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.