Another clinical example is very personal. My father died a horrible death because of prostate cancer in 1972, long before prostate-specific antigens or total removal of the prostate were considered standard treatments.
I was furious with him, with his son, his grandsons, his doctors. Why had he never mentioned symptoms related to difficulty urinating until it was much too late? It seemed as if my father had spent the bulk of his life nagging me about going to college and becoming a doctor. I had much anger and pain about seeing him suffer and die so miserably. In retrospect, I can reconstruct the depth of my anger at him for not letting us get him to a doctor or a hospital so that a diagnosis could have made by a simple rectal examination. By the time he was seen, his seminal vessels were hard and cancerous.
Losing my father hit me hard. My psychoanalytic training did not prepare me for the guilt I would have for a lifetime of angry feelings – real or imagined –that I lay at his feet.
Rethinking the Grieving Process
The idea of never speaking ill of the dead is one that must be examined and dealt with. We must are allowed to grieve those we love without being called clinically ill. Denying our feelings leads some people to become depressed – unnecessarily. The next time you go to a funeral, listen carefully for negative references of any kind. They will be hard to find.
It is time for us to change this. Some non-Western cultures can do it, but not those of us in the West. It’s not such a terrible sin to tell the truth about someone you have known positively or negatively.
There is a wonderful joke about a funeral in which the rabbi says to the congregation: "Someone has to come up here and say something nice about Moshe." No one moved. The rabbi says it again. The third time, exasperated, he says it angrily. Finally, a little old man gets up and trundles toward the front of the funeral home. When he gets there he says: "Well, I’ll tell you. His brother was worse."
Was that the worst thing he could say?
People don’t want to recognize the depth of their negative feelings toward a parent after they die. As in my case, I was angry because my father died – which is often a natural reaction when we lose someone important to us. And, as the Swiss-born American psychiatrist Elisabeth Kübler-Ross taught us, the grieving process involves numerous stages.
Dr. Kübler-Ross formulated her theories for her book, On Death & Dying, (New York: Scribner, 1969) from her personal experience with what she thought was impending death. When informed that her mother was dying, she rushed to Switzerland. Many of the theories she used in her book came from those trips. Her mother didn’t die for many years.
Most of those who grieve are not depressed – even though they seem so based on their symptoms. Oversimplification is not the direction we should be going. Our specialty’s future relies on a true merger of biological, psychological, and sociological factors to create a biopsychosocial model. We need to balance our psychoanalytic knowledge with what we know about pharmacology.
If we persist with the idea that all grief and bereavement is clinical depression, the diagnostic manual will be distorted – and we will be more likely to use pharmacology as our only guide. We must not let this happen.
Dr. Fink is a consultant and psychiatrist in Bala Cynwyd, Pa., and professor of psychiatry at Temple University in Philadelphia. He can be reached at cpnews@elsevier.com.