December 6, 2011


III. Bereavement
     As death of a loved one is filled with anguish and pain it should come as no surprise that grief is one of the most painful human emotions.  It is not clear how long grief should last (even if the category of 2-6 months is currently popular).

     The final lecture from my Behavioral Science class this block was about grief.  How appropriate.  And the above came from the reading.  The two to six months part is laughable to me, as it was to the psychiatrist who gave the lecture.  "My dad passed away during my residency and it takes a lot longer than 2-6 months.  I'm not sure where they got this number," she informed us.  The lecture then delved into how we as physicians need to try to distinguish appropriate grief from a major depressive disorder in our patients.  A very real and substantial part of me appreciates the contributions of a medical model of looking at the darker aspects of moods.  It has utility and it has value.  I've seen what happens when depression goes untreated and results in suicide.
     But as I read more and more about grief vs. depression, I began to think that there's something lacking in substance to the medical model.  Medicine seeks to treat or event prevent diseases.  If there's a broken bone, we reset the bone, immobilize it and allow it to heal properly.  For viral infections, we administer vaccines to eradicate the scurge of polio.  Antibiotics have made rheumatic heart disease a thing of the past. 
     But how does that work for someone's psyche?  The psyche is broken and we seek to fix it.  There's a certain material logic to it.  If someone is suicidal, we'd certainly like to prevent that.  But taking the "fixit" analogy can cut the journey short when 'fixing' equals 'happy'.  There is something quintessentially dark about the human spirit.  Jung called it the shadow side and the older I get, the more I think there's something to it.  Our society places way too much emphasis on being happy or content as the goal of life.  Pain avoidance, I suppose.  There's even a whole body of medicine trying to link positive moods with life extenstion, nevermind the countless self-help books on being happy or positive.  But life is more than the number of days.  Don't believe me?  Name any great story that has endured the test of time.  The overwhelming majority involve soul wrenching pain and suffering.  Very few are happy-go-lucky stories.  Greek tragedies, anything by Shakespeare, you get the idea.  Yes, there may be hope and triumph involved but at the base is still suffering.  There's a reason for that.  Every single human being will be faced with it at some point in their life.  It is part and parcel of the human condition where literature and philosophy have as much to say, if not more than medicine has to say. 
     So I think about that lecture and how I approach that from my own experiences and how I will (probably) approach that with my patients down the road.  And at the end of the day, I do not choose to differentiate between appropriate bereavement and major depression.  They seem one and the same to me, a part of the human condition with artificial labels.


Anonymous said...

My husband of 20 years passed away 7 years ago this last week. My best friend was killed in a car accident 9 days before I lost Larry. And 11 months before them, we lost our son who was 12 at the time to a brain trauma. I get grief. Here's what I also believe about it, and in turn you: There's more for you, and your brother's loss will be part of what makes you an edge more ready to face what that MORE will be. Not every physician will have that edge. But you will. I am truly sorry for your loss. Don't shut off or shut down. When you think you're not feeling or caring, find someone who reminds you that you are. And who doesn't mind having your back as you do. From one total stranger to another,

Anonymous said...

Isaac, choir director here. I read this entry with personal curiosity. I've been through some counseling after loss, two miscarriages and the loss of my daddy to name a couple. In their description of the "grief process", they list anger as first then acceptance, etc. You know the drill. I finally asked after the second miscarriage, where does sadness come? They told me it was the same as anger. At that point I decided that I had a problem with the "grief process." As I've kept up with your "grief process," I've not seen the word "sad". I can honestly say that I was never angry - I felt profound sadness. I know you had the anger part. I can tell from your writings. Sadness creeps back in every now and then especially when I am missing my daddy. I will say I guess I've gotten to the acceptance part and I've gone on with my life, as you have with yours. However, life as I knew it before will never return, And that makes me sad. I've adopted a new phrase - "new normal". I work every day with every change for the new normal. Most days I really like it! Hopefully you will get to this point soon.