Defining Grief

Submitted by: Mike Spindell, Guest Blogger

 The bible of psychiatric/psychological diagnosis is the “Diagnostic and Statistical Manual of Mental Disorders (DSM)” published by the American Psychiatric Association. What it does is provide a standardization of diagnostic criteria, which allows Mental Health professionals to communicate with one another in a clearly defined set of common understandings.

 “It is used in the United States of America and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers. The DSM is a legitimating document and provides legal, medical, and ethical justification for physicians to diagnose and treat, judges to incarcerate and excuse, insurance companies to pay.”

First published in 1952 the DSM has undergone five revisions since then. The latest revision will be the DSM V, scheduled for a May 2013 publication. The last major revision in 1994 was called naturally the DSM IV. There are many problems with the DSM.  Since this Manual is so important to the treatment for those suffering and recompense for those who profit from psychiatric/psychological needs, this is an issue that needs greater public awareness. I think is most pertinent to look at the underlying issues entailed in the DSM’s new iteration and how it affects us, or those we know. To do so, however, we must look at the problems with the DSM, from a psychological, systemic and economic perspective.

The first critical issue is that no health insurance company, Medicare and/or Medicaid will pay for psychological and/or psychiatric treatment and medication, without a professionally certified diagnostician categorizing the patient with a valid DSM diagnostic code. Thus the DSM’s definitions have critical importance to practitioners, provider agencies, drug companies and health insurance providers. I retired from the Mental Health profession seven years ago and other things have held my interest. However, l I caught a NY Times article, posted at the MSNBC website last week and it brought to mind issues that had bothered me during my career, specifically with the DSM.

The NY Times article titled: “Grief Could Join List of Disorders” was by Benedict Carey. Its title refers to an ongoing controversy about adding grief (in the case of the death of a loved one for instance) as a category of Depressive Disorder. The word has gotten around the psychological community about this change and the result has been a back and forth of angry claims by professionals on both sides of the issue.

On one hand:

“In a bitter skirmish over the definition of depression, a new report contends that a proposed change to the diagnosis would characterize grieving as a disorder and greatly increase the number of people treated for it. The new report, by psychiatric researchers from Columbia and New York Universities, argues that the current definition of depression — which excludes bereavement, the usual grieving after the loss of a loved one — is far more accurate. If the “bereavement exclusion” is eliminated, they say, “there is the potential for considerable false-positive diagnosis and unnecessary treatment of grief-stricken persons.” Drugs for depression can have side effects, including low sex drive and sleeping problems.”

That represents the side of this issue that believes the definitions of clinical depression should remain the same and feels adding grief to it will have far more negative than positive effects. There is the other side of course which thus far seems to be prevailing and:

“… experts who support the new definition say sometimes grieving people need help. “Depression can and does occur in the wake of bereavement, it can be severe and debilitating, and calling it by any other name is doing a disservice to people who may require more careful attention,” said Dr. Sidney Zisook, a psychiatrist at the University of California, San Diego.”

With a little research into Dr. Zisook I found this piece of information in a article called “Bupropion Sustained Release for Bereavement: Results of an Open Trial” by Dr. Zisook:

“Financial disclosure: Dr. Zisook is a consultant for Glaxo Wellcome, SmithKline Beecham Pharmaceuticals, Pfizer Inc, and Novartis Pharmaceuticals Corporation; has received grant/research support from Bristol-Myers Squibb Company; has received honoraria from Wyeth-Ayerst Laboratories, Eli Lilly and Company, and Forest Pharmaceuticals, Inc.; and is on the speakers bureau for Glaxo Wellcome and SmithKline Beecham Pharmaceuticals.” 

With my own full disclosure let me state that I know nothing of Dr. Zisook’s work other then what I am quoting above. He may well be a wonderful clinician admired by all and other than these quotes; I have no knowledge of his behavior. However, when I see any researcher, whose research is sponsored by drug companies and is on their speaker’s bureau, I must admit that my suspicions are aroused. The final six years of my career were spent creating and running programs for people with severe mental disorders, who were co-diagnosed as drug addicts. I saw the unnecessary use of psychiatric drugs as much as I saw their benefits. Too often the drugs were palliatives that avoided treatment and hamstrung the patients with noxious side effects from ever changing experimental cocktails. I have also seen wondrous breakthroughs in patients via use of medication, but not enough to convince me that they were completely the salvation of my profession.

