By Theodore Dalrymple
As Tennyson pointed out, it is better to have loved and lost than never to have loved at all.
Unfortunately, grief after loss is a near-universal human experience. Only the most psychopathic of psychopaths escape it altogether.
Grief, like any emotion, can turn morbid. Whatever is morbid is soon hypostasised these days to a disease, and every disease calls forth its acronym.
‘Prolonged Grief Disorder’, recently added to the ever-expanding stable of mental disorders, is now known, among doctors and other assorted shepherds of the human race, as PGD.
According to the Diagnostic and Statistical Manual of the American Psychiatric Association, that would-be Linnean classification of human madness and foible, PGD, consists of a period longer than 12 months after the loss of someone close of great yearning for that person.
It’s combined with a preoccupation of thoughts and memories of him or her that are intrusive every day.
Into the bargain, it includes at least three of the following: the feeling that part of one has died; a sense of disbelief at the death; avoidance of reminders of that death; emotions such as pain or bitterness; difficulty in resuming normal life; a feeling of mental numbness; a feeling (not present before the death) of the meaninglessness of life; and intense loneliness as a result of the death.
Of course, the cut-off point of 12 months is to an extent arbitrary. What is normal on day 365 cannot be abnormal on day 366.
But to object to categorisation because phenomena exist on continua rather than in categories is to reject categorisation altogether. No one ever denied the existence of anaemia just because the level of haemoglobin in the blood is on a continuum.
The archetype of the sufferer of PGD is Miss Havisham, in Great Expectations. Her loss was not caused by death, but by being jilted (and swindled). Afterwards, she stopped the clocks at the exact time she received the letter from Compeyson, the fiancé who betrayed her, announcing his betrayal as the moment ‘I and the world parted.’
Would anything have helped Miss Havisham to recover her joie de vivre? A paper recently examined all the controlled trials of various methods to assuage those at risk of developing PGD (spouses, parents and those whose losses are from sudden, unexpected or violent deaths), or those who had already developed it.
The authors found 169 such trials, and the conclusions were stark. There was little evidence that anything did much good, apart from some modest benefit of psychotherapy – a term that covers a multitude of techniques, including cognitive behavioural therapy.
I confess that I had good fun in my mind imagining a therapist trying to conduct CBT with – or is it on? – Miss Havisham.
There was something rather curious about the paper. The controlled trials the authors found were conducted on different groups of grievers: children, for example, grieving for parents, or parents grieving for children. The curious thing was that only four of the 169 trials were specifically aimed at older – a current euphemism for old – patients.
This is odd because, if my experience of life is anything to go by, loss grows more frequent with age. Perhaps this was not always so: later loss is a manifestation of the great increase in longevity we have experienced in the last two centuries.
But the old are now more aware of the proximate likelihood of death. Unlike the increased fear of crime that, for years, criminologists condescendingly dismissed as unjustified, this awareness is eminently reasonable.
To the grief of loss is added the griever’s knowledge that his own life is foreshortened. I can’t help thinking of Gerard Manley Hopkins’s Spring and Fall that begins:
‘Margaret, are you grieving Over Goldengrove unleaving?’ The last lines are: ‘It is the blight man was born for, It is Margaret you mourn for.’
First published in The Oldie at Press Reader
