It’s a disorder that is troubling mental health professionals. Published last March, the updated version of DSM-5, Diagnostic and Statistical Manual of Mental Disorders – a reference document on the “psy” planet, carried by the American Psychiatric Association – includes a new pathology: prolonged grief disorder (PDD).
What are we talking about ? Persistent malaise for more than a year after the death of a loved one for an adult, and persistent for more than six months if the bereaved person is a child. Symptoms : “intense pain”, “the refusal to believe in the death of his loved one”, “great loneliness”, “difficulties in pursuing one’s life, in making plans”, lists the famous manual, the contents of which have been disputed for years.
A medicalization of grief
If this new nomenclature is particularly controversial, it is because it “wants to medicalize grief and all the normal psychic reactions that arise after bereavement”according to Professor Maurice Corcos, head of the department of adolescent and young adult psychiatry at the Institut mutualiste Montsouris, in Paris. “Mourning, therefore, would henceforth be an illness? », wonders after him Lucille Rolland-Piègue, clinical psychologist in a palliative care team. «No, it’s a feeling does she reframe. Grief, fatigue, isolation are classic and legitimate reactions. » Better, “defense mechanisms who unfold to accept the reality of loss and the upheaval it entails in the lives of those left behind”describes Professor Corcos.
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By pushing the mourning on the side of the psychiatric illness, “we contribute to thinning the border between the normal and the pathological and to extending the hold of biology on what is ultimately an unavoidable hazard of the human condition” regrets the philosopher Damien Le Guay, author of the book The dead of our life (1) and Chairman of the National Funeral Ethics Committee.
Mourning, a source of distress and disability
In the eyes of Professor Viviane Kovess-Masféty, psychiatrist and epidemiologist, the controversy is a bit “unfair” and the debate more complicated. «No one will tell you that grief, in itself and in general, is a psychiatric disorder. Any medical professional knows that there is something called “the grieving process” which has different stages, from shock to acceptance. The mental disorder in question, in the DSMis prolonged mourning, complicated mourning, the one that shifts to the pathological side», she explains.
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For most of the bereaved, the reactions of anger, ruminations, nostalgia, feeling of lack, indeed fade in the months following the death. But for some (a little less than 10%), these reactions will become a source of distress and handicap. “You find yourself frozen, you can no longer function”, summarizes the researcher. He does not exist ” a “ good way to mourn, but if, at some point, “the suffering does not decrease and is accompanied by dark thoughts, insomnia, delirium, this is where psychiatric support (therefore often medication) can be recommended”she says.
A duration specific to each
That is. “But what is destabilizing is this desire to want at all costs to set a standard that would establish the ideal duration of a good mourning, namely one year, pointe Lucille Rolland-Piègue. Admittedly, the first anniversary of a death is a symbolic milestone, but mourning can be prolonged without falling into pathology.A fixed temporality denies the subjective reality of mourning, which is variable according to each person. » Especially, she adds, since the process is not “not linear. It is made up of days when you feel better and others when things are not going so well. »
According to a study conducted by the Crédoc (Research Center for the Study and Observation of Living Conditions) in 2016, a third of those questioned still felt in mourning, five years after the death of a loved one. “Wanting to shorten this time is responding to the injunction to turn the page, to get better, to move forward”, underlines the philosopher Damien Le Guay. Maurice Corcos, too, sees it as a sign of our times: “Even pain must become a manageable, channelable, controllable object”he berates.
“Characterizing this complicated and prolonged mourning can help”
Here again, Viviane Kovess-Masféty nuance. “Being a psychiatrist is not about ticking boxes in a textbook, counting the number of symptoms a patient has. A psychiatrist, before establishing a diagnosis of prolonged bereavement disorder, will take into account the social, family, cultural context of the patient, his or her history. Of course, not all lasting grief is psychiatric. Of course it’s not abnormal to be sad. But in the face of mourning, not everyone starts on the same starting line, nor crosses the same hurdles at the same time. Characterizing a complicated and prolonged mourning can then help people who have this psychological fragility there. » Naming for better care, in short. Moreover, raises Viviane Kovess-Masféty, “Yes the DSM created this prolonged grief disorder, it is also to allow American patients to be reimbursed by the health system, by having a precisely referenced diagnosis. It is less necessary in France. »
“But the psychiatrists did not wait for the DSM to identify complicated bereavements, which remain extremely rare,” retorts Maurice Corcos, for whom the answer is not systematically found in drugs. This should not prevent people in pain from seeking support, whether it involves talking or behavioral therapy. “Grief is a crisis that can be overcome. But you have to allow yourself some time. »
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For further
To read :
* Mourning and melancholy, by Sigmund Freud (Ed. Payot et Rivages, 96 pages, €5.10). A founding text on the impact of mourning on the psyche.
* Mourning, by Michel Hanus and Marie-Frédérique Bacqué (Éd. Que sais-je? 128 p., €9). Shedding light on the grieving process and its possible complications.
To listen :
“What is Prolonged Grieving Disorder? “. An interview with psychiatrist Patrick Landman, to be found on franceculture.fr