To put it bluntly, I am appalled at the attempt to turn grief into a psychiatric disorder, even as I am aware from my own personal experience how devastating grief can be. In my own life I was engaged in a prolonged grieving for my parents, who died when I was on the cusp of manhood. To me, to be human is to have to come to terms with grief in one’s life. We are mortal beings. Illness, disease, violence and accidents strike us all with many dying far before their time. Our organisms have evolved internal mechanisms to deal with grief, simply because it is unavoidable. Turning a normal human experience into a Mental Disorder seems to me to be the work of people who have seen much, but yet understood little. It also can be the development of a new cohort of consumers of psychiatric pharmacology, a profit center if you will. Is it cynical of me to wonder if the estimable Dr. Zisook is perhaps unconsciously motivated by his own self-interest? I don’t doubt that he sincerely believes in the medications he peddles, but I wonder if that belief is unconsciously informed by the need to remain in the good graces of his benefactors. The NY Times article shows that I am not a lone voice howling to the wind, but actually a latecomer to this debate, a minor player only by dint of this blog:

“Many doctors and therapists approve of efforts to eliminate vague, catch-all diagnostic labels like “eating disorder-not otherwise specified” and “pervasive development disorder-not otherwise specified,” which is related to autism. But a swarm of critics, including two psychiatrists who oversaw revisions of earlier editions, has descended on many other proposals.

“What I worry about most is that the revisions will medicalize normality and that millions of people will get psychiatric labels unnecessarily,” said Dr. Allen Frances, who was chairman of the task force that revised the last edition.

Dr. Frances, now an emeritus professor at Duke University, has been criticizing the current process relentlessly in blog posts and e-mails. Dr. Robert L. Spitzer, who oversaw revision of the third manual in 1980, has also voiced concerns, as have the American Counseling Association, the British Psychological Society and a division of the American Psychological Association. Some of the concerns have to do with important technical matters, like the statistical reliability of diagnostic questionnaires. Others are focused on proposed changes to the most familiar diagnoses.”

There are those who will say, at times with merit, that pharmaceutical companies act only to provide substantive relief to humans in distress. This is no doubt true in some instances, but then there are drugs like Paxil (Paroxetine) which has been found to increase suicidal tendencies in teens, addiction in the form of dangerous withdrawal symptoms and other problems. Yet at the time I retired it was widely used by my patients, via Psychiatrist’s prescription and I knew of a few instances of very negative consequences. This Wikipedia article may give you a fair idea as to why this widely prescribed medication is highly controversial.  Paxil, nevertheless is a highly profitable drug and so its producers are quite hesitant to shut down the “cash cow” even if the results are dubious. It must be understood of course that Paxil cannot be prescribed without a DSM diagnosis code and so its producers have a financial interest in this esteemed manual.

“Paroxetine [Paxil] is used to treat major depression, obsessive-compulsive disorder, panic disorder, social anxiety, Posttraumatic stress disorder and generalized anxiety disorder[1] in adult outpatients. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline.”

Please note above that Dr. Zisook is a consultant for the Drug Companies that introduced Paxil. Also note that it is no longer used for teens and younger children due to the increased effect it has on suicidal ideation. However, if this new revision of the DSM is issued, with the inclusion of grief folded into depression, perhaps the teen market will be replaced by another market. Also note about Paxil”

“In the United States, the Food and Drug Administration requires this drug to carry a black box warning, its “most serious type of warning in prescription drug labeling,”[28] due to increased risk of suicidal ideation and behavior.”

