grieves may learn to cope and another may not recognize as easily that coping mechanism. It may look on the outside, they are over the grief period, but in reality they are not.

Therefore, there is no way to measure time in relation to grief. One can only measure the effects of grief in a person’s life.

Coping with grief

Everyone copes with grief in their own way, and no one’s coping mechanism will be the same as another. Depending on how much one has spiritually grown through the journey, will affect how one integrates into normal life. As the individual learns from their journey, and opens up to the gift of grief within, they learn the power of acceptance on the journey.

However, there are some individuals who, no matter what they do, cannot cope. They seem distant from everything and cannot find any peace or solace in any area of life. They search for answers, but they never find anything that makes them happy. In fact, they are caught up in a never-ending spiral of grief. It gets deeper and worsens over time – instead of diminishing. This is a dangerous place to be in, and this is known as Prolonged Grief Disorder.

What is prolonged grief disorder?

Prolonged grief disorder is the newest disorder to be added to the Diagnostic and Statistical Manual of Mental Disorders. (DSM) Prigerson H.G. et al., (20121) corroborated the new criteria in the DSM-5. This condition was entered into DSM IV. It is included in the text revision of DSM-5 (DSM-5-TR), which was released in March 2022.

Prolonged grief disorder (PGD) is a persistent and debilitating form of grief. This experience lasts longer than what is considered a normal grieving period. That period is 6 months and anything over those six months is then considered prolonged grief disorder. It is characterized by long and intense yearning and longing for the dead person. There is difficulty accepting the death, feeling stuck in the grieving process, and avoiding situations and activities that remind the person of the loss. PGD is a recognized mental health condition.

Covid and PGD

In my work with many widows who have lost their loved ones from the COVID pandemic, I have noticed an increased incidence in PGD. When a loved one passes away from a known and accepted form of death, it is easier to understand the situation and the loss. However, with pandemic grief, it is very much an unknown, and the sense of confusion is compounded by ignorance, misinformation and expectations. There is no baseline understanding or acceptance of the mechanics of the passing. The sense of loss from an unknown factor causes a deeper profound grief.

The sense of isolation and disconnection from reality was found in over 90% of the cases investigated. This voluntary and involuntary isolation increased the likelihood of PGD. Kumar, R. M. (2023). As an individual is forced into grief by an unknown factor, that grief takes a different identity that society does not yet know how to deal with. The widows who are suffering from PGD are totally disconnected from reality and society as a whole.

Therefore, PGD can have a significant impact on an individual’s daily functioning and quality of life. It requires a professional diagnosis and treatment. It must be understood that dangers exist within PGD.

The Hidden Dangers Of PGD

There is a hidden danger of PGD and that danger could result in the individual causing psychosis because of the long-term grief and trauma. To make a correlation to this potentiality, one has to understand the psychopathology of psychosis.

Psychosis and Grief

Psychosis is a mental health condition that affects a person’s perception of reality. It can be a symptom of several mental health disorders, such as schizophrenia, bipolar disorder, or severe depression. The symptoms of psychosis can vary from person to person, but here are some common symptoms:

• Delusions: False beliefs that are not based on reality. For example, you might think that someone is trying to hurt you or is against you.
• Hallucinations: Sensory experiences that are not real, such as hearing voices or seeing things that aren’t there.
• Disorganized thinking: Difficulty organizing thoughts, making sense of information, or staying on topic during conversation.
• Disordered speech: Speech that is difficult to understand, jumbled, or contains invented words or phrases.
• Paranoia: Feeling that others are out to get you, or that you are being watched or monitored.
• Social withdrawal: Avoiding social interactions, or becoming increasingly isolated.
• Emotional changes: Sudden or extreme changes in mood, such as feeling very happy or very sad for no apparent reason.

Experiencing one or more of these symptoms does not guarantee psychosis. It is important that you seek the counsel of a qualified medical expert such as a psychiatrist.

Grief Correlation

There is a distinct relationship between grief and psychosis, and especially prolonged grief disorder. Each one of these conditions is an imbalance of the mind and so shares very similar psychopathology. Key’s, et al., (2014) gives an understanding of the potential effects of trauma in grief from sudden loss. This has a correlation with psychiatric illness. One potential correlate is the act of socially withdrawing. Whilst this can be a common symptom of psychosis. It is also a fundamental behavior in grief and is exacerbated with traumatic grief or PGD. In my own research into the effects of traumatic grief. There has been a clear distinction in the act of feeling or actively withdrawing from social environments. Individuals who face sudden loss often pull away from everything they have had comfort in. As a consequence, they exacerbate the feelings of loss and abandonment.

Another common symptom between psychosis and PGD is the dramatic emotional changes that one experiences while in the experience of grief. The feelings experienced can change from time to time. The person can go through many different emotions in a short amount of time. The drastic change in emotion can exacerbate the trauma even further.

It is important to have the experience acknowledged and understood. Failure to do this, can cause deeper suffering and a potential for psychotic episodes to arise.

Depression: The Pathway To Psychosis

An individual who is suffering from PGD often experiences deep depression. The depressive state in itself presents its own psychopathology, and can often be the catalyst to psychosis. Depression is one of the main symptoms of PGD, and of course it is one of the main symptoms in clinical depression. The danger is that when an individual who is suffering grief goes into a deeper depressive state, that can be a causation of psychosis. This is especially prevalent when the individual distances themselves from social circles and eventually from daily reality. Slowly other symptoms build on one another, and the griever becomes comfortable in their suffering. They see no way out except the potential of taking one’s own life.

