If a pill could end your grief, would you take it?

Grief is a natural process that brings suffering.  So it has always been, when we lose someone or something with great personal meaning in our lives.  Mental health professionals have twisted themselves in a pretzel trying to figure out what their proper role is, if any, in addressing  this suffering.  Recently, National Public Radio aired an interesting discussion of the issue on Morning Edition for 2 August 2010, called “Is emotional pain necessary?”.

Two opposing viewpoints each claim the role of protector of the human psyche.  The therapists who oppose medicating grief, think that doing so needlessly pathologizes the experience  by labeling it as a “mental disorder,” in need of medical intervention.  They wonder whether numbing grief with medication might in fact do emotional harm, by reducing a personal crisis to a symptom.  The therapists who are in favor of medicating grief, think that it is a form of depression, and ask why anyone should suffer needlessly when medication is available.  In its severest form, depression can lead to suicide, and the risk of not intervening is too great.

Here is where the power of the profession of psychiatry comes in.  The standard reference for all mental health diagnosis and therapy in the US, the Diagnostic and Statistical Manual of Mental Disorders , is produced by the American Psychiatric Association.  The fifth edition is now in preparation, and the debate about grief is a small part of their editorial process.  What they are debating is whether the intense sadness and emptiness that immediately follows a loss, should be included  in the description of clinical depression, or excluded, as it is now.   Psychiatrists are medical doctors, and for them, a healing response tends to involve a prescription.

The desire to avoid suffering is universal.   The meaning of suffering in our lives is ambiguous.  A life without pain is hard to imagine, and welcome or not, it teaches us and transforms us.  If we soften the pain of loss, by numbing ourselves with medication, do we miss something?   Suffering is necessary in order to grieve, but it can be treated compassionately.   The experience of incomprehensible loss is part of our struggle to make peace with mortality, the fragility of our life on earth.  The spiritual component of grief is a journey of inner transformation, as we come to recognize that which endures of our loved one or our changed life despite our loss, and to get in touch with the experience of gratitude.  It would be a shame to sleep through that opportunity.

The most difficult part of this conversation is not whether to provide care for people who grieve.   Of course.  But the balance of suffering and growth is delicate, and it is not obvious who has the expertise to decide when to shut it down.  Psychiatry is willing to make that call for us, in case our grief is too much to bear.  With this benevolence comes a caution, though:  what  is at issue is how we, as a society, decide what is normal.