Episode 7: Grief Part 2 -- What is prolonged grief and how can you help someone with it?

Unknown Speaker  0:03  
Hi, it's Lynne Thompson with the storied human. I did a short piece on grief two weeks ago. And I thought I was done. But today I saw a pretty amazing article, when should grief be considered a mental health issue. And I wanted to just expound a little bit about that, in this episode, which will be short, because I think it's super important. Especially now, because of the things that some people have been through during the pandemic. And really the sense of loss that almost all of us have had in some way or other, we lost our freedom for a while we lost our way of life, some of us lost our jobs. And some of us did actually lose people, they died and we weren't allowed to be with them. We were separated from family, these things bring up feelings of grief, and maybe we don't even realize it or call it that, because we're just being tough and getting through, you know. But when you lose a person that you're really close to, and if you tend to be if you tend to, you know, depression tend towards depression as I do. It's, it's, um, you're at risk for prolonged grief is what they call it. Now. They used to call it complicated grief. And there's other names that they give it. And that's, um, that's difficult to treat, it's difficult to recognize, and I just think it's really important to know about in case you're heading there, you can you can catch yourself, because I didn't have a clue. When I lost my mom, it was a very shocking, terrible death, there was a lot of suffering and I I kind of plummeted into prolonged grief and I didn't take care of myself. I didn't push myself, as I said before, to get out there and to talk to people I just sort of isolated myself. So that the big news is that they have literally identified prolonged grief as a separate disorder. And it's going into the DSM five TR, which is the diagnostic and statistical manual of mental health disorders, which means that doctors can diagnose it as a separate illness, and they can work up a way to treat it. Psychiatric epidemiologist, Holly person, has done extensive research in this field. She says that prolonged grief only impacts around 4% of those who grieve. So I am spreading the word but believe me it's it's a minority of people that actually get this complicated or prolonged grief. But it's serious. And I'm glad they're giving it the attention it deserves, especially now because we've been through, you know, collectively as a society, a tough time. And some people may be grieving and not even naming it. You know, that's what I worry about. So research on the topic of prolonged grief, which has also been referred to as pathological grief, unresolved grief, traumatic grief, complicated grief, persistent, complex, bereavement disorder, etc. Those dates back to the 1980s. But researchers have debated for decades whether or not the diagnosis is necessary, and there's still doctors on both sides of this. I think it's really important though, if it does affect people to have it, have its own name, have it have it be recognized as his own disorder. Adding prolonged grief disorder to the DSM five TR will allow clinicians to build insurance companies when treating people with the disorder. So how do you know you have this? I wish someone had told me these things based on the the announcement in September 2021, as well as the official diagnostic criteria. Here's a summary of how the DSM five TR defines prolonged grief disorder. Prolonged grief disorder can be diagnosed at the 12 month mark for adults, and six month mark for kids since someone close to them has died. Prolonged grief is characterized by experiencing the following symptoms for most of the day, almost every day, and for at least the last month, intense yearning and longing for the person you lost. And or you are preoccupied with thoughts about or memories of the person. It's just that terrible feeling that you can't move beyond this moment. In time, you can't move beyond what has happened to you. In order to be diagnosed, you also have to have experienced at least three of the following persistent symptoms for the last month or longer identity disruption, feeling as though part of yourself has died. disbelief about the death, of oneness of things that remind you that person has died

Unknown Speaker  5:00  
intense emotional pain, problems going back to everyday life, being emotionally numb, having the feeling that life is meaningless, and intense loneliness. I think the reason that I didn't get worse was because I had two little kids. So I just like, really worked hard to maintain some semblance of normality for them. But I do relate to these symptoms. And I did sort of fall into this, especially the avoidance of things that remind you the person that has died. I just couldn't hear anything with my mother's voice in it. I couldn't look at pictures. I couldn't read things in her handwriting. I remember that pain. So the duration of the person's grief exceeds expected social, cultural or religious norms. It is and is not explained by other mental health disorders. Dr. Sher, who was involved in developing this criteria for prolonged grief disorder, has researched grief since 1995. She states central symptoms that are really, really important are the yearning longing and preoccupation with the person who has died. We are all disrupted by grief. She says, the question is, does it persist? It's been a year since you were fully engaged, if it's been a year, since you were fully engaged in life, and your functioning is still compromised, that's when it is considered persistent. So that's some stuff to think about. It might not apply to you. But you should be on the lookout for other people in your life. If they don't seem to be moving past a certain point, you might want to gently recommend that they need help. Some of us need help to get through this kind of thing. Or you might want to recommend they need help before it gets to be complicated grief or prolonged grief. I kind of wish I had done that, or someone had done that for me. Because by the time I went to the therapist, it was tough. You know, I mean, they can help you a lot. They she helped me so much. But yeah, you know, if you could just help someone you know in your life or help yourself, then it's worth doing this podcast episode. So how do you treat prolonged grief disorder? Once you get into this place of prolonged grief, it's really really hard to get out. Dr. Shear says professional treatment can help to lead people symptoms. results published in 2016 showcased clinical success of a 16 week psychotherapy intervention intervention for prolonged guilt, grief disorder, that Dr. Sher developed, it features a series of what she calls psychological exercises that help people adapt and come to terms with loss as opposed to trying to change grief directly itself. I love that because you're going to have the grief and it sticks with you. But you can do these exercises that help you adapt and come to terms with it. In these exercises, there are elements of cognitive behavioral therapy, as well as Dialectical Behavioral Therapy. For example, one person who participated in Dr. sheers treatment, told The Times that she would narrate what she remembered about the day her brother died throughout her therapy sessions, and she felt a sense of acceptance by the end of the program. In terms of the medicinal treatment for prolonged grief disorder. Dr. Sher and colleagues were unable to confirm that antidepressants alone helped grieving patients. What medication does obviously help is other anxiety and depressive symptoms, which are commonly co occurring. She says, Dr. Sher also notes that antidepressants can be useful when combined with psychotherapy. A past review of clinical trials supports this. And also, I'd never heard of this one before and addiction medication called Naltrexone is currently being tested for the treatment of prolonged grief. Although some experts remain skeptical. The premise there is that grief is an addiction. So some people support using this medication to help reduce the suffering inside of grief, including panic attacks, anxiety, difficulty sleeping and loss of appetite. For example. When it comes to treating the actual grief, Devine, Dr. Devine believes talk therapy and other therapeutic tools are more useful. With our own clients. Devine focuses on acknowledgement during therapy sessions, which helps people feel heard. Then she addresses negative effects like anxiety, as well as sleep and appetite difficulties. We can use a lot of tools that we already have to support somebody inside their grief and get these outcomes we want. We don't have to solve their grief to reach these goals. She explains.