Suicidal PGD

In my own work as a medium who has given counsel to many individuals over the years. I have come across some who are suffering and have stood at the precipice between life and death of their own volition. It is important that we discuss suicide awareness and grief from the other point of view. They gave serious consideration to taking their own life in order to join their loved ones on the other side of life. Their depressive state they have found themselves in has become so deeply entrenched that the only way out and to peace was to consider the act of taking their own life. This is a definitive path from depression to psychosis.

When the loss of a loved one has left the widow feeling abandoned, and detached from reality, suicide feels like the answer. There is a false assumption that taking their own life would reunite them with their loved ones immediately. From my work as a medium, I can confirm this is not the case and does not solve the trauma. However, that is for another article and not the scope of this one, but it is an issue that needs consideration.

Tools To Cope With Prolonged Grief Disorder

It is important to know that it is not easy to deal with PGD. It is not something that a person should try to do alone. If you know someone who is suffering from PGD, then it is important to suggest they seek professional help. Going to a medium is not the answer to PGD depending on the severity. It is merely a panacea for the pain and, in the case of PGD, could be detrimental and cause further trauma. Nevertheless, there are a few choices you can make. I will base them around my own model (AAC) of Awareness, Acceptance and Choice.

Becoming aware of your grief is the first step in dealing with it. Like anything in life, nothing changes without first becoming aware of the need for change. When you first become aware of your grief, you can then arrive at a place of acceptance. Accepting has so many deeper aspects to the grief journey. It is not one aspect; there are so many facets to the acceptance of grief in your life that will help you to develop a positive relationship with grief itself. Then you can choose how you respond to the grief, both internally and existentially.

10 Tips to help you with your complicated grief

These 10 tips will help you with coming to awareness and acceptance of your journey. The tips are endless, but these are the most important ones each time. They will allow the PGD subversiveness to begin to reduce in small amounts.

1. Seek professional help: A therapist or counselor specializing in grief can provide guidance and support as you navigate through your grief journey.
2. Join a support group: Connecting with others who have experienced similar losses can provide comfort and understanding. Sharing stories and feelings with people who can relate to your pain can be therapeutic. We have our own private group for this reason. Go here to apply to join.
3. Establish a routine: A daily routine can give you a sense of stability and structure in your life. This will help you deal with your grief.
4. Practice self-care: Prioritize your physical, emotional, and mental well-being by getting enough sleep, eating well, exercising regularly, and engaging in relaxing activities.
5. Accept your feelings: Allow yourself to experience the full range of emotions that come with grieving. Don’t judge yourself for feeling angry, sad, or overwhelmed; these emotions are a natural part of the grieving process.
6. Express your emotions: Do not hold your emotions inside trying to hide them or have a fear of judgement. Let yourself express yourself.
7. Journaling: Writing in a journal can be a very rewarding experience. It can create a deeper sense of connection with your loved one. It can help you to reach new levels of awareness that you may have missed in your pain.
8. Creative Pursuits: creating art, or music, is a great way to express yourself and to help you connect with the deep divine power within. It can help you find strength where strength may have been lost.
9. Maintain connections: Reach out to friends and family for support and companionship. Although it may be tempting to isolate yourself, human connection is crucial.
10. Create rituals and traditions: Establishing rituals or traditions to remember and honor your loved one can provide comfort and meaning during your grief journey.
11. Be patient with yourself: Grieving is a complex process that takes time. Allow yourself the space to heal at your own pace and recognize that there may be ups and downs along the way. Remember that it’s normal to experience setbacks, and be gentle with yourself when they occur.

Conclusion

Prolonged Grief Disorder can be a very debilitating experience and at the worst case scenario, could cause severe psychosis and require medical intervention. However, the onus is not put upon the one who is grieving. We must, as a society, start to come to a place of love and acceptance of grief. We must stop hiding it away because we are afraid we will not be able to handle it. It is part of life, but it does not mean that life ends. Those who suffer from PGD, need understanding and no sympathy. However, there comes a time when someone who is entrenched in PGD, needs to become aware. Then we can transform the grief using awareness, choice, and acceptance.

References

Taylor.S. (2021) Extraordinary Awakenings: When Trauma Leads to Transformation. New World Library (7, 2021)

Keyes KM, et al. (2014). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study.
ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.13081132

SILVERMAN, G., JACOBS, S., KASL, S., SHEAR, M., MACIEJEWSKI, P., NOAGHIUL, F., & PRIGERSON, H. (2000). Quality of life impairments associated with diagnostic criteria for traumatic grief. Psychological Medicine, 30(4), 857-862. doi:10.1017/S0033291799002524

Prolongued Grief Disorder (https://www.psychiatry.org/patients-families/prolonged-grief-disorder)

Prigerson, H.G., Boelen, P.A., Xu, J., Smith, K.V. and Maciejewski, P.K. (2021), Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry, 20: 96-106. https://doi.org/10.1002/wps.20823

Kumar, R. M. (2023). The Many Faces of Grief: A Systematic Literature Review of Grief During the COVID-19 Pandemic. Illness, Crisis & Loss, 31(1), 100–119. https://doi.org/10.1177/10541373211038084