The Truth About Grief by Ruth Davis Konigsberg

The Truth About Grief by Ruth Davis Konigsberg

Author:Ruth Davis Konigsberg
Language: eng
Format: epub
Publisher: Simon & Schuster


6

The Grief Disease and Resilience

In 1991, at the thirteenth annual conference of the Association for Death Education and Counseling, Therese Rando, the psychologist in private practice in Rhode Island who invented the six Rs of grief, gave a keynote address titled “The Increasing Prevalence of Complicated Mourning: The Onslaught Is Just Beginning.” Rando asserted that Americans were on the brink of an epidemic with disastrous consequences: complicated mourning was rising dramatically, although she didn’t say by how much or mention who had actually measured the increase. Our failure to prepare for the coming onslaught, she warned, would “place our society at greater risk for serious sequelae known to emanate from untreated complicated mourning.” (She did provide a citation for the “serious sequelae”—her own forthcoming book about treating complicated grief.)

Rando went on to catalogue the causes of the onslaught, many of which seemed to have little to do with bereavement: wife-beating, abortion, child abuse, the rise in TV violence, “an increase in conflicted and dependent relationships in our society.” She finished her critique of society’s ills by pointing the finger at her fellow grief therapists: they too were contributing to the increase in complications by misdiagnosing them and hampering treatment (which was counter-logical; usually practitioners contribute to the rise of a disorder by overdiagnosing it). Rando offered this solution: a category for complicated grief needed to be added to the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (known as the DSM and updated about every fifteen years) so that clinicians would learn how to properly recognize and treat the oncoming horde of sufferers.

Grief made its first appearance in the DSM-III, published in 1980, in an entry for “Uncomplicated Bereavement,” which was defined as a “normal reaction to the death of a loved one” that occurs within the first two or three months of the loss. The entry was relegated to the back of the manual in a section for conditions that don’t qualify as full-fledged mental disorders such as malingering or senility. These conditions are known as “V codes” (because their coding begins with a V, not to be confused with the other kind of V codes, the three-digit verification numbers on the back of your credit card), and get little clinical attention because their treatment is not reimbursable by insurance. As of this writing, grief is still a V code (V62.82 in DSM-IV-TR ), although practitioners are given a means to fudge by diagnosing major depression if the symptoms are still present two months after the loss, reflecting the belief of some psychiatrists that any significant distress stemming from bereavement can be captured by the already existing diagnosis of depression, and doesn’t warrant its own entry.

Despite her concern about complicated grief, Therese Rando did not follow through on the lengthy process of getting a new disorder added to the DSM. That heavy lifting eventually fell to a member of the second wave of grief researchers to emerge in the 1990s, two decades after the beginning of the death and dying movement.



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