Mourning has no timeframe

Qn. “Is there an official period for mourning a loved one? A member of my team lost a child and I do not want to rush them back to work. I am very sensitive to grieving persons”

With your seemingly simple question, you have propelled us into one of the most important debates in mental health this century. The last time a conversation of this magnitude was on the table for psychiatrists was in 1973. That was the year that homosexuality was removed from the list of mental disorders by the American Psychiatrists Association. Prior to that, homosexuality was a disease whose symptoms and signs were clearly stated, and students of psychiatry were required to know the cure for it.

Since its removal from the list of diseases, the debate continues to rage in many cultures as to what is or is not to be done to or at gay people. The Christian Church in Africa is very clear that it is a condition that is prohibited by God, while the Americans and most Europeans take a different view stating that gay rights are human rights.

The debate continues to generate much heat but for the time being, very little light is shed by the opposing sides.

Last year, the fifth edition of the Diagnostic and Statistical manual was released by the American Psychiatric Association. Prior to its release, one who had been bereaved recently could not receive a diagnosis of major depression. In the earlier editions of the manual, the death of a close relative led to a diagnosis of a condition called bereavement, which should not at the time be confused with the disease, depression. DSM-5 on the other hand, argues that a rose is a rose whatever its colour. Put another way, whether symptoms of major depression follow a divorce or death of a loved one, or even straight from the blue, depression must be diagnosed as such. The cause must be disregarded! This new position has received much criticism from the lay public (and some specialists) because its medicalises bereavement, which is, in the view of some, a normal human reaction following the death of a loved one. In this respect, it is further argued that even elephants go through a recognisable grief reaction!

The stage is set for many years of debate, if the discussion on gay rights is anything to go by.

Now for a story. A few months ago, we saw a 72-year-old man who was sent to us by a cardiologist after treatment for a heart attack. The man had spent 10 days in ICU but had made good recovery and his heart was “on the mend”.

He was sent to us because his children had observed that he was not eating, was losing weight and spent most days in the bedroom with curtains pulled.

He spoke about being in a dark place, where his life had no hope. He felt sad, hopeless and useless. He was an angry man who could not understand how God could take his wife of 55 years without warning. She had died suddenly nine months before we saw him.

In the old system of classification, a diagnosis of a bereavement disorder was made and he was put on treatment and got better. Today, a diagnosis of depression would be made and the same treatment would get him better! Sounds so confusing. Same man, two diagnosis!

The story does not end there because, one has to deal with the fact that men tend to die of broken hearts often after the death of a wife. This observation was made many years ago when it became clear that after the age of 70 years, if a man lost a wife, chances of dying from a heart attack rose significantly!

It was speculated that the death of a wife caused the man much distress and hence the death from heart attack. No similar observation was made for women who lost husbands!

So, to your question, there is no official period of mourning after the death of a loved on. If however, the sadness is either too deep or prolonged, or if one has suicidal feelings, then one must seek help.

Loss of a child, particularly if the death is sudden can be very difficult and recovery could take much longer. Different people react differently. For some, it is easier than for others. Do not rush them to either pull themselves together or to get to work too soon.