Suicide Grief: Prolonged Grief Disorder?

Suicide Grief: Prolonged Grief Disorder?

Suicide [grief] can be complicated by feelings of guilt, shame, responsibility, rejection, and stigmatization.

National Library of Medicine, Grief interventions for people bereaved by suicide: A systematic review

What Is Prolonged Grief Disorder?

Complicated Grief

Known as complicated grief until 2022, long-term grief is now defined by the DSM-5 as Prolonged Grief Disorder. When you’ve lost a child to suicide, grief cannot be easily parsed into passages of time. Hours, days, months, and years of processing grief are not unusual.

The latest edition of the DSM-5, [the Diagnostic and Statistical Manual of Mental Disorders] sometimes known as “psychiatry’s bible,” includes a controversial new diagnosis: prolonged grief disorder.

Ellen Barry, “How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer, Ellen Barry, The New York Times, March 22, 2022

Read more about prolonged grief disorder here: “How Long Should It Take to Grieve? Psychiatry Has An Answer.”

Why Suicide Grief Is Complicated

Both Complicated Grief and Prolonged Grief terms are used interchangeably when discussing grief. But Complicated Grief is not officially labeled a mental disorder. That Prolonged Grief is labeled a mental disorder in psychiatry’s the Diagnostic and Statistical Manual of Mental Disorders, Volume 5, has made the new term controversial.

Read more about prolonged grief disorder and what the disorder characteristically includes here: “What is Prolonged Grief Disorder”?

Suicide Grief: Wrestling with Guilt, Self-Blame, and Why

Frankly, I don’t see how suicide grief can’t be complicated. Having lost my son to suicide, I believe Suicide Grief (especially after losing a child to suicide) is always complicated. You can read more about the challenges inherent in grieving a suicide loss here: 5 Ways Suicide Grief is Different.

The burden of guilt and self-blame feels impossible to move beyond. Strategies for coping with guilt and self-blame can help you through the immense, complicated grief of suicide loss.

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But is Suicide Grief Prolonged Grief Disorder?

The burden of questioning Why? What did I miss? Why didn’t I know? adds exponentially to the self-blame, shame, and guilt of moving through grief after suicide loss.

The Stigma of Suicide

That suicide is still stigmatized also complicates suicide grief. And the shame and rejection of losing your child to suicide? Not something easily worked through. It’s not unusual to grieve a suicide loss over the course of years.

The Healing Power of Grief

Elisabeth Kubler-Ross and David Kessler in their book, On Grief and Grieving, have this to say about moving through grief:

There is wonder in the power of grief. We don’t appreciate its healing powers, yet they are extraordinary and wondrous. It is just as amazing as the physical healing that occurs after a car accident or major surgery. Grief transforms the broken, wounded soul, a soul that no longer wants to get up in the morning, a soul that can find no reason for living, a soul that has suffered an unbelievable loss. Grief alone has the power to heal.

Kubler-Ross &Kessler, On Grief and Grieving

“Stop Trying to Heal From Grief”

Litsa Williams, who writes for What’s Your Grief, shares her professional view of grief in her article, “Stop Trying to Heal From Grief.” Williams’ article is worth reading. She talks about the fact that we don’t “heal” from our grief, but that instead our grief “heals” us.

Grieving is our normal and natural human response to…loss. It is the physical, emotional, cognitive, relational, existential, spiritual experience we all go through, in varying degrees and in various ways, after a loss.

Litsa Williams, Stop Trying to Heal Your Grief, What’s Your Grief Blog

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Moving Through Grief Takes Time

Grief after suicide loss takes as long as it takes, which oftentimes means moving through the grief process without a clearly defined timetable. The difference between my grief the first year after losing my son to suicide and now, at 10 years out, is vast.

The Advantage of Calling Complicated Grief “Prolonged Grief Disorder”

At this point, having a professionally recognized disorder, Prolonged Grief Disorder, means being able to seek professional help from therapists and counselors. It also means that the cost of working with grief professionals is covered by insurance.

Suicide Grief Needs Time for Healing

Up until this professional language change redefining complicated grief as Prolonged Grief Disorder, insurance companies often limited visits without regard to the difficulty of processing grief after suicide loss.

Suicide grief, with its added burden of working through guilt, self-blame, shame, and why, means those bereaved by suicide need sufficient time to move through their grief. Putting a limit of any sort, be it a passage of time; a certain number of visits (typically 3-9 visits); or complying with societal expectations, is not realistic for moving through the heaviness of grief after suicide loss.

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How Losing a Child to Suicide Complicates and Prolongs Grief

Complicated grief [Prolonged Grief Disorder] is characterized by intense longing, intrusive preoccupation with the circumstances of the loss, self-blame, avoidance of thoughts or memories of the deceased, avoidance of previously shared activities, and inadequate adaptation to the loss.

National Library of Medicine, Grief interventions for people bereaved by suicide: A systematic review, Multiple Authors

Intense longing? Intrusive preoccupation with the circumstances of the loss? Self-blame? Avoidance of previously shared activities? Inadequate adaptation to the loss? All of these descriptors describe what I moved through the first few years after my son’s suicide. I am now 10 years out from Dylan’s memorial date. Losing a child to suicide complicates and prolongs grief.

Has my grief changed? Was it Prolonged Grief Disorder those first few years? I lost my only child, my 20 year-old, to suicide. My grief was complicated and profound. It still is, 10 years later, though I have learned to carry ache and loss. You can read more about that here: Carrying Ache and Loss in Grief.