Now just supposing we have someone grieving for a loved one, finding it hard to cope. The person goes to a Psychotherapist seeking relief from this burden. In order for the Psychotherapist to get paid they need a DSM Diagnostic Code for the patient and with the revised DSM V the psychologist categorizes this person as being in a depressed state. Most Psychotherapists today have a Psychiatrist they work with. The depressed patient is sent to the Psychiatrist for an evaluation  and in order to get paid the Psychiatrist will generally use the diagosis already agreed upon. Seeing the patient in distress and that distress is defined as Depression, the Psychiatrist prescribes Paxil. This patient just happens to be, and there is no way to wean this out, one of those people in which Paxil produces suicidal ideation and in a disastrous confluence the patient kills themself. Since the Jonathan Turley Blog is primarily a legal blog you can follow this link for information about Paxil side effects lawsuits, which seem to have had some litigation success and perhaps ponder the Tort liability issues entailed.

My experience in Mental Health though, has made me rather cynical about the accuracy of many mental health diagnoses. Certain diagnoses, depending on the era, become popular among Mental Health professionals and thus they are given to a higher number of patients. Put another way, many mental health professionals project onto their patient’s symptoms, disorders that are au currant. Many of the diagnostic fads are pushed by Mental Health professionals who have staked a claim on a particular diagnosis. Perhaps they have written a book, or a paper, showing their success with a particular treatment regimen. In many cases their treatments and studies have been underwritten by Drug Companies.  I believe that the pressure that Corporations face to ever increase profits, lest their share price goes down, produces a response to push more and more drugs onto people by finding new problems to treat and/or expanding the amount of patients who have a diagnosis treatable with the drugs they produce. This is true of the huge industry that is Mental Health and the monetary stakes are such that in this case “better living through chemistry” doesn’t apply to plastics.

My experiences with the various iterations of DSM’s are that they are not precise diagnostic tools, but only work as a kind of descriptive shorthand between MH professionals. A common thought among those trained to use these manuals is that when you first start to read them, you will think you have every psychiatric condition in the book. This is based firmly in truth. These are imprecise definitions, agreed upon through a quasi-political process, often not grounded in persuasive data, which are influenced by economic and political considerations. Again from the NY Times article:

“Under the current criteria, a depression diagnosis requires that a person have five of nine symptoms — which include sleeping problems, a feeling of worthlessness and a loss of concentration — for two weeks or more. The criteria make an explicit exception for normal grieving, which can look like depression. “

When I talk of imprecise definitions think about the ones iterated in the quote above, which are three of the five needed for a diagnosis of Depression. Having been there, I know that the loss of loved ones would cause someone at least two weeks of sleeping problems, one might well feel worthless because they couldn’t save their loved one and certainly their concentration would be shaky. My training as a Psychotherapist and per the DSM, taught me the period of recovery from grief should normally take about six months in an average human. A normal person never ceases to feel the pain of their loss, but usually after six months they have come to terms with the fact that their loved one will never return, which will nevertheless pain them for the rest of their lives. Redefine grief and then send those with a loss to a Psychiatrist after two weeks and I’m positive that medications will be prescribed in nine out of ten times. To me this redefinition is reeking of increased profits for the Drug Companies and also an increased patient load for the Mental Health Community, increasing their profits as well.

To my mind and in my personal experience, almost every human feeling grief would have at least five of the nine symptoms. The question is does grief need to be treated by a Mental Health professional, or is it a part of life that we all must face? I believe most of us have, or can develop the capabilities within to cope with our loss and move on in our lives. I understand that for some it might be unbearable to the extent that help is needed and I believe when that occurs they should get that help. I contend, however, that by incorporating grief into the diagnostic structure of depression, many people would be pushed into treatment and medication for a problem they can deal with via support of loved ones and their own internal strengths. It is perhaps my cynical nature that thinks the impetus behind this redefinition of grief, is patients and profits. This seems logically true because if you look again at the nine diagnostic criteria for Major Depression, any clinician if necessary, can now use current diagnostic code for Major Depressive Disorder to insure their payment and any medication’s drug coverage. If this is the case, why change it?

The Mental Health System in our country and indeed the world is truly much less scientific than laymen believe. There is excellent knowledge that has already been developed in the study of the human mind and its processes, but like other fields of endeavor our knowledge is incomplete and flawed by the self interest of some in the field. In the area of the human condition we call grief; I can guarantee that every human being will be touched by the chill of its emptiness. As mortal beings this horrible feeling is inescapable and yet for most of us we learn to go on and perhaps grow in some way from the experience. To my mind a battle is being fought over grief, out of sight of the public, to take an intrinsic aspect of the human condition and find a way to profit from it. So what else is new?

