Is Grief a Mental Illness?

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For the majority of us, grief is an inevitability. 

If you have ever experienced grief, you may be familiar with questioning your own sanity… ‘Did I just fleetingly see my loved one wade through a crowded street?’

In some circumstances it can even result in us questioning our own reason for living. Whilst disturbing, these thoughts usually diminish over time, becoming less consuming and intense. However, sometimes these thoughts can pass the line into pathology, wherein treatment may be required to help alleviate and remove the developing problems. 

Pathological grief disorder (PGD) is a condition which is a fairly new addition to what has been dubbed the ‘bible’ of psychiatric disorders – referred to as the Diagnostic and Statistical Manual of Mental Disorders (DSM). This disorder is commonly known as traumatic or prolonged grief, wherein it typically lasts for longer than six months. However, the addition of the disorder to the DSM has been a fairly controversial one. The reason for this being because it allows for medical treatment of grief related depression within the first few weeks following a bereavement. Diagnosing someone with depression so quickly after a significantly traumatic event is, in my opinion, not the correct decision. 

Grief is a natural response the naturally diminishes over time. This is particularly pertinent to individuals who believe the ‘strong’ and ‘stable’ approach for other family members following a fatality – primarily being men. In 2017, Prince William discussed the destructive nature of the ‘stiff upper lip’ mentality, admitting that it had taken a devastating toll following the death of his mother, Princess Dianna. Thus, relying on medication to potentially numb the emotion of someone in grieving may only exacerbate the issue, especially when the medication is eventually withdrawn. If that was me, I would probably start to believe that prescription drugs were the essential crux for any potential happiness. Whereas in actuality, any recurring negative emotions would have likely reemerged due to not having sufficient time to process the death prior to pharmaceutical intervention.

Whilst immediate medication is not advised, it is crucial to identify signs of chronic psychological distress following a bereavement. Here are a few PGD symptoms to be aware of:

  1. Concentrating on little else apart from the deceased loved one
  2. Extreme focus on reminders of the loved one or excessive avoidance of reminders
  3. Intense believing that life has no meaning
  4. Inability to enjoy life or reminiscence on positive experiences with the loved one. 
  5. Wishing to die to be with the loved one.

Pathological mourning is not a new concept, with publications discussing its commonality and treatment options in the 1980s. The primary problem is that the DSM does not discriminate PGD from intense ‘normal’ grief, thus likely yielding huge false-positive diagnoses from psychiatrists. This is likely to cause additional stress to an already vulnerable individual.

A major reason for this is because the signs between PGD and ‘normal’ grief are practically identical. However, in PGD the symptoms are considerably more prolonged, debilitating and intense. Numbness and detachment can last for over six months, and perhaps extend considerably longer. It is in considerable contrast to feeling sensitive after being exposed to emotional triggers of that loved one – for example, videos and photos or anniversaries.

Nevertheless, ignoring any type of grief is potentially an extremely hazardous choice. The severe consequences of losing a loved one can, without intervention, manifest in post-traumatic stress disorder (PTSD). Whilst primarily associated with individuals who have worked within the military, PTSD is common amongst various groups, including the bereaved. A recent study looked into the rates of PTSD in 132 people who had lost a close relative due to cancer. Strikingly, at one month 30% of the volunteers were rated as having PTSD, with another 26% displaying pre-clinical signs of the disorder.

Interventions for pathological grief disorder

Because the diagnostic criteria for PGD is lacking, many suffers are instead diagnosed with major depressive disorder and are ‘treated’ with antidepressants. Whilst this is sometimes beneficial for the patient, evidence is lacking as to whether this is successful for PGD sufferers. 

On the other hand, grief counselling is available. Therapists for this type of support are widely knowledgeable and understand that each experience of grief is entirely unique, complex and emotional. Your culture, personality and individual experience will all affect the grieving process. A ‘one size fits all’ approach in terms of medication is unlikely to help the majoring of us. Grief counsellors on the other hand will intricately tailor treatment to meet your specific needs. 

