How to ease the seemingly endless pain of prolonged grief | Aeon Essays

Understanding Prolonged Grief and its Impact on Individuals

On a January evening in 1992, I was sitting in our kitchen, reading a comic book. My older sister Claudia went out to run an errand at a nearby minimart, just before it closed. Her keys jingled as she said goodbye and pulled the door shut. Her footsteps rushed down the stairs. A minute later, I heard her slam the garage door after she had pulled out her bicycle. Moments later, I heard a loud thud from down the street. I also thought I heard a muffled scream. I was 10. I couldn’t connect the dots.

A speeding car had hit Claudia while she was crossing the street. She didn’t die on the spot. Her boyfriend rushed my mom to the hospital. They spent the night at the ICU, while I spent the night in my best friend’s apartment. We set up camp on mattresses on his living room floor. He said: ‘I’m sure it’s just a broken leg.’ I said: ‘You’re right, she’ll be fine.’ We prayed. The next day, my mom stood in the doorframe, sobbing. ‘Claudia is dead,’ she said. I hugged her. I knew I had to be strong for her. What I did not know is that my sister’s death would, in some way, end my mom’s life as well.

The Impact of Prolonged Grief

We cried at the funeral. We cried at the cemetery. We cried at home. After a few months, I stopped crying. My mom never stopped crying. She became obsessed with Claudia’s grave. She would visit it every day, clean the white marble and bring fresh flowers. At the same time, she became frustrated and angry with the world. I spent my entire youth listening to her angry words, but her grief wouldn’t recede the tiniest bit.

Somewhere in my teens, I concluded that she must be suffering from depression. But I was wrong.

Understanding Prolonged Grief Disorder

It’s no surprise I had it wrong. Back in the day, even professional psychologists lacked an official diagnosis for persisting grief. That changed in March 2022, when the condition my mom most likely suffered from was added as ‘prolonged grief disorder’ to the latest revision of the psychologists’ diagnostic manual, the DSM-5-TR. The diagnosis hinges on two factors. The first is denial: mourners cannot accept the death of the person they lost. This, in turn, causes symptoms like sadness, anger or guilt that last for more than 12 months.

That persistence separates normal from prolonged grief. While the former is like a wave that occasionally flares up and then ebbs away, the latter runs like a horizontal line. Prolonged grief traps its sufferers in continuous rumination. This causes the second diagnostic factor: impairment. Some sufferers quit their jobs; others avoid people and places that remind them of their loss. Avoidance is just one of many hallmarks of this disorder. While guilt, self-blame and anger rank high, one of the most prominent symptoms of pathological grief is the loss of meaning in life. People who get stuck in prolonged grief often see no point in living without the person they lost.

The Impact of Prolonged Grief on Empathy

This matches what my mom said. Twenty years after Claudia’s death, she would still say: ‘When your sister died, a piece of me died with her. I will never be alright again.’ She would stay alive as long as she had to. The only thing she looked forward to was being reunited with Claudia. If she got cancer, she’d refuse treatment. I offered to help her find a therapist, but she scoffed.

Caring for me became her duty, but not a pleasure. I didn’t understand why. But now, a study by researchers in Japan and Italy shows how prolonged grief lowers empathy. The scientists showed bereaved people photos of their deceased loved one and other photos of a living relative or stranger. They then measured those individuals’ empathic response in an fMRI scanner. The result: the more patients were grieving, the less empathic they were with living relatives. Their empathy to the dead person was enhanced.

The Prevalence of Prolonged Grief Disorder

My mom wasn’t an isolated case. Between 7 and 10 per cent of all bereaved people develop pathological grief, a large study from 2021 shows. When the number of deaths went up during COVID-19, the number of pathological grievers, naturally, went up, too. The uptick was not just caused by the numerical increase of pandemic-related deaths. Rather, it is how people die that determines whether the survivors will develop the disorder. ‘If you unexpectedly lose a close person, you are much more likely to develop prolonged grief,’ says the clinical psychiatrist Katherine Shear who heads the Center for Prolonged Grief at Columbia University in New York.

Factors Influencing Prolonged Grief

Sudden loss includes death by murder, suicide, accident or an unexpected illness, like COVID-19. A loss may become more traumatic when you don’t have a chance to say goodbye. What ensues is often a feeling of powerlessness. Personal factors, like female gender, low education and an existing mental illness, further increase the risk of developing prolonged grief later on, as the psychiatrist Andreas Maercker writes in his clinical handbook Trauma Sequelae (2022). Being part of a tight-knit family and curating a circle of close friends, on the other hand, can mitigate risk.

Treatment Approaches for Prolonged Grief

But even a tight-knit family couldn’t protect Amy Cuzzola-Kern when she got stuck in prolonged grief. On a December morning in 2016, this social worker from Erie in Pennsylvania received a call from her father. ‘Something is wrong with your brother Chris. I can’t wake him up,’ he said. ‘I think he might be dead.’ She jumped into the car and rushed to her parents’ house, but it was too late. Chris, a sporty man who had just turned 50 that same year

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 5: Gender Equality
• SDG 11: Sustainable Cities and Communities
• SDG 16: Peace, Justice, and Strong Institutions

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
• SDG 5.5: Ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic, and public life.
• SDG 11.7: By 2030, provide universal access to safe, inclusive, and accessible, green, and public spaces, in particular for women and children, older persons, and persons with disabilities.
• SDG 16.1: Significantly reduce all forms of violence and related death rates everywhere.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator for SDG 3.4: Number of deaths and illness caused by non-communicable diseases, including mental health disorders.
• Indicator for SDG 5.5: Proportion of seats held by women in national parliaments and local governments.
• Indicator for SDG 11.7: Proportion of the population with convenient access to public transport, parks, and other public spaces.
• Indicator for SDG 16.1: Number of victims of intentional homicide and other forms of violence.

SDGs, Targets, and Indicators Table

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Source: aeon.co

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