Tuesday, August 2, 2011

Bereavement neurosis

Good on the DSM-5. This book to be published in 2013 has defined a type of grief that is a mental disorder or perhaps could be called neurotic.

They have put a time limit on normal grief. Somewhat of a courageous thing to do and one that I have been advocating for some time. People who are grieving excessively after a year are considered to be neurotic or have a mental disorder as they say.

This could bring some criticism as it is not a politically correct thing to do. Bereavement counsellors tell us that people grieve in their own time and way. I agree with this to some extent but it is also a view promoted by grief counsellors that in my view has lead to massive over servicing of such clients in a billion dollar a year industry.

clowns carry coffin

Some will see it as being too harsh on the bereaved. They will say to tell someone that their grieving should be somewhat complete after a year is a mean thing to do and not kind to a person who has suffered a great loss.

In my view, and this is supported by psychological research, after a year a significant amount of the grief should have passed. With a close loved one, one would expect there to be some more grief after that time but it will tend to be intermittent and not usually of a intense nature. It probably takes about 4 years for a person to fully psychologically readjust after the loss of a very close loved one. But the actual grief and crying should mostly be gone after 12 month period if the grief is allowed to proceed normally.

Some will argue that such a statement in the DSM-5 does not take into account cultural differences. I have also discussed this before. There are many wide and varied cultural differences in funerals and grief rituals. However underneath the rituals the same psychological processes apply no matter what culture one is from. The process cited in the paragraph above applies if you live in Australia, Egypt, Siberia, China or where ever. That same basic psychological process applies to all humans whilst the burial rituals do vary considerably between cultures. The actual burial or formal ceremony for the dead is only one very small part of any psychological grief response for the loved ones who remain.


The problem with bereavement is that it is so prone to secondary gains. A secondary gain is when a psychological problem starts to be used to the advantage of the sufferer. A woman who starts to be agoraphobic learns over time that this allows her to control her husband more. She cannot leave the house so she can ring him at any time to do tasks for her. A mother who develops depression may learn over time that her children start to feel sorry for her and visit more. These are what are known as secondary gains.

When you suffer the loss of a closed loved one what happens. People all of a sudden become kind and nurturing to you. They cook you casseroles, drop in to see how you are going and mow the front lawn for you. When you start to get over the grief that all stops and things go back to how they were before. For socially isolated and emotionally deprived people this can be very attractive and they will be reluctant to end the grief.

rose reds

Finally it should be noted that the development of a secondary gain is an unconscious process developed by an individual who is struggling with life. If it is a conscious thought out plan it stops being a secondary gain and becomes manipulation.

Good on the DSM-5 for doing this and it may come in for some criticism when the book is published.



  1. Lots of shoulds Tony.

    Imagine people liking to be nurtured. What a terrible thing - they should just get on with their lives without nurture in them I guess. I don't see the secondary 'gains' as a problem - my view is that people having their needs met (even the need for nurture) is a very good thing.

    Do you really think my mother should be 'over' her still-born child after more than 50 years? I don't.

    If DSM5 was advocating for healthy support for people I might have more sympathy. But they just perpetuate the nonsensical privatised notion of the individual that causes these kinds of neuroses.

    Am I saying that the DSM5 and such perpetuates neurosis? You bet I am!

  2. It seems we disagree on these points Evan,

    I don’t see many should's more statements about what some people can do. There is nothing wrong with people getting nurturing. If they feel that have to first experience the misery of grief to get the nurturing then I would hope that they can be at least aware of others ways to get nurturing where they do not have to suffer first. Secondary gains always cost the price of the pain and angst of some kind of emotional suffering first.

    If people want to grieve for many years as far a I am concerned that is up to them. I feel it is incumbent on the counsellor or theory to at least inform the clients that some counsellors are of the view that grief can be a finite process. To loose a close loved one is not a twenty year sentence of pain and misery. People can go through the process in about 12 months. Once they have been afforded access to such information what they do with it is up to them.


  3. One should is a time limit to define what is neurotic.

    And then there's intensity - people grieving 'excessively'.

    So the shoulds are about duration and intensity. They cover a lot of ground I think.

    You say you agree to some extent. How much? 56%?

  4. I dont agree with the DSM. Berne referred to it “The Standardized List Of Putdowns.” I agree with Berne.

    Grief is very personal. It is an adjustment process to a brutal jarring of personal circumstance. To try and measure the recovery process, I think, is near impossible. how long is a piece of string.

    I think the quality of the persons environment after the event is very important. Unfortunately the hussle and bussle of modern life and lack of intimacy between people demands that we get over it asap.

    When a tragic event happens, its as if the world needs to stop for the person, or rather they need to find a beautiful quiet place to find comfort and space to adjust. The chances for most people to do this is next to none. We know that full adjustment to grief can take up to 4 years, I think my mother is still grieving after 50. I see lack of any support and a toxic home environment in the essential first 1-2 years to blame for her grief to become complicated and life long.

    So if a person is considered neurotic after 12 months, does the other multi billion industry in this world step in to "help" with medication?

  5. Hello Evan & dwaterh,

    The point I was wanting to make is that some, including me believe there is a grieing process that is normal for humans and that it is a finite process lasting about a year. If it is taking longer than a year then the natural process is breaking down for some reason. One can call this neurotic or whatever they want, but it is not really all that important what title it is given.

    So that is the question

    Is saying 12 months for grief is a Parent ego state should or an Adult ego state fact? Obviously I believe it is an Adult ego state fact.

    I also think it is important for therapists to be candid with their clients. When they ask questions like how long will this grieving take (which they often do) one must tell them the facts ot at least different views that are held on that matter.


  6. Hi Tony,

    My problem is how the estimates are arrived at. What the shrink/counsellor has found to be usual? I'm not convinced the usual is healthy. What is the basis for the counsellor/shrink's judgement?

    Like you I think therapists should be candid with their clients. Therapists copping out and not voicing their knowledge or judgement to their clients is undesirable I think.

  7. Some time ago I wrote an article on bereavement Evan, and in that I quoted some research.

    Bartrop, Australian Psychologist, 1992
    Barbato & Irwin, Australian Psychologist, 1992

    Their research found the following
    After 6 months 75% of bereaved people showed a significant drop in the depressive symptoms one commonly finds in grief.

    After 6 months 70% of people showed a significant drop in their scores on
    Anxiety scales
    Depression scales
    Grief symptom checklists.

    The psychological function of greif I have discussed in



  8. If you mean that these are useful guidelines I agree. If you mean that people should use these to judge how well they are processing their particular grief I disagree.