Complicated Grief is, well…complicated…

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emotional health / human experience / mental health / Uncategorized

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According to Wikipedia, Complicated Grief Disorder (CGD) is a proposed disorder for those who are significantly and functionally impaired by prolonged grief symptoms for at least one month after six months of bereavement. (1)  It is distinguished from non-impairing grief (2) and other disorders.  It has been placed in the “lets take a closer look” bin by DSM-5 work groups (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) who have decided that it be called Persistent Complex Bereavement Disorder and will be further studied.

Ok well, Pick Me! Pick Me!  I’d like a little of that study action!

In fact, it’s so complicated that there is an actual center for it (complicatedgrief.org/) .  There are publications for it (http://www.health.harvard.edu/…/complicated-grief), homeopathic remedies for it (Ignatia amara, or Ign.; Natrum muriaticum, or Nat-m, etc), a plethora of psychoeducational information out there (just google “complicated grief”) and, of course, a diet for it (New Day Grief Recovery Workbook, Dr. Carolyn M. Deleon).

I don’t ever make light of this complexity as I may have it myself to some degree or another.  I think after a glass of wine at cocktail parties I’ve been waving it off as simply “sadness” in mixed company, and chuckling over it as “slight depression-or menapause-or whatever…and, more importantly, how are YOU”, while with close friends.  In the company of colleagues I’ve been known to label myself, “perhaps dysthymic…”, then adding,  “…during this adjustment period of my life.”  And that ends that.

Honestly, I don’t think in general most people care to actually hear how we’re doing in any intense way.  Call me a cynic. But I think that’s true. I, however, strangely enough, do care about people.  All people. Too much sometimes.

I manage this measured self-disclosure now depending on the audience I suppose. Perhaps the wave of emotion at the time and/or the amount of alcohol consumed makes the difference as well. The key to all of this is whether or not someone has actually asked me how I’m feeling about a certain thing, like my father’s death a few months ago, or my dogs death even more recently.  I don’t forecast my feelings even a little bit generally so that doesn’t happen very often.

THAT is MY job, after all. I am the one asking the questions then following up with more questions, only to enjoy asking the real, hardcore, probing, always surprising, generally uncomfortable questions to follow those up. Not because I’m nosy exactly but because I am a therapist by my very nature. I was helping neighbor kids deal with their unknown hostilities even as far back as preschool.

Being the oldest, tallest kid in Miss Diane’s preschool class in Brewer, Maine, I found myself “tutoring” my three and four year old “clients” in the art of straight line making without the immediate gratification frustrations one gets from skipping dashed or dotted lines due to deadline impossibilities or thick vs. thin writing instruments.

When my “friend” Scotty (don’t kid yourself, Scotty, we had an unspoken attraction) began to sniffle, eyes welling up at the prospect of missing outdoor time because he needed to complete his straight line exercise, it was the tall girl with the covered up bald spots (another story) that ran to Miss Diane and offered to give support to her fine-motor-skill-deficient “friend”.

He didn’t realize this at the time, but he was to be my first pro-bono, unofficial “client”. Scotty would join in the ranks of unofficial, completely blindsided “clients” that I would attempt to guide.  Whether in classrooms at glue stations during craft projects in 1st grade or at recess while aiding in 5th grade “couples therapy” when a girl friend of mine checked off “yes” to a “will you go out with me?” note passed via a third party who secretly had a crush on her, I was the go-to for helpful information.  In this particular case it seems the messenger didn’t have the nerve to write his own note to this same lucky gal and thus resented being the merge-agent.  Thank goodness I was there to help.  A tragedy averted!  Love IS a many splendid thing!  I know, as I brought my own blend of light to an otherwise bleak pairing.

This need to assist (help/advise/suggest strongly/be brutally honest/control)  continued onward. Eventually reaching parking lots, where I’d give advice to fellow parents on whether an affair was the best choice versus a fling, where I might suggest communication with hubby first; or something as simple as whether a box hair color was more fiscally responsible than a salon visit for getting that brunette brilliance minus the brassy finish that accompanies fading.

Eventually I would go to colleges to hone that skill before taking my passion to offices where I actually got PAID to be an intent listener, pointed questioner, option-giver, plan maker, implementation supporter! This was what I’d been destined for and truly enjoyed doing.  And did I ever stop to ask myself why or how this side of me came to be? No, not really. I just felt as if I’d fallen into it easily and quite naturally…my “calling”, if you will.

So when a close friend genuinely asked me the ever scary question shortly after my father died “so, Jules, how ARE you?…your feelings, I mean..and don’t try and change the subject this time” , I believe I felt a teeny bit faint. She allowed the question to dangle out there in a space filled with….silence.  Like dead silence.  Like she actually was waiting for a real response FROM ME silence!  What in the hell was wrong with this woman?  she was changing the rules!  I ASKED the questions, dammit! I was in control!  Not so much at this moment however.  

