As a mental health worker and as a bereavement consultant, I have struggled to clearly understand if a griever is experiencing complicated grief—recognized by the medical community as a psychiatric condition1—or not. Is it complicated grief with already-present mental health and/or addiction issues? Or is it the natural expression of grief exaggerated by these issues?

When does complicated grif occur?

I believe that complicated grief occurs when the death has added emotional trauma. According to Dr. Therese Rando,2 probably the leader on complicated grief, three situations can complicate grief when someone close dies:
  • the death threatened their own survival
  • the death is sudden and shocking, with mutilation of people other than a loved one
  • the death is the traumatic and/or mutilating death of a loved one

What is the medical view of “complicated grief”?

The medical community views complicated grief as a major depressive episode.1 The bereaved person may think the sadness is ‘normal,’ but seeks professional help for relief of associated symptoms such as insomnia. A diagnosis of major depressive disorder is generally not given unless symptoms are still present after two months.1 The duration and expression of ‘normal’ bereavement varies considerably among individuals and/or cultural groups. However, the presence of certain symptoms, not characteristic of a natural response, may point to a major depressive episode. These symptoms include:1
  • guilt about things other than actions taken or not taken at the time of the death
  • thoughts of death other than feeling that he or she would be better off dead or should have died with the deceased
  • feeling that everything bad happened because the survivor deserves it
  • much slower thinking and physical abilities
  • unable to do the usual tasks of daily living or job requirements
  • hallucinatory experiences other than transiently hearing the voice of, or seeing the image of, the deceased person
Symptoms of avoidance, numbing, increased arousal, depressed mood, somatic or sexual dysfunction, guilt or obsession, addiction or other related symptoms may also be present.

Is it? Yes or no?

I’ve seen all of these behaviours in people who didn’t have a mental illness before the death and who didn’t experience a complicated grief situation. Corporate presidents and school-age children find themselves unable to remember how to use the telephone. Those usually meticulous about their appearance wear dirty, wrinkled clothes. Some may say this is a major depressive disorder if it lasts longer than two months, as noted above. However, I know that sometimes it takes months for a griever to feel like they can get going with life again. People with mental health or addiction issues have usually had many losses including secondary losses related to their illness: (e.g., loss of income, relationships, employment, status, self-esteem and/or control, and losses due to discrimination and/or victimization). Often, in this population, I have seen unsupported, unresolved loss through death early in life. Not dealing with this early grief is frequently the main reason there is a mental health condition and/or increased use/misuse of alcohol and other drugs.