Unknown Speaker  9:59  
So there is controversy around prolonged grief disorder being described as a separate disorder. Simply put, some mental health professionals don't believe it's necessary to create a separate diagnosis for prolonged grief disorder and others do. Dr. Sher reiterates that there comes a time where intense and persistent yearning and pain should be addressed differently than non persistent grief. That's why she developed the 16 week intervention program mentioned above, which has shown success among those experiencing prolonged grief. It's her belief too, that although grief can coincide with depression, it should not be treated as such. And you know, we talked a little bit about that in my last episode, if you want to drop back and listen to that one. The symptoms are similar, but they're different. depression and grief, they appear the same. But there's really like an internal difference. So Dr. Sher and her colleagues could not find any benefit of antidepressants for grieving patients, unless there was also grief psychotherapy administered with it. And I have to say, emphatically, that that's what helped me, like I literally was on the mend. With both these things, I took a low dose antidepressant, I went to a good therapist, and I mended, I got better. And part of what the therapist did. And I really want to tell you guys this, because this is what I learned. And it's helped me so much in my whole life. And it's so simple. And maybe you already know it, but I want to share it. She identified that I'd been stuffing down my feelings for a really long time. I just always been afraid to share some, you know, my feelings. I, I wanted to be I wanted to fit in or I want it to be not not any trouble or whatever a lot of women do, you know, we stuffed things down. But she said to me at some point, well, you can stuff down for years, but it doesn't go away. And so we started to discuss some of the feelings that I was having. And some of the difficulty I was having, sort of expressing my sadness and moving through it. And she said, What are you afraid of, and I said, I'm afraid that if I start crying, I will never stop. And I really meant that at that time, I really felt like that kind of sadness I had never felt before. And I just felt like if I gave into it, it would never end. And I would never come out of it. And I've heard other therapists talk about how you can picture it as a tunnel, and you will come out the other side. And I really liked that. So my therapist said you will come out of it, you will move through your feelings, but that's the only way to get out of them is to move directly through them. You can't avoid them, you can't stuff them down. And it was It sounds simple, but I just didn't know that. And when we worked on that, and she talked me through that. And she helped me move through these feelings. She not only helped me get over the prolonged grief. She helped me handle feelings differently in my life ever since that point. And that was like 18 years ago, 1819 years ago, I literally came home. And I think I said this in my interview with John Chow. But it's worth repeating. It's just a lovely thing. I came home and when my children cried, like after that, if they would cry. In the past, I would say Oh, it's okay. Like I wouldn't try to stop them. But I think the way we comfort children sometimes is to, you know, shorten how long they cry. But now, I just would be with them. I would let them cry. I would say it's okay. It's okay to cry. I just looked at expressing your feelings differently from that time on and it's been so helpful. And when I would hug my children, I had read that, you know, children always they're not in a hurry. They want to hug you longer. You're probably thinking of what you have to do next. You never want to hug them as long as you break the hug. Usually before they do, you don't even think about it. But after I went through this experience and thinking about my feelings, when my children would hug me when I would hug them. I would hold on

Unknown Speaker  14:34  
I would hold the hug until they broke it. These little things just helped me so much in my life to connect with their feelings, my feelings if friends were hurting, you know, I'm a talker and I would just try to talk people out of stuff. And this whole experience taught me to be quiet and to be With the person and I've talked a little bit about that in the in the first grief episode, it's so important to be able to be with someone to be in the space, to share the sadness, to be there for them quietly. Because in that way, you help them feel it, and you help them move through it. And they don't have to do it alone. But they do have to move through it. And that's what that's the takeaway. Whatever you're feeling, you have to feel it, and you have to move through it. No matter how much it hurts, it's not going to go away. And I'm really grateful that I found a nice, compassionate, kind, gentle therapist. And I'm not saying everyone needs one. I'm just saying that if you know someone who's struggling with these kinds of feelings, it's not a bad idea to suggest to them, that getting help can can really improve things. And that's all I'm gonna say about that. I just wanted to make sure I shared this because this is kind of like the latest information about prolonged grief and I was kind of surprised to see it today. So I will put a link to this article and to others if you want to read more about it. And I thank you for listening as always on the story to human. Have a great night.

Transcribed by https://otter.ai