Submitted by: Mike Spindell, guest blogger

68 thoughts on “Defining Grief”

  1. idealist707,

    “I interpret them as kindly meant” … they were, but could also be too intrusive as I am a stranger to you and Kerstin.

    I wrote the words quickly but then let them sit for awhile before posting as I feared the intrusiveness of the request.

    Yes, I’m a risk taker. 🙂

    1. I’m so glad for your interest.

      But most glad for you gave me an opportunity to experience a very mild version of the obtrusiveness I have exposed innocent people to by my own actions over the many years. If no own sought me, as they did Mike S., then I chased them instead, snapping at their heels. No wonder they fled.

      As for risks, I continued to take very big ones without any forethought at all over the years. After some years with Kerstin she said she could not get my life history to coincide with the person she saw,. My ability to approach strangers checked out, but the rest…

      Thanks again for the invitation. I will take advantage of it. Ruminating for own consumption is not the same as for other’s. Later!!!

  2. One last and I’ll stop:

    For those wondering where I am some person today:
    I decided some weeks ago to end my roleplaying von oben as the omniscient professor, prepared to lecture at the drop of a word; and/or the all-wise advisor on life’s travail.

    But defrocked and standing naked, who and what am I? With no familiar role to play, what role do I assume instead, or do I need one???
    It has been a cautiion search for the latter position, the roleless one; one totally unknown to me.

    I decided to simply to be myself. and would have to DISCOVER myself.

    Assuming, in view of the real evidence over the years and now: that I was an ordinary person, NOT especally smart, literate, talented, or in any way remarkable, then the question was: how does an ordinary person act and speak.
    It was a shaking experience. My own idea, not my therapist’s. And deprived of my roles, I retired into what at times is a position of peace, awaiting the upwellings of “real” feeling from my inner part. No longer driven by the need to impress, it has been a more peaceful life. A life more considerate of others need for space, time, attention……Which has resulted in tentative relations being established for the first time.

    So know-it-all me is banned, although he attempts to regain the stage, often…
    Such is evidenced even now by my curlicued writings here, a way to shield off my feelings, which are still hard to reveal to myself and others. But I try.

    I know……we are expected as adults to be controlled, and not bother others with splashy emotions. But you do pass signals to each other. BUT I did and do not know how to do that, but am trying to learn.

    And for those who feel I’ve exploited you as a theapy group, well let me hope that ignorance and desire for contact would be an acceptable explanation/defense.

    I shall now cease and desist. The bandwidth can’t given over to my tales.

  3. I wrote Torah, when of course, it should have stood Talmud. Yes???
    LIke our ignorant politicians, who couldn’t keep straight which was Iraq and which was Iran, once upon a time. The Talmud, crudely put, is a commentary on the Torah. Please correct if needed.
    My only comparative religion studies have been my own.

  4. “Describing” the Torah’s development, a document which in different versions encompasses yards of shelves, in the scope of an hour’s TV is not hubris, as it is patently impossible. But it was enlightening and empathy creating. I have seen it in reprise to equal enjoyment.

  5. commoner,

    Thanks. I had to learn Greek back in the day when working towards a degree in theology. My professors encouraged me to tackle Hebrew but I simply didn’t have the time so I appreciate the translation.

    I see from your answer that you are going to make me do my own work … I was hoping to skate a bit … 😉

  6. That’s a very interesting question Blouise. If you would like a revealing and inspirational read on Orthodox judaism’s take on the ten Commandments, I can recommend “Aseres Hadibros” (ten commandments in Hebrew) from Amazon by Artscroll publications. It is Hebrew with English translations Perhaps your Sunday teacher meant that as Jesus was a Jewish scholar among many other things, and he most probably talked Aramaic, the language the Talmud is written in, (in “The Passion” he talks in Aramaic. I am able to discern many of the words spoken in “The Passion”) it may be beneficial to study the Ten Commandments from a Jewish perspective. I myself respect the teaching of Jesus and his disciples, just as I respect the teaching of Buddha and Confucius.