I would strongly recommending reading about grief counselling if you believe there is a loved one who requires it. Communication with health professionals (alongside loved ones) is absolutely crucial for healing and recovery. Unfortunately, grief is a normal and upsetting part of life. Instead of immediately jumping towards medication as a potentially damaging crutch, take the right initial steps following a bereavement: Emote and communicate with friends and family. But remember, never be ashamed to seek guidance and support if you think you need to. 

Social anxiety and loneliness.

Image: Pixabay.com

Fearnounan unpleasant emotion caused by the threat of danger, pain, or harm. 

Does that sound familiar to you and your experiences? Perhaps it may. Anxiety is often coined to be a particular type of persisting fear, wherein we worry about potential future outcomes associated with specific events. In fact, the way we feel when either frightened or anxious are extraordinarily similar, because the basic emotion for both remains the same. So, despite not being in any immediate danger, anxiousness can result in similar symptoms to that of fear: increased heart rate, feelings of sickness and/or dizziness, and a loss of appetite. For many, new social situations can be a common trigger of these symptoms, often termed as social anxiety. 

Social anxiety: what is it?

Also labelled as social phobia, social anxiety presents itself as a long-lasting fear of being humiliated or scrutinised by others. It is sometimes (and incorrectly) compared to general shyness. However, whilst shyness often manifests for many prior to an unfamiliar situation, this usually dissipates following exposure to the new social situation. This is not the case for social anxiety. The latter often manifests during adolescence, when the opinions of friends and peers become increasingly important. This impairment can continue into adulthood, wreaking havoc on a wide variety of important life events. Separating social anxiety symptoms from those of general shyness is thus essential before discussing management and treatment options. 

The symptoms

Symptoms of social anxiety (as with any form of anxious behaviour) can be wide ranging, and it is unlikely that any one individual would experience them all. All anxiety disorders can be associated with the symptoms mentioned previously. However, common identifiers for social anxiety usually include the feeling of dreading everyday activities, such as starting up conversations with strangers, speaking on the phone to unfamiliar people, or even going into work. As a consequence, social anxiety can result in the avoidance of many social activities such as eating out or going to parties.

Can social anxiety effect my health? 

Because of the primal need for social interaction between humans, the consequences of social isolation on both physical and emotional health can be catastrophic. A recent meta-analysis – a statistical approach which combines data from multiple studies – identified that a lack of social connections can heighten health risks as much as smoking fifteen cigarettes a day or having an alcohol consumption disorder. The analysis suggested that social isolation can significantly increase the risk of premature mortality, with the magnitude of risk exceeding that of other common leading health threats. A recent study in 2019 analysed the data from more than 580,000 adults, finding that social isolation increases premature death risk for every race.

The negative impact on both mental and cognitive health is also apparent. Evidence supports a link between social isolation and adverse health effects including poor sleep quality, depression and accelerated cognitive decline, the latter of which is associated with problems in memory, language and judgement. A 2018 study also discovered a clear association between loneliness and dementia, increasing a person’s risk of developing the latter by up to forty percent. Examining data from more than 12,000 U.S. adults aged fifty or older, participants rated their loneliness and social isolation alongside completing a battery of cognitive tests every two years for up to ten years. 

Do you think this applies to you?

As reported by a 2018 survey, loneliness levels have reached an all-time high. Of the 20,000 U.S. adults approached, nearly half reported feeling alone, with the youngest generation being the loneliest of all. However, isolation is also well characterised in the elderly. According to Age UK, over two million people in England over the age of 75 live alone, with over one million stating that they go for over a month without conversing with a friend, neighbour or family member10

It is essential to determine whether social anxiety and/or loneliness applies to either yourself or a loved one, and then take appropriate action. It is important to try and communicate with friends and family where possible. However if this is hindered, it is imperative to seek out advice from a qualified medical professional.