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When Does Grief Become Pathological?

Jonathan's* father had always taken care of everything, from their business to social activities. Jonathan, even though he was 50, was comfortable taking a back seat while his father drove, both literally and metaphorically. He'd been trained to believe that his secondary status was normal. His father was a big, blustery, commanding man operated and owned a chain of electronics stores throughout the country. When he died suddenly of a brain aneurysm at 75, Jonathan was stunned. Four years earlier he'd lost his mother to lung cancer. Now he had to endure his father's death.

The vast fortune, including his father's five homes, 11 electronics stores, seven cars and other miscellaneous luxury goods went to Jonathan, the only child. Jonathan was overwhelmed. He felt like staying in bed and pulling the covers over his head, but since he came from an old, prominent family where appearance meant everything he went through the motions of dealing with the relatives and the funeral. Inside he felt like a tiny, scared child acting the part of a gracious adult. He was the executor of his father's will, but the estate attorney kindly told him to take his time, they could resolve matters when Jonathan was ready.

Read the rest at AOL/Huffington Post's Healthy Living.

Thanks as usual to Gina Misiroglu of Red Room for putting me in touch with the Huffington Post people. It’s just one of the great ways she's bringing traffic to Red Room and getting attention for Red Room's authors.

*Not this person's real name

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Dealing With Loss and Grief

Dr. Berman,

We all have multiple roles , both simultaneously and sequentially through life's stages, the most elemental being one's role as a human being.  Moreover,  for any experience as all-encompassing  and highly personal as loss and subsequent grief, though general principles may apply broadly,  each individual  will "process" his experience differently. Procrustes' mythic bed [any rigid framework] thus had and has its limitations. Dealing with loss and grief varies as well with the type of relationship; e.g., spouse-spouse, parent-child, etc.

 I understand that you are writing  this analysis of grief in your role as a clinician, seeing data through the trained "eye"  and mind of a scientist. Though Jonathan does not "come through" as a  sympathetic or attractive figure, he is still a human being, and thus I could not escape feeling a very human response to your case study of him as you cited data and judged his behavior.

My education and life's work with literature and philosophy present interesting contrasts with yours in psychiatry, obviously accounting in great part for the different "lenses" through which we each view human experience. I'm sure there's another dimension of your "being" as well, given your artistic interests, that your case analysis did not reveal. For me, experiences and people in literature and real life tend to function as mirrors and lamps which first, reflect to me images of myself interacting with others and events, and, secondly,  illuminate or shine light on reality and clarify or bring it into sharper focus and understanding.

This perspective gives  pause or caution in making judgments, since one is  reminded of the folk wisdom that human beings prefer and benefit more from those who "walk with them" than those who merely "show the way." One recalls, as well, a 19th century commentator's observation:  "I view my fellow human beings as animals in a menagerie but always remember that I am one of them and not their keeper."  This balanced approach integrates both the clinician's objectivity and detachment with the humanist's emotional identification with others.  I would be interested if you ever find the latter human role interfering with the clinical one.  Your case report indicates an "expertise" in keeping them separate. 

What may make sense in an intellectual or scientific way may not be applicable or true and real in all or even most individual instances. As Jonathan Swift illustrates in his personal life, we can "love" mankind in generalized observations based on idealism but prefer to keep our distance in specific cases. 

The cultural norm for grief's duration being two months raises issues of how the norm was established and definition of "grief" in its various phases or levels of intensity. Though I view myself as a fairly functional person after the sudden and unexpected loss of my wife last year, I would consider something seriously being "wrong" with me if my grief  had conveniently ended after a mere two months. If an outsider's diagnosis infers a pathological condition, let him or her "walk in my shoes": "Woe is me. To have seen what I have seen, see what I see!"  Nor would I be presumptuous enough to challenge  a  poet's eloquent and profound insight, "What falls away is always and is near."  I hope the same holds true for you.

At risk of challenging an even more "sacred" canon in Kubler-Ross's stages of grief, based on my own experience, I would have to say that for me resignation describes the  mental state of the actual latter stage much better than acceptance, a view that places me among the best of company with poets (Emily Dickinson and Edna St. Vincent Millay come to mind) and friends who have lost loved ones.   A higher artistic truth  and actual reality defy and trump the theoretical, wouldn't you agree?