Grief from a death of a loved one is part of life. It can take from one to two years and with certain deaths five years. And with important relationships, one never fully recovers. This is the human condition. The DSM IV of the American Psychiatric Association suggested that when grief lasted over two months, it is a brain disorder, MSD (Major Depressive Disorder) and anti-depressants should be used. The new DSM5 dropped that down to two weeks… Two weeks. Even the old eight weeks is itself an insult to the human condition.
Mourning is the biological process of the brain-body for healing and recovery from loss. Human attachment is deeply mapped in the limbic cortex, as the story of our relationships. It exists in the brain as the top-down cortical mappings of relationships. Mourning a death is the change from the deeply held story of a relationship to a new “play” where the loved one is dead and gone. (see the my Post “Mourning is the Key”).
Keep in mind that antidepressants should never be prescribed for grief. They inhibit mourning. They numb out feeling and harden the personality. I’ve treated many patients who had been on antidepressants for years and years after a death. It wasn’t until they got off of them that they were able to mourn and feel and come back to the world of the living. This is what it is to be human. Grief is not a brain problem, but part of the human condition.
The processes of mourning follow the basic brain principles for change in top-down cortical mappings. Here is an example of a change from in a simple top-down cortical mapping to another – the changing of a hand position for a chord on the guitar. When I learn the B7 hand position on the guitar I am actually laying down new neuromuscular mappings in the motor-sensory areas of my brain. This is accomplished by devoting my full attention to putting my fingers on the frets of the guitar. It hurts my hand; I can’t do it very readily. I can’t do it as a unit; It takes a long time to get my fingers right. Over time with repeated efforts and a few nights’ sleep, I get it. My brain mappings get established for top-down cortical functioning – I can play the chord as a whole, automatically, without thinking and incorporate it into playing music. Now, let’s say I had learned a scrunched up hand position and I want to change it. Then the following steps take place – I have to utilize my attention to disuse my old hand position; In order to have a new hand position for B7 I have to create a new neuromuscular map; I hold my hand on the fingerboard differently. Once again it hurts; I can’t do it well; after a while the new neuro-muscular maps establish themselves. And once formed, I can operate automatically and with ease. This is the paradigm for changing from one top-down cortical brain mapping to another.
Change in the limbic-cortical play of consciousness for relationships follows these same principles, but in this case it is not neuromuscular mappings, and the pain is not muscular. Since the ‘play’ is anchored in the limbic-cortex, the pain of change is in the realm of feeling. And the pain, by its nature, is powerful feelings. To change the top-down limbic cortical mappings from one play to accept a play of absence is called mourning. This is the process for healing from death, loss, trauma, and pain in psychotherapy.
One of my sons almost died in the World Trade Center. If he had, it would have taken me years to get back on my feet, at least partially. I would not have been able to practice psychiatry any more, because I have to be exquisitely responsive in feeling with my patients. This would not have been possible. And for sure, if I’d numbed myself out with antidepressants I couldn’t have been emotionally available. Life is difficult and healing from tragedies is very hard and has a life of its own.