  7. commoner,

    I appeal to your understanding of Judaism in asking this question that won’t be in a question form.

    It was always my understanding that the 10 Commandments were given as guidelines, ie “optimal way to live life on Earth”. If one wants to live a good life, experiencing all the beauty and knowing how to deal with the ugliness then God suggests one follows these next 10 suggestions.

    I was raised in a Christian culture but it was the very free-thinking, Congregational way and that is how the 10 Commandments were taught. I remember my eighth grade Sunday School teacher, who had a PH. D. in Biblical history, explaining to us that we must look at the 10 Commandments as the Jews viewed them for that was the best way to understand the teachings of Jesus and the culture in which he lived and taught.

    Was she right to present them as such?

  8. idealist707,

    Kerstin was one remarkable lady and I would be very interested in knowing, in terms you are comfortable with, how you met and married. For instance, did she see through all those well constructed layers to the core of you and persist in breaking them down or was there a look in her eye that caused all those layers to drop away when you were with her?

    It is rather amazing what love can do especially for one whose childhood was as you described. People like Kerstin are a real gift.

    1. Blouise,
      Thank you for your questions, I interpret them as kindly meant, and will return when my mullings (not the first time on that subject) give me something comprehensible but concise.

  9. “The basic concept was that illness was a punishment for sins.”

    Sin and redemption, are as far as I understand it Christian, not Jewish concepts. Christianity is mainly concerned with the “afterlife”, whereas Judaism is not an “afterlife” centered religion. I my experience as a Jew I’ve never heard anyone who said that illness was retribution for sin and that whole concept is quite alien to me. A Jew leads a way of life adhering to the 613 commandments because it is believed that is the optimal way to live life on Earth, not with the feeling that they will be punished after she/he dies.

    I agree and disagree with you on this Michael. That is, you are entirely right that Conservative and Reform Judaism is not afterlife centered, but Orthodox judaism sure as hell is. (pardon my pun). However Idealist errs perhaps in saying that Judaism in any form regards sickness as a judgement for sin. On the contrary, there are special prayers for the sick on Saturday in public where the Hebrew names are publicly read and Psalms (of David) are traditionally said as a merit for the sick. My Rabbi contracted a vicious form of cancer and the entire community prayed for him. He survived but unfortunately remains a very sick man.

    Idealist, Michael, Blouise, I sincerely feel for your losses. Blouise is my second case, a normal person for whom loss required psychiatric intervention, not something to be ashamed of at all, by the way. Also Michael, as you are a person who lost both parents at a young age, you have a special religious status of an “orphan” of which it is said that God himself pays extra close attention to their plight and needs. It is also said that it is a very serious thing to insult an orphan. I therefor publicly and humbly request forgiveness from you Michael if anything I have written has insulted you. I have a lot of respect for you and your opinion really matters to me.

    1. Commoner,
      You owe me no apologies because you’ve never insulted. me. Disagreeing with me is not an insult but an opportunity for both parties to learn, if their minds are open. I never had the impression that the Orthodox were that into an afterlife, but I know you have greater knowledge of them than I do. As far as orphans being blessed by God, I don’t know if I agree with that, yet my life has had a great many blessings.

    2. Excuse me, Commoner, I don’t intend to distract from the main thrust of your letter vav your relations with others here.
      However I wish again to clarify my knowledge or lack thereof. As in so many things, I am a magpie, who in his wandering, picks up shiny objects and takes them home to cherish. So, it is with my “understanding” of judaism, i.e., picked up at random pieces. I, in referring to sickness as punishment for breaking the rules, was speaking of the allegedly common attitudes at the time of Jesus, NOT in reference to today to current attitudes or “dogma” (if you have dogma). Jesus, it stands, purged the swine of demons; and did so in some interpretations also to the waves in the stormy sea, both of their demons who were responsible for their behavior.

      Another bright bit was a film, on public service TV (no commercials) here.
      which during an hour described the development of the Torah, starting with the split between those forced to Babylon and those who remained in Judea.
      And on through the intervening years and places of the diaspora.

      Hope that clears up my degree of ignorance on the subject.

  10. Good job id…

    Just remember that there are many wise people on this blog…then again…there are some that think they are wise…and then there are some that are just wise…You have a smorgasbord here….it is what makes this blog different than the rest….