Losing My Son to Suicide: My Grief

I lost my whole world in losing Dylan. I’ve spent the last 10 years since Dylan’s memorial date rebuilding and creating a life where I want to live on. In the early years of my grief, I simply didn’t want to live without my son. Read more about first year grief here: The First Year of Grief After Losing My Son.

Acute Grief in the First Year

The acute grief and agony of suicide loss, however, is not confined to the first year. The grief of losing a child to suicide will always be with me. But suicide grief, even losing a child to suicide grief, can be worked through with the help of support, books, and resources. See: Help, Hope, Healing After Suicide Loss: Support, Books, Resources.

But the the healing process takes as long as it takes. Grief is not something we choose; grief is our physiological response to loss.

 we heal through grief. . .grief is healing.

Stop Trying to Heal Your Grief

Grief is how we process. . .loss. After loss we open our eyes to a world that in no way resembles the world we once knew. In this new world, grief is how we come to understand who we are, how we feel, and how we will survive in this new world. In grieving we create a relationship with a person who died.

Stop Trying to Heal Your Grief, What’s Your Grief?

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Why Prolonged Grief Disorder is Controversial

Grief is not something we need to heal from. Rather, grief IS the healing.

Stop Trying to Heal Your Grief

The Downside of Labeling Grief as “Prolonged Grief Disorder”

Grief is not our adversary

Grief can make our lives disordered (and grief itself is inherently messy), but our grief is the natural response to loss.

“If the language I hear early after my loss is that I must ‘recover from grief’ or ‘heal from grief’, I see grief as an adversary,” writes Litsa Williams in Stop Trying to Heal Your Grief, an article from the What’s Your Grief Blog. Williams goes on to explain:

That language [that grief requires healing, and that I must recover from grief] molds my understanding of grief itself, seeing it as a problem. Or worse, as a threat, something that has in and of itself caused harm, a thing to escape. It is no surprise that I might then avoid my grief. Or I might interpret signs of ongoing grief as a sign of failure.

Stop Trying to Heal Your Grief,

We heal through grief

If I hear, early after my loss, that we ‘heal through grief’ or that ‘grieving is an ongoing and evolving process of healing’, my understanding of grief is shaped in a fundamentally different way. Grief is no longer my adversary, a boogeyman hiding under the bed. Instead of something to escape, battle, or eliminate, grief is a companion. And when I am no longer fighting against my grief, I am able to invite it in. I can listen to what it is teaching me about myself, about those I’ve lost, about how to live in this new world.

Stop Trying to Heal Your Grief

Grief is a companion

I like Williams’ way of seeing grief, that grief is a companion. In the midst of the shock and immediacy of the pain of loss, the last thing I would do is call grief a companion. But I do see, after 10 years out from my son’s death by suicide, that my grief is a steady companion. Bittersweet moments remind me that while I’ve learned to live again, Dylan’s loss will always be with me.

Grief and grieving are not the source of our pain. The source of the pain is the loss itself.

Litsa Williams, Stop Trying to Heal Your Grief

Grief is not a “disorder”

An associate professor of social work at Arizona State University, Joanne Cacciatore, has this to say about the recent addition of “Prolonged Grief Disorder” to psychiatry’s be-all, end-all manual of diagnoses:

‘I completely, utterly disagree that grief is a mental illness.’

Dr. Joanne Cacciatore, How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer, Ellen Barry, The New York Times, March 22, 2022

Grief is not a “mental illness”

Joanne Cacciatore has published widely on grief. She operates the Selah Carefarm, a retreat for bereaved people. She continues to explain why she disagrees that grief (Prolonged Grief Disorder) is a mental illness:

‘When someone who is a quote-unquote expert tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions. To me, that is an incredibly dangerous move, and short sighted.’

Dr. Joanne Cacciatore as quoted in “How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer, Ellen Barry, The New York Times, March 22, 2022

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The Upside of Labeling Grief “Prolonged Grief Disorder”

We develop the continued bonds that will evolve with us as we move forward in a world without that person. Grief allows us to turn inward [to] assess what we need from ourselves and others in this life after loss. It has the power to clarify our values and our priorities. In grief we begin to make sense of who we are in a world without a person who defined us. 

Litsa Williams, Stop Trying to Heal Your Grief, What’s Your Grief?

Its inclusion in the Diagnostic and Statistical Manual of Mental Disorders means that clinicians can now bill insurance companies for treating people for the condition.

“How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer, Ellen Barry, The New York Times, March 22, 2022

Is Suicide Grief a Prolonged Grief Disorder?

So in the end, labeling grief that lasts longer than 6 months to one year “Prolonged Grief Disorder” can help those seeking counseling gain access to a seeing a professional in the mental health field. It really all comes down to licensed clinicians being able to bill insurance companies which ensures those who want help moving through grief, get the help they need.

And seeking help from a counselor or psychiatrist is an individual choice. All grief is painful to move through, but suicide grief? And losing my only child to suicide? There aren’t even enough words to express the agony of this grief. My grief is profound and prolonged. It always will be.

I can’t even imagine trying to make it through the enormity of this grief on my own. Support groups, friendships with other parents who have lost a child to suicide, reading about grief and child loss, counseling, time out from Dylan’s suicide (10 years), walking, being in nature, art, music, and writing all help. Dylan couldn’t live with his pain, but I have found a way (most days) to live on, to move forward carrying ache and love.

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