I’ve just been re-reading Freud’s remarkable essay, Mourning and Melancholia, in which he presciently paves the way for current controversies on the differences and similarities between mourning and depression. These differences are an ongoing topic of robust debate in psychiatric and psychological circles: when does grief for the loss of a loved one become depressive illness requiring treatment; should mourning be immediately treated with anti depressants, what are the wider repercussions of diagnosing grief as a pathological state?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the American Psychiatric Association’s classification and diagnostic tool. In the United States and in Australia, the DSM serves as an authority for psychiatric diagnosis. According to this informative Q and A in the Huffington Post, in the DSM’s last edition the committee removed the “bereavement exclusion” from both depression and adjustment disorders. What this means in its simplest terms is that a person who is grieving a loss potentially may be diagnosed with depression or an adjustment disorder It is the removal of the bereavement exclusion from these diagnoses that has become highly controversial.
A major aspect of this controversy is that with the pathologising of grief and the introduction by the DSM-5 of a category of mental illness known as “complex” or “abnormal” grief, drug companies now have a wider market for anti depressants, and doctors could be encouraged to prescribe these drugs as soon as two weeks after the death of a loved one.
This pathologising leads to an economy of grief that Freud likely did not imagine, though one of his three core principles of the conceptual architecture of psychic organisation was his Economic Hypothesis. According to this hypothesis, psychic process can be evaluated in terms of gain and loss, for example, when a symptom mobilises a certain quantity of energy, other activities show signs of impoverishment. There is a circulation of value, a distribution of resources in the psychic household, or what he also referred to as the household of the soul.
In mourning, it’s not unusual for the mourner to withdraw her interest from the world, so demanding is her labour of grieving. In melancholia, a similar withdrawal might occur, with the distinct difference that in melancholia it is not necessary that there be an external loss: the depression can emanate from internal sources. In both cases, psychic resources are focused on loss, depriving other possible concerns of energetic engagement.
When grief is co-opted by capitalism it is commodified: by defining it as an illness, the opportunity arises for the marketing of a cure, or an amelioration of its symptoms. In a similar manner, the pathologising of post traumatic stress disorder in American war veterans has led to intense drug therapy, often causing uncontrollable and deadly side effects.
There is little abnormal in the intense reaction of an individual to traumatic circumstances of all kinds. The pathology lies not in the individual’s reaction to a situation, but in the situation itself. War is pathological. The sexual abuse of children is pathological behaviour on the part of the abuser. The distress and dis-integration of people subjected to pathological events is a normal human reaction to diseased circumstances.
Capitalism profits from pathological circumstances, and it’s in the interest of capitalism that such circumstances continue to exist. Those who suffer adversity as a consequence find their adversity pathologised, commodified and exploited, in the instance of grief and the war veteran’s post traumatic stress, by pharmaceutical companies.
There is a growing body of dissent on the usefulness of intense drug treatment of war veterans, and an increasing suspicion that the unholy alliance between drug companies and the US military is the driving force behind what many medical professionals regard as dangerous over-medication. Psychiatrist Dr Peter Breggin, author of “Medication Madness: The Role of Psychiatry Drugs in Cases of Violence, Suicide and Crime,” claims the increase in drug treatment of veterans: …cannot be accounted for by anything other than military decisions at the very top that were certainly influenced by the pharmaceutical industry, which markets from the top down, then the drugs flow to millions.
The economy of the household of the soul is obliterated by the capitalist economy of Big Pharma, and the labour of mourning, which is also a significant aspect of post traumatic stress, is named as mental illness requiring drug therapy.
This is not to say that drug therapy is always unnecessary or unhelpful. That would be a ridiculous position to take. Rather, as well as drug therapy we ought to be considering a causal inversion in which the circumstances are recognised as pathological, rather than the normal human reactions to traumatic situations that give rise to disturbing symptoms, disrupting the individual’s psychic economy.
Today, all mourning is in danger of being defined as melancholia in the interests of profit, and we are all impoverished as a result.
As readers of this blog and The Practice of Goodness will know, I’ve been struggling with the loss of my husband for some time now. My loss began not with his death, but when he suffered a massive stroke that left him paralysed, unable to speak, and subject to a degenerative process that was agonising to witness, and during which he became increasingly comatose and unable to recognise me. This went on for over two years, culminating in his death in June, 2014.