  11. I am overwhelmed with the sharing of your personal stories and experiences here and so sorry for all the losses that you many of you have gone through. Thank you for your wise words,wisdom, and generosity..

  12. Mike S.

    I’m six hours ahead of you all, but years behind.
    Thanks for the one missing element in my life, acknowledgement.

    I must begin at birth because it began then; born in a depression stricken family formerly in Hupmobile status; a jobless engineer became a religious convert who refused to work on Saturdays, and a mother, having failed to arouse his instincts by birthing his only child, divorced him to support me and my half-brother whose father had died suddenly.
    My mother working, my 10 year older brother had strict instructions not to near the colicy baby. The only memory of closeness was sitting in the lap of my mother’s cavalier, his tweed vest scratching my cheek, and his smelly cigar. No other expression were ever experienced, nor even seen.
    No claps, no hugs, nothing. (She gave presents to her grandchildren instead of love.)
    Always feeling outside (afraid of others I presume), I never acquired either friends or acquaintances. By the second grade, I stood in front of the principals desk for a reprimand; and my mother was called for consultation.
    The problem continued, year after year.. Often standing in the dunce corner, or in the corridor to be laughed at by other students.
    At age eleven I was sent to Duke University for EEG (petit mal?) but without pathological result. I was counseled by a psychologist in the same period of a few weeks through the Red Feather charity.
    I was constantly seeking attention. And had adopted the strategy of showing that I was smartest in what for me was the easiest way: my use of language. Lacking social contact, I never learned to talk normal.
    (In my new country, it was primarily books from which I learned to speak—not social contact, and not through my girlfriend with whom I lived.)

    By the eighth grade my reputation well established I spent the last 6 weeks in the principals outer office then, and similarly in all schoolyears, again subject to idle scrutiny.
    My mental talents were adequate (130), and our surprise english quiz, meant to instill a sense of humility in us before a new course, showed that myself and Caroline graded 100 percent on a spelling, definition and useage test.

    Every year included at least 6 weeks suspension.
    But worst of all was the social isolation. I had in grammar school adopted a strategy of attacking before being attacked, a perfect way to keep people away from you. Odd that I could pick out their weaknesses to ridicule verballly but could not understand cues or social skills.

    Let me summarize the rest, by saying I got a BSEE from NCSU, served as a signal officer in *60-62; had an interesting job in aerospace, and after visiting Paris, etc longed to get back to Europe. This was accomplished by working designing Amerian airbases in Thailand, living in Bangkok for a year.

    My life has been pockmarked by many explosions and total ostracism in terms of collegues and friends. My career has been spectacularly successful for periods, pioneering and establishing a reputation which gave cred which balanced my lack of social/cooperative skills.
    I sought support before being bypass and valve operated. ( I did not want to die without knowing why I had had such a miserable life) Unusually for myself I have not read up on Perl, although my psychologist the last 8 years has been an authorized gestalt therapist.

    Challenging my teachers was a trait that continued to make my life difficult. Even in working environments

    I was unintentionally first of twenty-five engineers in my Signal officer basic course. I challenged most forms of education later on, as I found they were poorer than they had to be. The most elementary pedagogic elements were lacking.
    I would get irritated by others stupidity and point out the obvious defects in front of an auditorium full of co-employees.. etc. etc.

    How to transform oneself from a Martian to a human?(Yes, I felt so essentiallly different. Humans were mysteries I did not understand)
    Therapy has helped with much, but the greatest personality change was that produced by Citalopram, now 40 mg/d. That changed me from the eternal pessimist to a cautious and then jubilant optimist. That was thanks to the psychosocial staff at the cancer clinic.

    Since then it has entailed a lot of work on my part and good coaching from my gestalt psychologist. Simple matters to you: How does one approach a group in a pause discussion in a Cosmology course. Not for me. Took several attempts but progress was noted. Even in one on one relationships, which is also a deep dark mystery.

    Am I cured? No. Am I making progress and feel more comfortable, and quite simply am at ease with others now, ie casual contacts. Yes.
    Want go into more detail but want to respond more to Mike S.

