OpenAxis had a conversation with Dr. Arvinder J. Singh, a psycho therapist and trainer, about the recent addition of prolonged grief in the DSM-5.
Hello, Dr. Arvinder! This conversation is pegged by the recent inclusion of prolonged grief in the Diagnostic and Statistical Manual. Grief is a part of normal human experience. It is inevitable. So, by including grief are we reducing the horizon of normal human behavior?
Dr. Arvinder J. Singh
Pathologizing is not always the way out. We need to ensure that a normal human emotion such as grief should not be stigmatized. I stay away from diagnosis because diagnosis has a way of stigmatizing and pathologizing. Moreover, anxiety and grief affect different people, differently, and conversation is the way out. Even at Ashoka we have the gatekeepers programme to ensure that situations of anxiety and grief are smoothly taken care of.
In your clinical experience, have you ever felt, need for such a diagnosis?
I stay away as far as possible and refrain from diagnosing and labeling. I think because what it does is it just limits the kinds of ways you look at it because any kind of mental health concern has many strands to it. So it’s not necessarily just this one diagnosis and you operate out of that one. Moreover, there are no medical or blood tests to pinpoint a cause.
I think what is important is for us to see emotions like grief or anxiety could impact different people differently and there’s no predicting. Even the duration after which grief is tagged prolonged is highly debated. Six months is politically incorrect whereas one year sounds better because it is the anniversary of everything. The conversations around such issues are very nuanced. It is not only about generational gaps but differences in personalities. Due to the pandemic we saw a loss in the grieving spaces, and a loss of contact and spaces..
Coming to DSM, how do we know if the grief is prolonged or delayed? How do we label it? And if you indeed label you need to understand the consequences of that label. If you club prolonged grief with depression, you end up stigmatizing the person. Grief might come up as an illness rather than a very normal human emotion.
Grief can be triggered by numerous different causes, and sometimes small triggers lead to a huge impact and vice-versa. So, how do we understand the complexities of grief?
So I think there are many factors involved. One is the preparedness. How prepared are you for the change? For instance, graduating from high school or losing a terminally ill relative leads to a less severe form of grief compared to unexpected losses.
Secondly, it depends on your coping mechanisms. How do you deal with your emotions? DO you talk or do you isolate? Thirdly, is it about how robust your support structure is? A stronger support structure helps in healthy grieving. Finally, it is about attachment. How attached were you to the person or item that you lost? While working in Gujarat, during the Bhuj Earthquake, a girl was grieving for her dog while her mother was grieving for her father. The two cannot be compared because both are grieving according to their attachments. Acknowledgment of pain is also really important. Denial might suppress the emotions for some time, but they will come back again and again. Final step is to seek support from people you can while following well-being practices.
When talking about well-being and accessing providers of well-being services, there is always an aspect of elitism. Seeking mental well-being services is perceived as elitist. So how do we bridge that gap? How do we make well being services more accessible?
That is an excellent question, because the gap between the number of professionals available and number of professionals required is humongous. Now, to bridge this gap, there are two ways. One is that it need not completely depend on professionals. So what we do is to bring the issue of a model, where we do capacity building from within the community, and we encourage open conversations around mental health and wellbeing.
Secondly, to not see well being as a time waster but rather as investment. Even at Ashoka our current model in place follows these principles of emotional robustness at the heart of education. That is why we promote conversations around problems people are facing, it is okay to talk about them and we need this kind of model in our community as well.
Before, joint families were the norm and it provided a safety network. Now the family system has disintegrated, and we ended up with two working parents and a single child, leading to isolation. With the advent of the digital medium people have lost real connections that end up with people living in their silos. But if we have these connections and spaces we must go and talk. I always encourage students to go and check on each other. In the worst case scenarios they might end up not talking. Or they might find a company, and will be grateful that you checked on them. The notion, however, is very individualized.
Finally there is awareness. People have very little awareness about terms and well-being. They throw words like ‘OCD’ and ‘depression’ like that, but we don’t wish that on anyone, because it is hard. For the longest time, people did not know the difference between mental illness and mental retardation. Many other things in the illness spectrum also get the same treatment. What is a disorder? What is behavior? These are all nuanced conversations about which people don’t know much because they haven’t been talked to. Moreover, mental health is such an invisible space whereas physical disability is visible to all. People are compassionate about them and it is easy to talk about. On the other hand, mental health has a lot of stigmas around it. Most people don’t understand how crippling any anxiety or depression can be. So we need awareness to bridge the gap and make spaces for open conversations.
Mental Health should not be seen from only an illness spectrum, it should be seen from a wellbeing spectrum. Practice various practices that are informed by positive psychology, whether it’s mindfulness, gratitude, or self-care. You don’t need to go to a specialist everytime there is a mental health concern, you can also deal with it yourself. If you can listen to somebody passionately without judging, advising, and moralizing. People will themselves come up with solutions, you won’t have to give it to them. It all starts with stress, if you don’t deal with stress, it becomes distress, and distress becomes crisis. If we deal with it at the stress level itself, the situation becomes much easier for both the professional and the patient. People also feel empowered enough to say, we can deal with this. So if these are the things that we work upon, and empower or enable the community capacity building, it definitely would bridge the gap.
Dr. ArvinderJ. Singh is a psycho therapist, consultant and trainer who has worked for over 20 years in the area of leadership as well as building healing spaces through listening and stories including in areas of political violence and natural calamities. She is the founder of an initiative called Listening Circles Healing Spaces that builds on this aspect of her work. She is currently Director of Ashoka Centre for Well-being and guest faculty for the course ‘Effective Leadership Strategies’ at IIM, Ahmedabad where she teaches mindfulness and empathic leadership.
Interviewer: Lakshya Sharma
Picture Credits: Harper’s Bazaar
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