Prolonged grief becomes a psychiatric illness from 2022

Within a year, agronomist Ricardo Guze, 44, lost his father, father-in-law and an aunt to Covid-19 complications. The brother and an uncle also died of other illnesses. Dealing with so many deaths and caring for his widowed mother, weakened by the aftereffects of the coronavirus infection, made him succumb.

“It felt like a machete coming and taking everyone away. At first, I held back the whole reprimand, but my life turned upside down. I got really bad, a panic syndrome, a racing heart and a very strong depression. I didn’t want to get out of it. home, see no one,” says Guze, who takes antidepressants and started physical activity on medical advice.

Accountant Michelle Bressiani, 36, lost her father and mother to Covid in a 15-day period, and is also trying to rebuild her life with the help of medicine, quantum therapy and spiritism. She moved from the apartment where she lived with her parents because she couldn’t bear their physical absence.

“The hardest thing for me is to accept the abrupt way in which they left. I’m trying my best to calm my heart a little, not cry so much. If I didn’t believe in spiritualism, I would have already done something crazy. But I believe they are. together with me, helping me to get well,” he says.

The deaths in the Covid-19 pandemic accelerated a recommendation that had been discussed for years by the mental health field: from next year onwards, prolonged grief will become a psychiatric disorder in new versions of the manual for the diagnosis of mental disorders ( DSM-5) of the American Psychiatric Association and ICD-11 (International Classification of Diseases).

Like Guze and Bressiani, most people face difficult times after the death of a loved one, but over time they accept the loss and find meaning in life. A portion of them, however, cannot resolve this grief.

“Some losses have a greater or more prolonged intensity than expected. These will now be recognized as a disease, something that is disrupting life. It is important to recognize this because it is only possible to treat what is within the ICD”, explains psychiatrist Tania Maria Alves, who coordinates the IPq (Institute of Psychiatry) grief clinic at Hospital das Clínicas in São Paulo.

According to her, depression is one of the symptoms of grief, but it is not the most common. The most frequent are cardiac problems, such as arrhythmias and hypertension, and the use of psychoactive substances. “Grieving can be complicated both by its intensity and by the time. It drags on, it doesn’t go away. At that moment, it is called prolonged. Until it is named, it will have the name of the person’s reaction, such as arrhythmia” she says .

And what defines prolonged grief? “A lot of suffering and lack of the person who died, having constant thoughts about him, a constant search for the other, a very great anguish when talking about him, social isolation. And the champions are somatic diseases”. says the psychiatrist.

In his opinion, when the elaboration of grief is not done, psychic pain turns into somatization. One example is broken heart syndrome, which causes heart attack-like symptoms, especially in the elderly. In younger adults, arrhythmias, hypertension, gastritis, skin changes are reported.

According to the ICD criteria, this set of sufferings needs to last at least six months to be considered prolonged grief. For DSM, the time is one year or more.

“One year is the time in which a person lives for the first time the great expressive dates that evoke the person’s absence”, explains psychologist Maria Helena Franco, professor at PUC-SP and author of the book “O Luto no Século 21” ( Summus Editorial), which deals with the different types of grief, resources for diagnosis and modes of therapeutic intervention.

According to her, the new definition seeks to differentiate grief from depression so that it is not treated in the same way, although some symptoms are similar. A debate that has been taking place in the middle is whether the new classification will exacerbate the medicalization of grief.

“The pathologization of grief already exists. There are people who have seen a person crying for a week and think they have to prescribe an antidepressant. It is important to monitor the process. Assess not only the risk factors, but also the protective factors, the network support,” says Franco.

According to Tânia Alves, this was one of the reasons for the delay in considering mourning a disease. “They said: ‘this is not a disease, everyone has it, everyone will have it at some point in their life’.

For her, the treatment will depend on the symptoms and how much they disrupt the person’s life. There is no single solution or one that is the same for everyone.

“If the complication is hypertension, won’t you treat it? If the complication is isolation, the person doesn’t want to have a relationship with anyone else, he enters the area of ​​psychotherapy. If the person starts to use a lot of substances or stops eating and if becomes anorectic, enters psychiatry.”

Antidepressants, according to the doctor, should only be used if the complication of grief is in fact depression. “Psychic pain is also treated with antidepressants, but with lower dosages.”

According to experts, during the pandemic, the risk of grief becoming more complicated and prolonged has been greater. Some studies show that in normal situations, mourners have a 4% to 10% chance of evolving into complicated grief. In a pandemic situation, this can reach 70%.

“If the loss was quick and unexpected, the brain doesn’t have time to elaborate. It’s a blow, a great stress, the person feels in shock. Today, in the ICD, this is called an acute stress reaction. If it went beyond six, it will now be called prolonged mourning”, explains Tânia Alves.

According to her, the fact that people didn’t have the space to elaborate the death for Covid is another complicating factor, as is the lack of support.

“The impossibility of ritualizing death due to distancing measures and the sudden and unexpected death of young, healthy and working-age people also tend to aggravate the evolution of mourning”, explains psychiatrist Rodrigo Martins Leite, also from IPq .

Guilt can also be another complicating factor. “If I took [o vírus] I went home and lost my mother, that grief will be difficult to resolve because the guilt is real”, says Tânia Alves.

“The bereaved during the pandemic should be evaluated to see if they are in mourning complicated immediately to be evaluated and followed. It is the model followed by countries that take mourning seriously.”

Psychiatrist Rodrigo Martins Leite reminds us that the phenomenon of grief cannot be dissociated from the context in which it occurs. “The pandemic has heightened social vulnerability. In this way, grief reactions can become persistent.”

In addition to the death itself, stress-generating factors such as unemployment, financial problems and insecurity tend to interfere in the resolution of grief. “The economic impact for families that have lost people who were working is an issue that should be placed high on the agenda of social assistance policies.”