The war on grief

by Robert D. Stolorow

The DSM5, the most recent version of psychiatry’s diagnostic bible, makes it possible to classify grieving that endures beyond a rather brief span of time as a mental illness.

This pathologizing of grief has ancient roots extending back at least as far as the Stoics, whose stern ascetic morality preached a perfect indifference that eschewed all passionate attachments. The ideal of selfless asceticism was carried forth in early Christianity, showing up dramatically, for example, in the Confessions of the prominent 12th century monk, Saint Bernard, who was wracked with guilt over his grief for his beloved dead brother. His brother, after all, was enjoying eternal happiness in heaven, so Bernard could only feel his grieving his loss as a manifestation of a wicked selfishness on his own part.

The pathologizing of grief was continued by the philosopher Rene Descartes, usually considered to be the initiator of the Enlightenment and Modernity. In letters to Princess Elizabeth of Bohemia and Constantijn Huygens, he warned that sadness and grief could cause serious physical illnesses, and he recommended a form of mental discipline—reminiscent of both the Stoics and contemporary cognitive-behavior therapies—in which the imagination was to be directed away from the sources of emotional pain and toward objects that could furnish contentment and joy. In the current psychiatric and medical climate pathologizing grief, psychiatrists (and even general practitioners!) are conflating painful feelings with clinical syndromes and prescribing anti-depressant medication for naturally occurring intense or prolonged sadness and grief.

“Pain is not pathology,” I wrote in my book, Trauma and Human Existence. The traumatizing impact of human finitude, as disclosed in the loss of a loved one, is not an illness from which one can or should recover. The enormity and everlastingness of the grief following such a loss are not manifestations of psychopathology; they are a measure of the depth of love for the lost beloved. Traumatic states of sadness and grief can devolve into clinical depression when they fail to find a context of emotional understanding—what I call a relational home—in which they can be held, borne, and integrated. In a psychiatric climate that pathologizes grief and that advocates treatments aiming at emotional riddance, such a relational home for emotional pain is becoming ever more difficult to find. Such a circumstance is actually likely to increase the incidence of clinical depression.

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Copyright Robert Stolorow

Robert D. Stolorow, Ph.D.. is a Founding Faculty Member at the Institute of Contemporary Psychoanalysis, Los Angeles, and at the Institute for the Psychoanalytic Study of Subjectivity, New York City. He is the author of World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (Routledge, 2011) and Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (Routledge, 2007) and coauthor of eight other books. He received the Distinguished Scientific Award from the Division of Psychoanalysis of the American Psychological Association in 1995, the Haskell Norman Prize for Excellence in Psychoanalysis from the San Francisco Center for Psychoanalysis in 2011, and the Hans W. Loewald Memorial Award from the International Forum for Psychoanalytic Education in 2012.