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Medicalization of Grief: Normal and Abnormal Labels

Updated: Mar 19, 2019

It is important to realize how much death and grief have been medicalized over the last few decades. This is not a criticism, rather, a reflection and call to understanding current practice and discourse. The medical services available today, for the most part, continue to regard death as something to be resisted, postponed, or avoided altogether [Clark, 2002]. Many question whether or not dying patients can experience a 'natural' death, unless in the care of a palliative care team. This medicalization theme has spilled over into the experiences of grief and bereavement as well. With good intentions, volunteers and professionals alike, have been known to use terms that indicate, for example, that 'healing' and 'recovery' from one's loss are to be sought out. As a symbolic interactionist, I refrain from using such terms as they may send a message to a bereaved individual that they need help in the way an ill person needs assistance. Both death and grief are natural normal experiences we will all have in our lifetimes and our reactions to them are varied and oftentimes misunderstood.

Reactions to losing someone close to us can be complex for numerous reasons. How we process the loss can be connected to the manner of death or the circumstances that surround it, a person’s history of loss experiences, multiple losses over a short period of time, one’s personality, the relationship to the deceased, and a lack of social support for the survivors (adapted from Worden 1991). The medicalization of death coupled with a more public response to loss, contributes to the medicalizing of grief with a need to distinguish what is a ‘normal’ response to what is ‘abnormal’. This labeling surfaces in the medical community as grief and bereavement now need attention.

Reactions to grief are also categorized through the use of labels by grief scholars. For example, Worden (1991) suggests ‘chronic’ (where normal grief continues for an extended period of time with no satisfactory conclusion), ‘delayed’ (where reactions occur after a lapse in time post-death), ‘exaggerated’ (where a person is so overwhelmed by the symptoms that they develop major psychiatric disorders) and ‘masked’ (where one’s reactions causes physical symptoms). This labeling provides a starting point for which to treat clients in the counseling arena and has been adopted in the bereavement care industry by some agencies.

According to Walter (1999), early in the 1990’s, medical teachings (or what he refers to as clinical lore) put a great deal of emphasis on the three elements of expressivism, resolution and a notion of normal and abnormal grief. The first, expressivism, suggests that one who grieves should not only deal with their personal feelings but should also verbalize them. Next, resolution implies that one should move along in their grief, letting go of the deceased person and return to emotional steadiness. These two expectations lead into the third, the ‘normal’ versus ‘abnormal’ labels, where not letting out feelings and holding on to the deceased will place one in the ‘abnormal’ range. In the past decade, however, there is a move away from this approach as we gravitate towards an acceptance of highly individualized grieving styles where diversity is recognized and an assortment of grieving behaviors are normalized.

Other labels are associated with grieving, such as complicated, chronic and traumatic grief. References to ‘complicated’ grief include irregular reactions following a loss of a loved one, for example, having signs of significant distress long after the death and the inability to function in one’s everyday life. Some researchers (Prigerson,, 1999:67) who previously used terms such as ‘complicated grief’ switched to ‘traumatic grief’ referencing both disorder and syndrome in their work and note:

Although we formerly referred to the disorder as 'complicated grief’, we prefer 'traumatic grief’ for several reasons. Similar to Horowitz, et. al (1997) we acknowledge the reaction to be a stress response syndrome and note that, as such, many of its symptoms resemble those of post-traumatic stress disorder (P.T.S.D.; e.g. disbelief, anger, shock, avoidance, numbness, a sense of futility about the future, a fragmented sense of security, trust, control). The trauma to which we refer represents a specific type of trauma - what appears to be a 'separation trauma'. . .

Others, such as O’Connor, (2008) indicate that daydreams about the deceased may present for some individuals a type of longing for the reward response that may make adapting to the reality of the loss more difficult. This view suggests that grief can be likened to an addiction and is labeled as chronic grief. Complicated grief, also referred to as ‘prolonged grief disorder’ is diagnosed using an assessment tool with various factors developed by Prigerson and colleagues (2009). These include separation distress, five or more cognitive, emotional and behavioral symptoms with a duration of at least six months from the onset of separation distress. Supposedly, these cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (e.g., domestic responsibilities). They must also not have a relation to other mental disorders such as Major Depressive Disorder, Generalized Anxiety Disorder or Post Traumatic Stress Disorder.

Re-emphasizing Walter’s (1999) argument that the medical field defines normal grief by regulating and normalizing the emotions surrounding it, we can understand why there is so much research and terminology attempting to identify and define behaviors outside of what is considered normal and expected responses to loss. On the one hand, grieving is viewed as an individual experience and the person’s emotions and behaviors are normalized, but on the other, there is a prescription from practitioners to keep within the realm of normal by utilizing these various models and theories to assist them. This paradox may contribute to a dependence on the formal care practitioners, where emotional expression is encouraged (although time-limited) but frowned upon in the presence of close others, such as in the informal support system.

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