When the Grieving Process Gets Stalled

‘Complicated grief’

Joanne Weingarten, senior clinical coordinator of adult programs at Our House Grief Support Center in Los Angeles, says the newly added prolonged grief disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) allows insurance to cover treatment costs. But she says some have concerns about “diagnosing something that is a natural response to a situation and the potential for pharmaceutical companies to try and medicate grief.”

However, psychiatrist Paul Appelbaum, M.D., a professor at Columbia University in Manhattan who chaired the committee overseeing the DSM revisions, says grief is not depression and doesn’t respond to meds. For the tiny percentage of the bereaved — perhaps as small as 4 percent — who exhibit symptoms of what’s been described as complicated grief or profound grief, he says, “this is not a disorder for which any medications are available.”

The official recognition as a mental health condition by the American Psychiatric Association (APA) specifies that the grief can persist for more than a year and continues to disrupt a person’s emotional and physical health.

“We all miss the person you lost, but if you’re so consumed by grief that you’re unable to get back to life and school and social relationships, it’s time to seek assistance from a mental health professional to diagnose whether you’re experiencing prolonged grief disorder,” Appelbaum says.

Specific forms psychotherapy designed to target prolonged grief do work, says Katherine Shear, M.D., an internist and psychiatrist who began studying grief in 1995. She was among the experts on the APA’s review team. As founding director of the Center for Prolonged Grief at Columbia, she developed treatment that she says, “can turn around a person’s life in a four-month period.”

“Their grief process gets stalled,” Shear says. The reasons can include preexisting mood or anxiety disorders or struggles with mental health, many life losses in a small period, sudden or unexpected death — as well as who died, how they died and how old they were at death.

“COVID is a big one,” she says.

Loss of end-of-life rituals

The overarching social isolation of the pandemic, combined with stressors such as being prevented from physically being at their loved one’s bedside at death or not being able to attend a funeral due to coronavirus restrictions can cause longer term ill effects, experts say.

“Having your grief witnessed is one of things that facilitates your healing. We need rituals that bookend a life and many people were robbed of those rituals,” Kessler says.

Juan Lopez and his mother Juanita Zavaleta

Courtesy Juan Lopez

The unknowns of the coronavirus in April 2020 prevented Juan Lopez, from traveling across the country to the Boston suburb of Beverly to see his mother, Juanita Zavaleta, when she ran a fever and died of COVID-19 at age 79.

“I was not physically there and didn’t get to say goodbye to her in person,” he says. “At the time, there were no vaccines. I didn’t know what to do and I felt helpless. I felt like she was taken from me.”

Lopez, 47, of Los Angeles, says he’s “still dealing with it.”

“It’s been very difficult,” he says. “It created a huge shock wave in my family and situations with my siblings, who are all dealing with it in different ways, including some not speaking to others. I don’t have that support.”

New data released in May by the World Health Organization illustrates the extent of worldwide pandemic-related death or death due to inability to be treated because of the pandemic: Nearly 15 million more people died than would have been expected during normal times. Additionally, Imperial College London’s global calculation of orphanhood and caregiver deaths shows that an estimated 7.9 million children lost one or both parents, and as many as 10.4 million children lost a primary or secondary caregiver. The new data on children is an update to research published in April and in October 2021 by Susan Hillis, formerly of the Centers for Disease Control and Prevention.

“The principal sources of support for the child are less physically or practically available and less present than in the pre-pandemic period,” which Hillis says, “dramatically increases prolonged grief.”

Kimberly Junda, of Clifton, New Jersey, sought online grief support when her father, Gregory Junda, 70, died in 2020 of COVID. Despite an initially positive prognosis, he was gone within a month.

“We weren’t allowed to visit in the hospital,” she says. “We could communicate with him via video chat. In that sense, COVID played a major role affecting our grief and being able to support the person and go visit.”

Junda, an only child, recalls that she and her mother were allowed to see her father as a farewell when death was imminent.

Unlike Junda, Josie Rodriquez spent seven years caring for her father, who had dementia. She and her seven siblings lost their mother as kids. So, when her father, Julio Pastrano Rodriquez, was diagnosed with dementia in 2013, she retired early from her job as a sixth-grade language arts teacher to care for him.

Rodriquez, 63, was his primary caregiver until his death in 2020.

“I got to know him in a way I couldn’t do with my mother,” says Rodriquez, who divides her time between Santa Fe, New Mexico, and Austin, Texas. “There was still a tremendous sense of loss.”

“Grief does not have a time limit,” Shear says.