She noticed something strange: In many cases, patients responded well to antidepressant medication, but their grief, measured by a standard set of questions, was unaffected and remained stubbornly high. When she pointed this out to psychiatrists on the team, they showed little interest.
“Grief is normal,” she remembers being told. “We are psychiatrists and we do not worry about grief. We worry about depression and anxiety. “Her response was,” Well, how do you know it’s not a problem? “
Dr. Prigerson set about collecting data. Many symptoms of intense grief, such as “longing and craving and craving,” were different from depression, she concluded, predicting poor outcomes such as high blood pressure and suicidal thoughts.
Her research showed that for most people, the symptoms of grief peaked in the six months after death. A group of outliers – she estimates it at 4 percent of those left behind – remained “firm and miserable,” she said, and would continue to struggle with mood, function and long-term sleep.
“You don’t get another soulmate and you are somehow out of your days,” she said.
In 2010, when the American Psychiatric Association proposed to extend the definition of depression to include grieving people, it provoked a backlash, prompting broader criticism that psychiatric professionals overdiagnosed and overmedicated patients.
“You have to understand that clinicians want diagnoses so they can categorize people who come through the door and get reimbursement,” said Jerome C. Wakefield, a professor of social work at New York University. “There is a lot of pressure on DSM”
Nevertheless, researchers continued to work with grief and increasingly viewed it as separate from depression and more closely associated with stress disorders, such as post-traumatic stress disorder. Among them was Dr. M. Katherine Shear, a professor of psychiatry at Columbia University, who developed a 16-week program of psychotherapy that draws heavily on exposure techniques used for trauma victims.