How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer.

She noticed something odd: In many cases, patients were responding well to antidepressant medications, but their grief, as measured by a standard inventory of questions, was unaffected, remaining stubbornly high. When she pointed this out to psychiatrists on the team, they showed little interest.

“Grief is normal,” she recalls being told. “We’re psychiatrists, we don’t worry about grief. We worry about depression anxiety.” Her response was, “Well, how do you know that’s not a problem?”

Dr. Prigerson set about gathering data. Many symptoms of intense grief, like “yearning pining craving,” were distinct from depression, she concluded, predicted bad outcomes like high blood pressure suicidal ideation.

Her research showed that for most people, symptoms of grief peaked in the six months after the death. A group of outliers — she estimates it at 4 percent of bereaved individuals — remained “stuck miserable,” she said, would continue to struggle with mood, functioning sleep over the long term.

“You’re not getting another soul mate you’re kind of eking out your days,” she said.

In 2010, when the American Psychiatric Association proposed expanding the definition of depression to include grieving people, it provoked a backlash, feeding into a broader critique that mental health professionals were overdiagnosing overmedicating patients.

“You’ve got to understthat clinicians want diagnoses so they can categorize people coming through the door get reimbursement,” said Jerome C. Wakefield, a professor of social work at New York University. “That is a huge pressure on the D.S.M.”

Still, researchers kept working on grief, increasingly viewing it as distinct from depression more closely related to stress disorders, like post-traumatic stress disorder. Among them was Dr. M. Katherine Shear, a psychiatry professor at Columbia University, who developed a 16-week program of psychotherapy that draws heavily on exposure techniques used for victims of trauma.

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