    My connecting sin/violation of rules would result in divine retribution in form of sickness. I think Jesus as a jew, was expressing a common idea that it was devils who had entered and plagued the ill person.
    Sin and redemption are indeed a christian couple. Jews as I understand at least before did not believe in heaven or hell, only that all would go the a dismal existence after death.

    Any diagnosis with a name is essentially, I think, a disservice to the person being helped. I have used them, having been officially classified, but my gestalt therapist asked me why. Why, it helps explain why I’m different, I reply. Now I feel that it is a crutch which one will lean on instead of working on discovering “causes” and how they effect you, your comfort, your personality, your ease, your ability to sense others, your developing of patience, your finding out who the real you is, under all that armor which has protected you not only from others, but from your own pain which has been hidden there all these years.

    As for saying Kaddish, it wasn’t the religious significance that occurred to me, rather the routine of facing the fact every week and, as you say, the routine which might have helped him. I assume folks are non-religious it they don’t say otherwise, a comfortable assumption in my childhood and my current residence. Our high school Homecoming queen was jewish. I never heard it mentioned. I knew it as I had been their paperboy at 12 years old and collected the subscription fee. They were just people to me.
    ( I said to one customer when collecting: “If this is an inopportune moment, I can come back later”. It just came out that way, spontaneously. He gave me a peculiar look in return. I wonder why?).

    As for charlatanry, and profit driven industry expansion. I am aware of both. Through my girlfriend’s former sex buddy I got accepted by the most reknown psychiatrist here. The buddy was a scion of a side-branch of a billionaire family. My complaint was gastric stress and high tension.
    When I mentioned him to the cancer psychiatrist and a curator, they were extremely interested: “How was he.” I told them that after he first made sexual advances to my girlfriend (she thought that it was cool), but when he did the same to me, I quit. Maybe he wanted to test my sexual orientation, who knows. I could and woúld have discussed that willingly, but not in that fashion.

    Now my gestalt therapist, not included professionwise here as a subsidized medical activity, although usual psychologists are So I pay myself.
    I have so many traits to un-learn. There’s usuallly one a week which bites me and shows me the error of my ways.

    Thanks to all others.
    Especially Blouise. My wife Kerstin (Sherstin), was a proud but deformed psychicly Lion from the beginning. The oldest of two daughters, she unfortunaltely bowed to her parents’ wishes but moved away and made her own life, interspersed with service to her parents a day’s journey away. Her father was a farmer, built it all with two hands, and was a chess genius, routinely doing exhibitions playing simultaneous chess with 25 opponents and many district championships. Kerstin was outstanding in her way, and ended her last ten years as a director of operations etc in the largest pension insurance company here.
    Your other advice is much appreciated.
    Thank you all again.

    I shan’t take so much space here again. But perhaps Mike’s example inspired more than me to open up We seem to be friends here. I mean like family you’re born with, friends you choose—-at least I still hope to do so.

    1. Idealist707,

      Thank you. I think we are existential brothers, our stories are different, yet very much the same.

  13. “We already have a diagnostic category for “Adjustment Disorder,” and IMHO that is exactly what problems with grief are.” (OS)

    “Adjustment Disorder” will do nicely … Lord, one learns a great deal on this blog.

  14. Mike, I fail to see the need for therapy until and unless the grieving person turns it into something else. We already have a diagnostic category for “Adjustment Disorder,” and IMHO that is exactly what problems with grief are. There is absolutely no need for the addition of another diagnosis in the DSM-V.

  15. “If I knew your wife’s name, I would use it here thus giving you and her the respect of acknowledgement and recognition of a loving existence. I learned to refer to my brother and father with their names when talking about them.”


    That whole comment was filled with excellent advice.


    Forgive me for not referring to your wife’s passing in my answer. It was an
    un-empathetic oversight on my part. The loss of ones soul-mate must be devastating and the emptiness close to unbearable.

    1. When we are caught up in our thing, social things don’t come up.
      In my case, total lack as described elsewhere.

      Hope I haven’t blocked the site by the long time it took to write my comment. Yee gods, if so. Will write somewhere else and copy/paste next time.

      Blouise had excellent advice. I’ve already started.

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