She sits quietly at the table with her head bowed just enough so that the shadow of her hair crosses her face, blocking a clear view of her melancholy affect. Her fork dances among the food on her plate, moving food from one spot to another but never lifting food to her mouth. Her eyes are hollow and empty, looking but not seeing. Her face and shoulders sag like those of a cartoon hound dog. One arm rests on the dinner table, sometimes serving as a prop for her heavy head.
It is Thanksgiving, and she sits at the family table surrounded by parents, grandparents, aunts, uncles, and cousins. The laughter causes her muscles to ache, and the banter brings sharp pains to every joint in her body. She wishes she were invisible, but politely responds when a question is directed at her. The effort drains her energy. Silently, she counts the minutes until she can return to the cave of her apartment, cut off from the world. This is not where she had planned to spend the holiday.
Four months ago, her plans for Thanksgiving included her husband and two children visiting his family in another state. It would be their first Thanksgiving as a family in four years. Then, three and a half months ago, she was notified her husband would not be coming home, he had been killed on the outskirts of Kabul by an IED—two months before he was to come home from his last tour in Afghanistan. Now, she is a widow with a nine-year-old son and a five-year-old daughter. Now, each night she holds her daughter as she cries for her daddy. Now, her son sleeps with the combat helmet his dad gave him before leaving for this last assignment.
The days are long, but the nights even longer. She has difficulty falling asleep, and when she does she is often awakened by bad dreams or nightmares. Her employer had generously given her eight weeks off from work after the funeral, but since going back to work, she has had difficulty generating the energy to both work and care for her home and children. Her grief is not just for the loss of her husband, lover, best friend, and father of her children. Her grief is also for the uncelebrated holidays, birthdays, and anniversaries. Her grief is the loss of plans, dreams, and hopes. Her grief is over the loss of life as she has known it, as well as over the effort required to build and construct her new life.
As anyone who has experienced the loss of a loved one can attest, this is grief and bereavement. The process of grief is different for everyone. Some are able to work through their grief in weeks or months, while others may wrestle with their grief for years. For some, grief is a process of recalling memories and experiences, for others grief is a process of eliminating reminders and markers of the loved one gone. Grief is cyclical, the various phases or stages of the process often have to be experienced through several cycles before the pain begins to diminish.
In existential psychology, we accept that grieving is a normal and natural process in life. We recognize that bereavement is a necessary and needed aspect of living. We believe that the grief process involves time, emotional support, and adaptation to new ways of existing. However, under the new guidelines in the DSM-5, this women’s grief will be diagnosed as a major depressive episode or disorder, treatable with medication. A normal aspect of life is now trivialized as a diagnosable disorder, and a necessary life process is marginalized as one more problem resolved with pharmaceuticals.
With the publication of the DSM-5, psychology takes another giant leap in aligning itself with the medical model. Under the DSM-5 guidelines, this 35-year-old woman moves from being an individual struggling with a normal human experience to a diagnosis and a problem solved. Instead of walking along beside this young lady in her experience of loss and grief, she is now an object to be managed and a question to be answered. Her pain is declared as abnormal, and her bereavement unacceptable.
This is not the type of psychological care I signed up for when I entered my doctoral program almost nine years ago. I am not willing to treat a human being as an engine needing repair or a computer requiring programming. I am for an approach that honors the person and his or her encounters with living. I am for valuing the feelings and emotions the individual is experiencing. I am for the patient, gracious process of walking with a person as they cry, laugh, scream, reflect, hope, despair, or rejoice over what he or she is going through at this moment in his or her life.
This young woman’s journey through grief is about living, it is not about her being an illness.
— Steve Fehl