Thread by @refugeingrief

There's no such thing as prolonged grief disorder. Calling normal human emotion a pathology is a symptom of our "good vibes only" culture. There's NOTHING wrong with you if you're sad, lonely, or have a hard time finding joy or meaning after your person dies. A THREAD:🧵

We get lots of requests for me to talk abt “prolonged grief disorder" (PGD). All the time. TBH, it’s such a massively messed up thing, I dread getting into it. But major media outlets insist on publishing articles claiming "the whole world is at risk!" so I can't avoid the rant.

TL;dr: If you’re not up for a rant today, here’s a very brief summary:
Grief is bad because it makes it hard to be productive. Our work hard / make money / be resilient culture does not like “unproductive.”⁣ Sadness makes onlookers twitchy too, and we can't have that.

Prolonged grief disorder combines the historical avoidance of pain, plus misogyny, racism & capitalism, PLUS the insurance reimbursement systems that say you can’t get help if you aren’t “broken,” so we need there to be something broken in you that we can fix.⁣

If we normalize this very normal human experience, insurance companies won’t want to pay for treatment/support, which means a lot of people can’t access care if they aren’t labeled with a “disorder.”

And THEN we’ve got folks who feel they need the official medical diagnosis in order to prove to their friends and family that they have a right to grieve – it’s a way to legitimize their feelings and experience, and that’s important.⁣
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This is what I mean friends – addressing the issue of PGD is a whole cauldron of inter-related problems that go far beyond grief itself. It’s a symptom of the machinery of capitalism & greed & when you’re grieving – you don’t always care much about that stuff (with good reason)⁣

for now, the short the answer of why we’ve even got a pathology-based view of grief, backed by the medical industry, is capitalism. If you’re sad for too long, you’re not “productive,” and your emotional state is a real downer to the people around you.⁣

When you read articles online about prolonged grief disorder and how “the whole world is at risk,” remind yourself that grief is normal and healthy, and no one gets to tell you how to grieve. If it helps, read those things and tell yourself “it’s a broken system.”⁣

If you'd like to hear more on this, along LOTS of other issues related to Normal Human things going sideways, tune into Here After with Megan Devine wherever you get your pods. refugeingrief.com/meganspodcasts/

it's also RUDE AF in the wake of a still ongoing pandemic to basically diagnosis millions of people via @nytimes article. You know how many people are grieving right now? And you want to add "oh shit, I'm doing GRIEF wrong?!" on top of that? @APA - what a crappy move.

and another thing: popular articles like this teach would-be supporters that they should be worried about someone if they're "still sad" a year after their person died. It's faulty information with real world consequences.

Popular articles calling normal, healthy human emotion a disorder - and giving grief a very clear timeline in which to be resolved - means more people will stop talking about their grief at all, rather than be judged.

Suppressing grief has given us epidemics of drug addiction, loneliness, interpersonal violence, and suicidality. We have a change RIGHT NOW, while the world is grieving, to normalize this normal human experience. But NO. We've decided to double down.

You know why people are lonely? Because they can't tell the truth about how they feel. If you're going to be cheered up, corrected, or told you have a disorder - you're going to stop talking. That doesn't make grief go away.

Loneliness is a public health issue resulting in LOADS of health conditions (see studies on loneliness by @Cigna) Grief - and disconnection because we can't talk about grief - is at the root of loneliness. Calling grief a disorder creates far more problems than it tries to solve.

It's not "just" an article. It's something friends/family/medicalproviders will use to assess the grieving people in their lives, & those grieving people will not pass the "all better" test. Shit like this makes things worse for people going thr the hardest times of their lives.

OMG I AM COMING IN HOT TODAY. This stuff is enraging.

okay, but wait - doesn't #ProlongedGriefDisorder unlock access to the #FMLA? Nope. Not necessarily. A thread within a thread:

it's murky, but bereavement in general is not allowed under FMLA. You can take FMLA to care for a dying family member, but once that person dies, FMLA no longer applies.

They expect you to lean on your company's bereavement policy - which presumes your company even has a bereavement policy (it's not required). Most bereavement policies cover 3 to 5 days, provided you lost someone "close" to you. Best friend died? You're out of luck.

You can, in some instances, unlock family medical leave with a mental health diagnosis. Remember that a diagnosis of PGD happens, at the earliest, 6 months after the "qualifying loss" - which means PGD won't unlock FMLA anytime during those first 6 months of grief.

we already have diagnostic categories that *might* be used to gain access to FMLA in the early days & weeks of grief - depending on your situation. PTSD, Adjustment Disorder (which works great for grief!), depression - these are often qualifying diagnoses for family medical leave

your doc or therapist would need to know how to use mental health diagnoses to improve your chances of getting FML, but most aren't experts in the FMLA. This 2020 article is a good overview: factorialhr.com/blog/bereaveme…

so the idea that calling grief a disorder if it lasts longer than 6 months is somehow a *good* thing because it unlocks benefits for grievers is not exactly a sound, logical argument.

ok ok but say the person muscled through 6 months, minus their 4 days of bereavement leave, and they're "still" having a hard time - a prolonged grief disorder diagnosis is a good thing at that point, right?

this presumes that they wouldn't have already met the diagnostic criteria for adjustment disorder or PTSD (depending on the loss), for which they could have been receiving support the whole time.

"Bereavement" has been a diagnostic code 4-eva, but insurance companies don't cover it (it's known as a "v code" - aka "we don't pay for these situations). It would've made a lot more sense to move the existing "bereavement" diagnosis into the "we pay for these" part of the DSM.

rather than make up some new thing that pathologizes normal, incredibly difficult emotional responses to death and other losses, we could've just lobbied to have the insurance industry pay for therapy when you're grieving.

so if you're a therapist or provider, what are you supposed to DO with this new diagnosis?? Well - educate your clients. You can let them know that diagnosis codes are created for the insurance industry, and they aren't personal judgments, even though they sound like it.

you can tell them that their grief is normal - no matter how much it's messing with their sleep, worldview, relationships, or emotional stability, AND that sometimes having a diagnosis will let them access supportive counseling Inside the Awful.

you can tell them that you wish it was different - that they shouldn't need to say something's wrong with them in order to be supported. Just acknowledging the messed up system goes a long way, here.

you can equip them with the tools they need to survive what has been asked of them, and help them navigate a social and medical world that tells them they're doing it all wrong.

as I said earlier in this 🧵the prolonged grief disorder diagnosis isn't going away. It's in the hands of providers now to help their clients & patients understand the mechanism of pathology-based language so they don't heap shame onto themselves as they grieve.

oh right - but doesn't this new diagnosis unlock funding for treatment and research? YEP. Yes it does. Research & treatment operate within the pathology model: let's get people back to work ASAP by erasing their grief.

apparently, some of the new research is looking at pharmaceuticals used in substance addiction to "treat" grief, as grief is seen as... an addiction. A maladaptive response to pain or loss. Um.

so... yes? Yes, Prolonged Grief Disorder being named an official condition unlocks funding for research, but is that the kind of research we want? New ways to drug people out of their grief? Don't get me wrong - meds are AWESOME for many things. But grief itself? Not so much.