I felt like a cornered mouse might feel with a cat glaring at it only inches away after the nauseating awareness that there was no escape hole in the floor boards, or that feeling I got most recently when a car was speeding down a road and just about crashed into the driver’s side of my car as I was pulling out of a WaWa convenience store because my depth perception was off at 9:00 pm without my glasses on.

Panicked. Fight or flight turned into self condemnation, “Shitshitshitshit…MOVE OUT OF THE WAY!!! Press the f’g gas!!!!NOW!!!

So metaphorically speaking, that’s what I did.  I got my foot on that gas pedal, aimed for the correct lane to end up in, closed my eyes tightly and prayed for a miracle. Wouldn’t you know, I dodged a bullet.  That miracle came in the form of a tumbled over glass of red wine on my sweet friend’s taupe rug. Oops. Best part: it wasn’t even me who had made that happen.  Physically anyway. This time.

Physician heal thyself is now my mantra. My grief is complicated, however, I, too need help to be able to put words out there to manage the overwhelming abundance of sadness and anger and relief and emptiness. It’s that simple. And it’s that complicated.

Bottom line: I’m changing.  We’re all changing. Pain changes people. It just does. Hopefully for the better. And it’s a waste if we don’t stop and learn something from all that turmoil.  I mustn’t kid myself that I’m suffer-resistant somehow. Teflon doesn’t run through my blood as I’d hoped it might.  My father’s recent death has woken up much of the fabulously quiet, raw-emotion-laden volatility; that ugly, tangled messiness which is the stuff of human existence, it turns out, is also within me.  Now more than ever I dare say.

I figure if I mix this with my best self I might be able to build on this! “Comfortably Numb”, my favorite college soundtrack, The Wall, by Pink Floyd, no more.  I am fully alive, not just to be there for whomever may need a shot of honesty mixed with motivation and wisdom, but to heal thyself.

My greeting card might go something like this:

To One Hell Of a Gal On Her “Coming Out” Party!

Welcome to the world of feelings!  You want ours but neglect to share yours.

You might think it’s because you are selfless and giving; we rather think you are fearful and quite torn.

You think we don’t really want to know when we ask how you are doing; and that is probably so,

but deep inside you don’t want anyone ever to really know you. You’re afraid to truly show.

You’re afraid your honesty is too much for others to bear.   It’s much easier to hide behind others regardless of whether that’s fair. 

 many don’t care to see their own blindness, and sometimes it’s ok if they don’t. Just be there for who wants help and always include yourself!

Congratulations on living the human experience along with the rest of us who breathe.

Now be honest with yourself too. You’re a better you when you learn to grieve!

Congrats!  Keep up the good work!

Me, Myself & I

 

1. Shear, M.K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., et al. (2011). “Complicated grief and related bereavement issues for DSM-5”. Depression and anxiety, 28(2), 103-17. 2. O’Connor, M.F., Wellisch, D.K., Stanton, A.L., et al. “Craving love? Enduring grief activates brain’s reward center”. Neuroimage (2008), 42:969-972.

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The Author

I am a licensed clinical social worker who just happens to adore the written word. I have had a private practice and am now writing a memoir on my life in the company of my father and many of my clients who have been diagnosed with bipolar disorder. I hope to dispel some myths and break down some barriers for those with mental illness. I write out of need and complete joy, which I hope to convey throughout my blogs. The human experience is not exclusive to one group. I hope to appeal to most as I touch on some pretty heady material with some self-deprecating humor and raw emotion thrown in for good measure. I have four amazing children, one HUGE dog and a tolerant husband. I am blessed.

7 Comments

  1. Well it does sound like a blessing to actually end up in the career that you knew you were made for as a child. Thats Awesome! So complicated grief disorder could that also be described as complex PTSD? I haven’t heard that term before -more for me to read up on -thanks! I like your story lots.

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    • Hi Chely5150! Great question…Complicated Grief according to the DSM-V is up for debate actually. They have it in the back section under “to be revisited” or some such backburner; however, Columbia University’s School of Social Work has a “Center for Complicated Grief”, which states that, “complicated grief is an intense and long-lasting form of grief that takes over a person’s life.” Unlike the “normal” grieving process, this is a form that makes a person feel kind of “stuck” in her/his grief. It doesn’t recede into the background as healing diminishes it, as other grief would. The “complicated” part refers to things that might interfere with a regular healing process.
      Complex PTSD isn’t yet recognized by DSM-V (Diagnostic and Statistical Manuel of Mental Disorders); however, it shares the same “complex”-type nature in that Post Traumatic Stress Disorder is a disorder highlighting emotional/social or interpersonal trauma caused in the context of either captivity or some kind of entrapment, resulting in lack of control, helplessness and damage to sense of self and identity. The prolonged and incredibly intense PTSD would be considered complex I’d imagine, just as it does for grief. However, grief is more about the loss of something or someone significant and doesn’t get into the entrapment and such. Sorry for such a lengthy description…I’m a tad wordy!
      I so appreciate your inspirations!!!

