My son is dead. He hanged himself at 17 but meh… whatever… that’s yesterday’s news and I’m totally over it now.
I don’t long for my child or feel any sorrow or pain. Actually I hardly think about him or his death any more. I completely accept what has happened and am fine watching the odd hanging on TV. I know the world is a wonderful place and that people can be trusted. I have forgiven the doctors whose actions resulted in Toran’s death. I’ve adapted to not being a mother any more and don’t get upset when I have to tick the box on a form saying I have no children. I feel my life holds great purpose and I keep myself busy skipping around in fields of flowers sprinkling glitter on sad people and kissing little kittens.
I most certainly don’t suffer Prolonged Grief Disorder (PGD), the new mental disorder proposed for DSM-V. I’m not one of those crazy bereaved mums who do insane things like crying over their dead child.
I’m ever so glad the APA has realised that the lunatics who experience the symptoms of prolonged grief, need rounding up and treating. Particularly those super-crazy ones who are bitter that their normal healthy kids ended up dead as a result of mental health treatment.
Here are the criteria for the newly proposed Prolonged Grief Disorder
A. The individual experienced the death of a close family member or close friend at least 12 months ago. In the case of bereaved children, the death may have occurred at least 6 months ago.
B. Since the death, at least one of the following symptoms is experienced on more days than not and to a clinically significant degree:
- Persistent yearning/longing for the deceased. In young children, yearning may be expressed in play and behavior, including separation-reunion behavior with caregivers
- Intense sorrow and emotional pain in response to the death
- Preoccupation with the deceased
- Preoccupation with the circumstances of the death. In children, this preoccupation with the deceased may be expressed through the themes of play and behavior and may extend to preoccupation with possible death of others close to them.
C. Since the death, at least six of the following symptoms are experienced on more days than not and to a clinically significant degree:
Reactive distress to the death:
- Marked difficulty accepting the death. (Note: In children, this is dependent on the child’s capacity to comprehend the meaning and permanence of death.)
- Feeling shocked, stunned, or emotionally numb over the loss
- Difficulty with positive reminiscing about the deceased
- Bitterness or anger related to the loss
- Maladaptive appraisals about oneself in relation to the deceased or the death (e.g., self-blame)
- Excessive avoidance of reminders of the loss (e.g., avoidance of individuals, places, or situations associated with the deceased). (Note: in children, this may include avoidance of thoughts and feelings regarding the deceased.)
7. A desire to die in order to be with the deceased
8. Difficulty trusting other individuals since the death
9. Feeling alone or detached from other individuals since the death
10. Feeling that life is meaningless or empty without the deceased or the belief that one cannot function without the deceased
11. Confusion about one’s role in life or a diminished sense of one’s identity (e.g., feeling that a part of oneself died with the deceased)
12. Difficulty or reluctance to pursue interests since the loss or to plan for the future (e.g., friendships, activities)
Hell, crazy doesn’t even begin to cover it!
Now I know some of you anti-psychiatry types will mutter about medicalisation of normal human emotions but you need to know that very clever and important researchers have found PGD leads to cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits. And while you might think this is because when you’re grieving doctors dismiss any physical pain as being a ‘grief reaction’ and don’t properly investigate and treat medical conditions…that’s just because you’re a scientologist.
Apparently the APA have carefully considered the risks of pathologising grief but because they are such wonderful caring people, they are prepared to take that risk to avoid the worse risk that the bereaved miss out on treatment for their lunatic behaviour.
If you’ve read the literature on treatment for prolonged grief, you will know that neither CBT, IPT or group therapy provide any statistically significant benefits to the bereaved and have in fact been shown to be iatrogenic but that treatment with antidepressants is promising.
Pharmacological treatment of course has the added benefits of opening up a new market for pharmaceutical companies and providing lucrative research opportunities for psychiatrists. And if you can’t see the benefits of this…you have obviously been captured by the church of scientology.
According to recent research in the PGD field “when [a] close person dies, roles, goals, personal attributes, and other aspects of the self that the lost person co-defined, subsequently can become unclear, fragmented, and unstable. Researchers have found this most common in parents who lose a child particularly when the death is sudden and violent.
Your only child dies and your roles, goals and sense of who you are become uncertain!
Total madness, obviously. What we in New Zealand would describe as being a couple of sandwiches short of a picnic.
Dr. Katherine Shear, Professor of Psychiatry at the Columbia University School of Social Work in New York and her colleagues know how silly and crazy this is. In a recent paper which considered whether prolonged grief met the criteria for a treatable mental disorder, they identified that about 10% of bereaved people develop complicated grief, and decided that persistent feelings of disbelief and anger, a sense of emptiness, suicidal thoughts, estrangement from other people warrant treatment.
They concluded that “a new category of complicated grief is needed in DSM-5” and suggested that the management of bereaved people can be improved by this and other modifications in DSM-5.” According to Dr Shear “It’s striking, when you work in this area, to see how it helps patients enormously to know what is wrong with them,” She also points out that “one of the primary advantages of adding complicated grief to the DSM is that it will spur the development of treatments.” She’s a real brain and a highly sensitive soul that Shear. I bet people who see her feel so much better as they leave with their list of deficits and bottle of pills.
Personally, after my son died, I found it highly unhelpful to be told that my grief was abnormal and to be given a list of things that were wrong with me. I was less interested in being ‘managed’ than being supported.
Dr Shear would know that that’s because I’m a silly girl who thinks those supporting the bereaved should take a strengths rather than deficits based approach and while I don’t believe I have any religious leanings, obviously she would pick up that I am a scientologist at some deep, sub-conscious level.
