A new article published in the Journal of Humanistic Psychology critiques a research study that frames prolonged grief as a form of addiction and uses the opioid antagonist naltrexone to “treat” it. The authors discuss how this approach minimizes the significance of the relationship between the bereaved and deceased and could be potentially harmful in disrupting social connections, which may significantly impact marginalized communities. They also emphasize the importance of social connection to healing and recommend interventions that focus on healing with others.
The research proposal was authored by Gang et al. (2021) in collaboration with the National Institutes of Health (NIH) and the National Cancer Institute (NCI). Gang et al. (2021) suggest that longing for loved ones in prolonged grief is similar to cravings in addiction.
They offer naltrexone, which has been shown to reduce feelings of social connection and is commonly used in treating opioid addiction as a way to “treat” prolonged grief. They theorize that naltrexone will reduce social connectedness with the deceased, resulting in less loneliness and emotional suffering for the bereaved.
The authors of the current article, led by Kara Thieleman of the Resilient Parenting for Bereaved Families program at Arizona State University, write:
“Treating grievers with naltrexone further expands the mental health industrial complex into the realm of bereavement, where grief at the death of a loved one is viewed as just one more form of pathology to be treated with pharmaceutical agents, with no consideration of the context in which grief occurs, including the relationship to the person who died, the circumstances surrounding the death, the history, and quality of the relationship, or the degree of attachment to the person who died.”
In their proposal, Gang et al. (2021) reference the work of Inagaki et al. (2016) to justify the use of naltrexone to disrupt social connections purposefully. However, Inagaki et al. (2016) identify disturbances in social bonds as an adverse effect of naltrexone and emphasize the importance of social support and bonding to the recovery process – which Thieleman and colleagues argue is just as crucial to bereavement.
Further, naltrexone cannot target specific social bonds and, therefore, could reduce social connection. Research suggests that it may negatively affect desire in other domains, such as food.
Given that perceived social support, especially animal support, is crucial to grieving individuals and is associated with better quality of life and protects against complicated grief, posttraumatic stress disorder, and depression, intentionally disrupting an individual’s social bonds could be potentially devastating to both the suffering individual as well as their loved ones.
Not only could impairing social bonds affect psychological health, but loneliness has been shown to lead to increased risk for mortality in bereavement. Cutting off the benefits and the drive for social support could worsen this problem.
Moreover, as a significant symptom of Prolonged Grief Disorder (PGD) is a struggle to feel connected to others, it is unclear how disrupting social bonds would benefit those experiencing complicated grief.
Reducing social connectedness could negatively impact marginalized and oppressed populations, including Black, Indigenous, and People of Color (BIPOC) communities and sexual and gender minorities. Although research on bereavement tends to focus on elderly, White, cisgender, and heterosexual individuals, available research on marginalized groups has demonstrated the importance of social connection and support in these populations. Stripping away social bonds with naltrexone could disproportionately affect marginalized populations who tend to rely more on informal forms of support.
Additionally, distrust in the health care system is prevalent in marginalized communities, fueled by discriminatory healthcare practices and experiences. As a result, BIPOC communities tend to rely more on natural healing practices and emphasize ancestorial healing practices to address generational trauma.
Community-based modes of healing, which include healing and disability justice, stress the need for recognition of oppression and inequality as being key to recovery. They also focus primarily on community connection to empower oppressed individuals to work towards systemic change. Therefore, blunting social connection through the use of drugs is not reflective of culturally competent care and could cause further distrust of the medical community in marginalized groups.
Although Gang et al. (2021) present the risk of naltrexone for prolonged grief as low, Thieleman and colleagues argue otherwise, pointing to research that indicates that bereaved individuals tend to feel isolated and vulnerable and are often subjected to cultural demands that push them to repress or minimize their own emotions to make others around them feel more comfortable, as well as to meet economic needs of productivity.
They highlight how these unreasonable demands on bereaved individuals have likely been worsened by urges by psychiatry to pathologize specific experiences of grief, despite research suggesting that some losses result in longer-lasting and more intense grief.
While individuals experiencing this type of grief need support, medicating them is not the kind of support they need. Sadly, with the American Psychiatric Association’s addition of PGD to the Diagnostic and Statistical Manual of Mental Disorders in 2013, it is likely that additional attempts to pathologize and medicalize grief will occur.
The authors conclude:
“We believe interventions should focus on helping people heal in relationships with others, not on impairing the very capacity for social connectedness. Bereavement-related interventions should be rooted in compassionate, attuned support and allow grievers to share their stories, struggle with questions of meaning, and build their capacity to hold their pain, not through attempts to minimize, deny, or medicate away their pain and grief. Being fully alive means being willing to feel what needs to be felt under conditions of safety, including the pain of the death of a loved one, not further alienating oneself in an attempt to numb the pain. Perhaps, the ultimate goal of bereavement-related interventions is to help people recognize their capacity to become whole, if broken-hearted, human beings.”
Thieleman, K., Cacciatore, J., Thomas, S. (2022). Impairing social connectedness: The dangers of treating grief with naltrexone. Journal of Humanistic Psychology, 1-9. DOI: 10.1177/00221678221093822 (Link)