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      • Thank -you for your answer. I dont think it was too wordy at all. Could be because Im the same way -long winded -is the term my family uses. I find your definitions to be good ones, as they make it clear to me the difference. Sometimes the more I learn the less I have hope to be successful in my marriage. I recently did a post on labels. Maybe you can help me clarify the difference between sociopath and psychopath. Because my h could be either , but he’s the successful covert and charming self centered narcissist. Thats what I was labeling his disorder as but now Im not so sure which of the three would be correct in my case. Thanks for your responses I enjoy your posts and admire your goals. Thanks again – chely

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  2. Hi Chely 🙂
    I’m wondering what your thoughts are concerning your husband and labels you speak of. Would it somehow make it easier to label him so that you can place him in a concrete kind of category in order to further understand him and to think about whether or not he’s going to be able to make changes in order to continue as a married couple?
    DSM lists both psychopath and sociopath as within the Antisocial Personality Disorders. They do have similar characteristics and do similar actions. The term psychopath came way before sociopath, I believe. But both have been used interchangeably. Perhaps main difference is what person born with, considered psychopath (hard wiring) vs. environmental stressors that would contribute to one’s personality (sociopath).
    Both have a complete disregard for the feelings and rights of others (to include cruelty to animals). Important to understand that this is way beyond adolescent mischief. Both do not feel remorse or guilt. They seem to lack a conscience and are completely self-serving (like narcissistic personality disorder). They disregard rules, social norms and laws and do not care about putting themselves or others at risk.
    From my own perspective I have used the term “sociopaths” as the more outgoing of the two. It’s almost as if they can get away with more as they convince you somehow that it was your idea. They could sell a desert to a fish. Many arguments about the two terms. So it was a great question to ask. Bottom line: may depend on who you ask!

    Narcissism is self focused, but generally not harmful with regard to safety of self or others. These folks see themselves as somehow better than others, therefore their needs come first and foremost. Vanity is very important to these people. They do take advantage of others, are jealous, have difficulties with relationships, judgmental, disregard for other’s feelings while expecting constant praise. They will follow rules and regs as long as it isn’t too much of a deterrent to what they see as self-serving. It crosses the border of healthy confidence and self-esteem. Underneath all of this is often a very fragile self-esteem being defended by the boastful, difficult narcissist.
    Both or all diagnosis are very difficult to live with. One is more potentially dangerous as he has no conscience. It sounds like you have quite a struggle on your hands.
    Here to help!
    Jules

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    • Thank -you for the info -it is confusing. Yes I guess thats part of why I needed to clarify but mostly when blogging and im describing his behavior just dont want to use the wrong “label” and be talking about it and appear to not know what im talking about. I always seek to gain insight into whatever it is im researching. I do wonder if I can ever expect improvements-in many ways It is so much better having to deal with all that comes to light discovering an affair by him. I am willing to forgive for past indescretions but I cant accept anymore of that behavior, and it worries me because the experts seem to have gotten his behavior right so far and that doesn’t bear well for him staying faithful. Trying to stay positive as I gather the evidence I need to come to final decision. I need to know so to wrap my head around it. Im just still so in the dark and that is the hardest for me.

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      • You are in such a tough spot. Let’s see if we can simplify it just a bit by thinking about some basic questions (got to get the emotion out so you can think instead of feel for a moment):
        1. What has your history with him been like? Percentage-wise, more positive/neg?
        2. Do you have any children together?
        3. Do you want to if you don’t?
        4. Would/is he a good father candidate if you did? (my apologies for anything you’ve said in posts I haven’t gotten to yet! I promise to catch up!)
        5. What’s your self esteem like?
        6. What were male figures like growing up?
        7. Where do you see yourself in 5, 10 years ideally?
        8. Is he in the picture?
        9. Pros and cons of this man
        —now for feelings—
        10. Past – how has he had an affect on your emotions early on?
        11. Was it totally shocking that he would have an affair?
        12. When you say narcissistic behaviors, where does that leave room for your needs in this?
        13. Do you love him and/or do you need him –financially, emotionally, physically
        14. Can you rebuild trust?
        15. Is couples therapy an option?

        just some thoughts for what it’s worth, Chely…been thinking of you and want you to find what you need for you. xo Jules

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