Psychologist Paul Boelen and his friend psychiatrist Holly Prigerson say that its possible that after our loved ones die we are distressed because we lose our ‘self concept clarity.’ Apparently we crazies struggle to adapt to not being a mother or husband or sibling any more and to having our goals and dreams taken away from us.
Boelen and Prigerson don’t have any patience with this particular form of madness. If we haven’t sorted it within 6-12months we officially become mentally ill.
Prigerson thinks its important that PGD is included in the DSM because “standardized criteria would enable clinicians to detect, treat, and receive reimbursement for the treatment of PGD and enable researchers to investigate the prevalence, risk factors, outcomes, neurobiology, prevention, and treatment of this disorder. I know she meant to include the importance of helping people who are suffering loss and trauma but lets be fair, she’s a very busy and important psychiatrist who can’t be expected to remember everything!
I think Boelen and Prigerson are on to something but that they’re being coy about the real problem with grieving families.
In the ultimate madness, some of us whose loved ones have died as a result of being prescribed psychiatric drugs redefine ourselves as (shudder) activists and reset our goals to preventing the drug-induced deaths of others.
We present evidence of psychiatry’s lack of science and corrupt and harmful practices to the public. We undermine the credibility of the people who are only trying to help us by telling us whats’ wrong with us and trialling experimental treatments on us. Not just mad but ungrateful.
Clearly this is not a situation that can be tolerated and inclusion of PGD in the DSM –V will assist with ensuring no one listens to our scientology driven nonsense because we now have a recognisable mental disorder and as such our mad rantings can be given no credibility at all.
Ok I lied.
I’m not ‘over’ my son’s sudden, violent and preventable death.
I won’t ever be.
I will experience the symptoms of prolonged grief disorder for the rest of my life.
I consider that as a measure of my love and loss and what distinguishes me from an inanimate object. I think I’m a very normal grieving mother and I know hundreds of grieving mums just like me.
Of course psychiatrists will pathologise me for that, because that’s the only way they know of relating to people. So as a gesture of goodwill and in an effort to connect with them, I’ve sent the APA a proposed new diagnostic criteria based on fieldwork I have done in supporting those bereaved by suicide. In the spirit of partnership, and using your very own model, here’s my offering to the APA for the DSM-V.
Psychiatry As Usual Disorder
A. The individual decided not to practice real medicine but to ‘treat’ disorders that have no basis in science.
B. Since commencing practice as a psychiatrist, at least one of the following symptoms is experienced on more days than not and to a clinically significant degree:
- Persistent longing to define everyone in relation to what is normal for a white male psychiatrist with no experience of trauma, grief or other difficult life circumstances.
- Intense sorrow and emotional pain in response to being challenged on the lack of safety and efficacy of their practice.
- Preoccupation with prescribing potentially fatal drugs whose mechanism of action they can only presume in the absence of evidence.
- Preoccupation with their own importance and circumstances.
C. Since qualifying, at least six of the following symptoms are experienced on more days than not and to a clinically significant degree:
Blind faith in pharmacology:
- Marked difficulty accepting the evidence that their practice kills people and/or causes serious harm.
- Feeling outraged at any criticism
- Difficulty with considering any human moods or behaviours as a normal part of the human experience.
- Bitterness or anger related to being held accountable for the consequences of their unscientific practice.
- Maladaptive appraisals about oneself in relation to groups who are clearly inferior, particularly patients and families.
- Excessive avoidance of research or real world evidence that their diagnoses are subjective and treatments have never effected a cure.
7. A desire to be seen as real doctors who treat real illnesses despite having chosen a form of voodoo as their medical specialty
8. Difficulty trusting patients own assessment of their response to difficult life events or circumstances preferring their own assessment of responses to events they have never personally experienced.
9. Feeling alone or detached from other individuals due to a sense of inherent superiority.
10. Feeling that other people’ lives are meaningless or empty or that they cannot function without psychiatric drugs.
11. Confusion about one’s role in life or a diminished sense of one’s identity e.g. believing one is God and incapable of being wrong or making mistakes.
12. Difficulty or reluctance to pursue the truth.
Should the APA be interested in including this disorder in the DSM-V, I can provide thousands of case studies and transcripts of inquest evidence to support the inclusion of this important new diagnostic category. And in the spirit of goodwill, I hope that Dr Shearer’s experience that people benefit from being told what’s wrong with them, means that the development of the Psychiatry as Usual Disorder criteria enhances the lives of psychiatrists around the world.
Oh and here’s a tip from a mad mum – If you stopped giving people psychiatric drugs clinically proven to at least double the risk of suicide, you could reduce the prevalence of Prolonged Grief Disorder overnight.
 Prigerson, Holly G.; Bierhals, Andrew J.; Kasl, Stanislav V.; Reynolds III, Charles F.; et al Traumatic grief as a risk factor for mental and physical morbidity. The American Journal of Psychiatry, Vol 154(5), May 1997, 616-623.
 Boelen, Paul A., van den Hout, Marcel, A. 2012 The role of self-concept clarity in prolonged grief disorder. Editor: Keijsers, Loes J Nerv Ment Dis Volume: 200, Issue: 1, Date: 2012 Jan , Pages: 56-6
 Collier, R. 2011 Prolonged grief proposed as mental disorder CMAJ. 2011 May 17; 183(8): E439–E440.
 A case for inclusion of prolonged grief disorder in DSM-V. Prigerson, Holly G.; Vanderwerker, Lauren C.; Maciejewski, Paul K., Stroebe, Margaret S. (Ed); Hansson, Robert O. (Ed); Schut, Henk (Ed); Stroebe, Wolfgang (Ed); Van den Blink, Emmy (Illus), (2008). Handbook of bereavement research and practice: Advances in theory and intervention., (pp. 165-186). Washington, DC, US: American Psychological Association, xiv, 658 pp.
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