It has only been in the last few months that I’ve allowed myself to begin to grieve this awful period. Instead, I engaged in a variety of displacements, including embarking on an affair with a man who was also seriously ill, but well enough to ask for and respond to love, concern, and desire in ways in which my husband could not. For much of my life I had also sublimated a powerful wish (and its devastating regrets) to have been able to help and save my stepfather, who committed suicide when I was sixteen. I was in the zone, as I put it to myself, of desperately wanting to save men to whom I had a powerful attachment.
Were I to be Freudian about my affair I would name it as transference, the unconscious redirection of feelings from one person to another, frequently but not necessarily originating in childhood experience.
Grief makes you do weird stuff.
It was only when the affair came to a horrible end that I collapsed for several months into a state of profound grief during which I couldn’t write, or read, or engage with the world, and during which I had consistent and terrifying suicidal thoughts. I spent hours every day trying to work out a way in which I could end my life without anybody knowing I’d done it on purpose, because even in the midst of this collapse, I couldn’t bear to leave such a legacy for my loved ones to deal with. I imagined in great detail the methods I could avail myself of. I stockpiled drugs. I could simply disappear, I thought, and die in the forest, but then I realised the anguish my disappearance would cause, without even as much as the resolution of knowledge of my death.
The only circumstance that kept me in my life was my love for my three-year-old grandson, Archie, with whom I have an exceptional bond. There is much yet to pass between Archie and me, and I could not, even in my worst hours, deliberately leave before seeing that through. He will never know that he saved my life, and nor should he.
I sought no psychiatric or psychological help through this period. I mostly stayed in bed or lay on the couch, exhausted. I suspect that had I presented myself at the doctor’s in this state I would have been diagnosed as severely depressed, probably hospitalised, and encouraged to take anti depressants, and that would have been a responsible reaction on the doctor’s part. Although I had to visit the doctor for other reasons I never mentioned my state of mind, and my physical illness accounted for weight loss, lethargy and other symptoms.
In retrospect, I think I simply didn’t have the energy to find the words, let alone speak them. As Freud would have noted, the symptoms of my mourning drew heavily on my psychic resources, and left every other aspect dangerously impoverished.
Grief is always complicated. Nobody comes as an adult to the loss of a loved one without an accumulation of losses and griefs of varying degrees, many of which remain unresolved because we aren’t taught or encouraged to resolve them. The shock of loss, which is always as shock even if you have, like I did, two years to know it’s coming, ruptures the protective membranes that allow us to conduct productive daily life in an environment that is, although we might deny this, all too frequently hostile to our psychic and physical well-being.
One of the unforeseen side effects of the massive rupture caused by significant loss is that it allows other sorrows, other traumas, other losses that haven’t been dealt with to leak through, infusing and complicating the main event and causing overwhelming feelings that transport us to an altered state. Grief is an altered state. It is nothing like “ordinary” life. Once you’re in grief, anything can happen, although that might not always be evident to observers.
Increasingly, we are encouraged to medicate these altered states so they achieve a two-fold outcome for capitalism: we buy drugs to get us off the couch, back into the workforce and consuming again, but what does such an approach do to stabilise our psychic economy?
The greatest sacrifice we make to live in our current dominant culture is the sacrifice of self-knowledge and self-understanding. Who has time to unravel the psychic complexities that drive us? And yet, what could possibly be more important to us as individuals and as communal beings than understanding how and why we do what we do?
Instead, we have drugs whose sole purpose is to render us capable of functioning within this society, in the manner that supports its capitalist goals. The adverse effects major and minor of anti depressants, for example, were for me antithetical to a life fully experienced, fully lived. They dulled my senses and my mind, and didn’t suit my chemistry at all. There is little opportunity offered for the processes of the psyche, which can often seem slow and laborious, to unfold, and anything that takes one’s attention away from worldly considerations is regarded as a symptom of pathology.
I’m not done with my labour of mourning. I will be grateful for the rest of my life that this crisis occurred at a time when I was able to withdraw, and allow it to take its course. When eventually I got myself to a psychiatrist I chose an analyst, one who would not persuade me to medicate myself out of the psychic processes, but on the contrary, travel with me through them.
Freud was, of course, both formed and constrained by his times, as are we all to some degree. There is much to disagree with in his theories, especially for a woman like me, who found her first liberation in feminism. Yet to revisit his writings is to be astounded at his vision, and the poetic manner in which he expressed that vision. Just now, his essay on Mourning and Melancholia is a source of great comfort, like the right poem at a particular moment can ease the heart with the reassurance that others have felt these things, mad and isolated as they might seem to be.
Grief makes you do weird stuff. True fact.