What happens when people fail to recover from grief? Through a critical analysis of theory, policy, and practice, this book investigates how recovery is the prevailing discourse that measures and frames how people grieve, and how failures to recover are socially perceived and acted upon. Focusing on how people make sense of grief, how grief is managed, and the type of identities people come to inhabit following bereavement, this book draws on in-depth interviews with bereaved people and the professionals who help bereaved people to ‘recover’ from grief, to investigate how grief, commonly understood as a private issue, is increasingly framed as a public problem. The book begins by considering notions of normality and the changing constructions of what it means to successfully recover following bereavement. Mental health practice has a long history of defining and labelling normal and abnormal behaviours, and the influence of psychological theory on understandings of mental states once considered ‘normal’ reflects the general medicalization of everyday life. The defining and labelling of grief is a contested territory—a territory examined in this book—occupied by prominent claims that posit scientific explanations for grief while experiencing repeated resistance from theories that emphasise the natural, human and ‘normal’ nature of grief.
Recovering Normal
In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychological Association 2013) was published, provoking a flurry of controversy in the field of grief and bereavement research. The DSM-5 included key changes that proposed a significant change in the understanding and treatment of grief. Bereaved people, if showing depression symptoms as little as two weeks following bereavement could be diagnosed with a major depressive disorder without any special consideration for their grieving state, and the manual proposed a new diagnostic category describing a persistent, complicated form of grief. The substantial criticism that arose from these changes centred on an objection to what was seen to be an increased ‘medicalising’ of grief. The critique of medicalization, which has a long history within the social sciences and the anti-psychiatry movement of the 1960s, garnered wide support from the pages of The Lancet (2012) and the British Medical Journal (2013) to Psychology Today whose regular columnist, psychiatrist Allen Frances, was one of the DSM-5’s most ardent critics and who pleaded against what he argued was a medicalising of ‘normal’ grief (Frances 2012). The title of Frances’ column ‘Saving Normal’ and his accompanying book of the same name (Frances 2013) set the tone for numerous critiques of the DSM-5, described as ‘[t]he war on grief’ (Stolorow 2014). An editorial in The Lancet (2012) concluded: ‘[F]or those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy rather than pills’ (589).
Within the responses to the DSM-5, grief was positioned as something under threat and to be protected, and psychiatric intervention as the dehumanising force intruding into the most human of emotions. While the dispute over the changes in the DSM-5 and the perceived attempt to ‘medicalise’ grief was a call to protect ‘normal’ grief, it was agreed ‘abnormal’ grief was something that required intervention (Bryant 2012). Even among those who most fervently opposed the idea that grief could be diagnosed as indiscriminately as depression, the belief in complicated or pathological forms of grief was widely accepted (Wakefield 2013a, b; Wakefield and First 2012; Walter 2006). Indeed, despite ongoing debates over the best means to categorise complicated forms of grief (Reynolds et al. 2017; Prigerson and Maciejewski 2017; Maciejewski and Prigerson 2017; Boelen and Smid 2017), the diagnosis of ‘Prolonged Grief Disorder’ proposed by Prigerson and colleagues (Prigerson et al. 2009) has been included in the World Health Organisation (WHO) 11th Edition of the International Classification of Diseases (ICD-11).
The debates surrounding the publication of the DSM-5 surfaced longstanding tensions in a field that strives to develop scientific means of theorising and treating grief. Dominant theories of grief, drawing from psychological studies, have presented ‘normal’ grief as a linear, staged process with a defined endpoint: often described as recovery. This is embedded within the familiar stage model of grief that suggests bereaved people move through five stages: denial, bargaining, depression, anger and acceptance (Kübler-Ross 1970). In recent decades, bereavement researchers have sought to dispute the validity of the five stages suggesting they should be ‘relegated to the shelves of history’ (Stroebe et al. 2017). Yet the lived experience of bereavement is still heavily embedded in enduring cultural logics of staged and time-limited grief (Kenny et al. 2017). This is evident in how ‘complicated’ or ‘prolonged’ grief is categorised, defined as a form of grief that has been ‘derailed’ from its agreed natural course (Shear 2012).
Specifically, the development towards establishing psychiatric categories of grief posed new questions for the notion of ‘recovery’ from grief, implying that in some cases people ‘fail’ to progress through grief to recovery. However, ‘recovery’ remains a contested term in grief and bereavement research and practice (Balk 2004, 2007). Recovery is a term that has connotations with illness and implies a return to prior functioning. Researchers and practitioners favour other terms such as ‘resilience,’ ‘adapt,’ ‘deal with,’ or ‘adjust’ (Paletti 2008; Tedeschi and Calhoun 2008). Yet, beyond the bereavement literature, there is a growing interest in recovery within United Kingdom national health care services, particularly mental health, where service users and providers are embracing a ‘recovery model ’ of care (Department of Health 2001; Glyde 2014).
The role of government policy and psychiatric diagnostic categories are two of the types of social and political discourse analysed in this book, examining how different practices are popularised and how bereaved people are encouraged to make sense of and manage grief in certain ways. Yet theories of grief have tended to differentiate between ‘private’ and ‘public’ grief, demarcating an individual and natural course of grief and recovery as distinct from the cultural and political context. It is this distinction between public and private grief that I focus on next.
Public and Private Grief
Grief is commonly understood as a natural and inevitable part of human existence and yet academics, clinicians, psychologists, and psychiatrists have proposed numerous means of theorising, understanding, and treating grief. Grief has been described as a mode of detaching from the deceased person (Freud 1917), as a syndrome (Lindemann 1944), as a process (Parkes 1972), as containing a number of phases or stages (Kübler-Ross 1970), as well as a matter of reintegration, or reunion (Bowlby 1979; Klein 1940) and as an ongoing process of continuing bonds (Klass et al. 1996; Stroebe and Schut 2005). Grief is something of great territorial interest and has been viewed through various lenses: psychoanalytic, psychiatric, psychological, sociological, and increasingly as an object of neuroscientific study (O’Connor 2005).
Since the beginning of the twentieth century, the academic study of grief has grown, yet how bereaved people come to experience and express grief has been framed by the enduring belief in death as a ‘taboo’ in modern western societies; a thesis often attributed to the work of scholars such as Gorer (1965) and Ariès (1974) who claimed that western societies were ‘death denying.’ Robert and Tradii (2017; Tradii and Robert 2017) documented the origins and trajectory of this thesis highlighting how the belief in death as a societal taboo gained traction as a powerful ideology at the turn of modernity; a time where traditional rituals around death in westerns societies such as the UK were changing within the context of secularisation. The ‘death denial’ thesis served a purpose in stimulating the growth of organisations such as the Association for Death Education and Counselling (ADEC) in the United States and Cruse Bereavement Care in the UK, dedicated to promoting awareness of death and the support of bereaved people.
For sociologist Tony Walter this development of death awareness signalled a ‘revival’ of death that contested the notion of death and dying as a social ‘taboo’ (1994). This revival argued Walter, could be separated into the modern and postmodern period. Walter’s theory claimed that in a postmodern era where the individual and their sense of identity is paramount, death and bereavement posed a threat in the absence of ‘traditional’ rituals that previously served to manage the uncertainty of death. This conflicted with a modern rationalism that saw medicine exert further control over death and which, as a result, formed a divide between ‘public’ and ‘private’ realms of grief where the public, in the form of medicalisation, was encroaching on the private nature of grief.
This distinction between modern and traditional forms of mourning, as described by Walter, is still commonly found in texts on grief and bereavement, as well as popular media, perpetuating the idea t...
