When You Just Can’t Get Over It: Prolonged Grief

A new diagnostic tool for better mental health.

Outward symbols of mourning vary across cultures and religions—whether tradition dictates wearing black or white clothes, throwing a parade, or hanging flags at half-mast, we learn our particular traditions early on. Some of them, anyway. When my father died at the height of Covid’s Omicron wave, I knew he wanted to be buried beside my mother, but I wasn’t sure we’d be able to bury his cremated body in the Catholic cemetery (we could). The biggest surprise, however, was how widely mourning periods differed across various communities.

For Jews, official mourning lasts thirty days, whereas for Buddhists this period may go on for 100 days; for Muslims it’s 40 days; and for Hindus, it’s two weeks. Two weeks? None of these stretches even began to cover my experience with grief. And so I felt extremely fortunate that my friend, the author Eric Weiner, had recently recommended a title from Florence Williams, Heartbreak.

Knowing little else, I got a copy of the book and began reading.

Williams’ book turned out to be a reported memoir, in which the author delves into the latest medical research on the topic of grief from the context of her experience getting a divorce. Without knowing my efforts might be prescribed, I’d tried the same experiments, from solo trips in nature to meditation to cognitive behavioral therapy. What was this thing she was calling prolonged grief disorder or complicated grief, and why hadn’t I heard of it before?

Added to the DSM-5 in March 2022, the condition is ascribed to people who continue to grieve beyond six to twelve months following the loss of a loved one. Symptoms of prolonged grief disorder include:

• Feeling as if part of you has died or is missing.
• Disbelief about the loss.
• Intense emotional pain related to the loss.
• Difficulty moving on, an inability to plan for the future or connect with friends.
• Melancholy.
• Believing that life has lost its meaning.
• Loneliness.

The definition shocked me. Less than six to twelve months is what’s normal? Between the two heart-shattering episodes I’ve endured, I’d known those symptoms for years at a stretch.

Like Williams, I found masterful spiritual teachers, fantastic lovers, and great therapy (EMDR especially) to eventually break free from the grip of prolonged grief. It just took me a lot longer.

I trust it’s not a spoiler to reveal that, down to a cellular level, heartbreak isn’t good for a person. One example Williams writes about is Takotsubo cardiomyopathy, also known as “broken-heart syndrome.” The event presents like a regular heart attack — chest pain, fluid in the lungs, shortness of breath, and compromised heart function — but with Takotsubo there is no cardiac blockage. Broken-heart syndrome is but one of many ways that grief can devastate the body. Grief can suppress immunity, elevate inflammation, and induce pain in the body.

Like all un-sexy research topics, prolonged grief disorder isn’t widely studied. One thing we do know is that people with substance abuse disorder are more likely to experience this syndrome. And in my research group of one, I’ve found that to be true whether I’m sober or not.

That said, it’s heartening to see this diagnosis arriving as we collectively emerge from the pandemic. I’ve lost many loved ones in the past couple of years, but not gone into the same kind of downward spiral as before. I take great comfort in knowing such a diagnosis exists so that, should the symptoms rear again, it doesn’t mean I’m flawed but that there is treatment available. In my case, I would go straight to EMDR treatment.

Someone I loved once

gave me a box full of darkness.

It took me years to understand that

this, too, was a gift.

— Mary Oliver

Grief can’t be avoided, nor should we try to bypass it. We learn and grow from life’s challenges. But rare is the person who truly suffers in silence. It’s in everyone’s best interest to be aware how unhealthy prolonged grief is, and the steps that can be taken. The only nobility in suffering is the alchemy that results after the fact.

More immediate help is available. If you or someone you love is struggling with this disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800–662–4357 to find support and treatment near you.

If you’re experiencing suicidal thoughts, call 800–273–8255 to connect with a trained counselor. In case of immediate danger, dial 911.

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