Grief Gets an Expiration Date, Just Like Us
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The article discusses the author's ongoing grief after losing her husband, challenging the medical definition of 'disordered grief', and sparking a thoughtful discussion on the complexities of grief and its cultural context.
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I would guess her grief is not "disordered" though. As she says she functions - she works, she looks after her child, she looks after herself.
> We medicalize grief because we fear it.
Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
We also stigmatize mental health care in the west, telling people to “suck it up” or “get over it”. So our money spending usually doesn’t direct us to a more helpful path.
I often wonder how dealing with death compares to the east where ancestors are commonly remembered, contemplated, and revered.
In what way is this not western as well? Implying that western culture does not remember, contemplate, and revere those that have gone before us is a bad take.
With ample exceptions of course, a stereotypical "secular" person thinks of their ancestors as racist people that lived in an irrelevant time, and doesn't feel some sort of connection to them, or an obligation to continue them. So I think the poster you're replying to is kinda correct from a today point of view.
I think you missed the "stereo" in front of your "typical".
Not to mention that such a routine might very well be part of the medical therapy that we are talking about here.
I was very religious for 30 years, and have a very religious family. I've been athiest for more than a decade now, and it's sad to me that to leave religion behind I had to give up all my family traditions to process death. Those traditions are still there, but I can't relate to them since they are based on a belief I no longer agree with
I also think its not a simple east-west divide. Different cultures have many different ways of dealing with death. The contemporary west does have a problem, although i doubt it is the only culture for which that is true.
My family follows a mix of Christian tradition (e.g. memorial masses) and Sri Lankan (e.g. donations of food in memory of the dead).
I think this idea is ~10 years out of date. If anything, we now seem pathologize every behavior and personality quirk into a mental health issue. At least on social media, it's also trendy to have a mental health issue to the point that people will claim to have ADHD because they're easily distracted by their phones. I've also lost count of the number of big "content creators" who casually mention their therapist or going to therapy. If there is a stigma, it's not found among the younger generations.
I am also introverted, procrastinate, am not very organized, and am not very good at housekeeping. My view on how I would change those things would be to just suck it up and do better, if I had to. And when it matters, that's what I do.
I don't mean to say that this is the only correct way to approach life but it is how I look at things.
Do you have any advice for overcoming my problem with atleast procrastination (i suspect that it is probably causing the other two issues).
I do agree that younger people are trying to take more care of their mental health but I do not see healthy reasons for which they are chasing that improvement. For example the “pursuit of happyness” is indoctrinated and people think they always need to be happy. At the same time I think people are self-diagnosing which I do not include as “health care” as I meant it, but rather self care or even passive-hypochondria.
>> Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
I never thought about it but it likely stems from loss of religion, like many other problems. If I see my life as insignificant in the chain of generations - as a conduit between ancestors and descendants - and believe in the soul at least as a metaphor - then personal death or that of others is sad, but is in the context of a deeply meaningful existence.
On the other hand, if I am closer to atheistic hedonism/nihilism - there's nothing else but me and my thoughts and experiences, then my existence or non-existence takes on a very heavy weight - and we project that onto others.
If anything, I find religious people are the ones who believe humans are special.
As a religious person, I see my life as insignificant compared to Gd, and compared to the chain of generations, but what I do with my life is extremely significant. As in, whether I bring children into this world and raise them well, is massively significant.
So maybe the way to say it is - religious people see themselves as insignificant in the context of much greater significance.
The other view of insignificance is that nothing is significant - including myself. I don't subscribe to that.
What's significant though is the PREVALENT opinion. 100% of my religious friends want and have kids, while the majority of my secular friends do not. I work in FAANG and previously in finance, so my peers are people who can certainly afford kids and are positioned to take care of them - and yet literally most are choosing to do something else.
I am not commenting on a universal attitude, I am commenting on a significant trend that I think is obvious.
Do all of your religious friends subscribe to the same religion?
If so, does this religion proscribe having children and raising families as a necessary, or desired, component of the faith or community?
Because you could be confusing religion and culture here. Secular values often abrogate traditional gender and sexual norms, so secular people may not feel compelled to "be fruitful and multiply." I wouldn't ascribe that to lack of religion per se so much as not being affected by the same cultural pressures. After all, plenty of theists are essentially forced into marriage and children because it's what's expected, not because it's what they want.
Religious people see "be fruitful and multiply" as a literal command from G-d and one of the fundamental points of religion. So while religious culture can evolve, the evolution of this attitude isn't a flexible point.
On the flip side, secular culture has no intrinsic reason for "family values" - which is why, I think, atheist culture over time devolves to childlessness - because reasons "why not" are more immediate and in your face, vs "why yes."
So yes it's "culture" but what the culture is is obviously determined by your underlying beliefs and that which you consider eternal and that which you consider negotiable.
I don't think the data supports this, yet. Religiously affiliated completed TFR is 2.2 while unaffiliated is 1.8. However, completed TFR means this is looking at those older than 60, so expect those numbers to drop in the future.
https://www.pewresearch.org/religion/2025/02/26/religion-fer...
From my observations, TFR is not much different between most people who describe themselves as religious and most people who describe themselves as non religious. However, the TFR is different for those who I would describe as the most religious, compared to the "casually" religious/non religious.
For example:
https://danielgordis.substack.com/p/israel-has-high-birth-ra...
The people that show up to the casual one once a year or even a few times a year aren't really "different" than someone who doesn't bother to show up. It's good they are there but the religion isn't influencing how they think and act - which is why the TFR is similar between casually religious and casually non-religious.
Where things differentiate is on the extremes. Someone explicitly atheistic (vs just non-religious) has a TFR around 1 from what I remember, while orthodox and ultra-orthodox have 3.3 and 6.6 respectively. What makes the difference is the degree to which they allow the religion to permeate their mundane existence, which is a factor of faith.
For what it's worth, krapp's comment is better written but is what I'm talking about here.
And if the GP thought it did, he would not have bothered to qualify it with those labels.
Since they _did_ specify "atheistic hedonism/nihilism," we know they're talking about those specific stripes of atheism, and can discuss that.
It's not the first time I've made such a clarification - it's a very human impulse to defend your belief system from unjust attacks that aren't actually there.
Not having "answers" to what comes next has never been a weight for me - at least not since I was a child. Death being a completion, or a finality, is freeing; The end of what has been and what I hope continues to be a wonderful journey. The only weight I carry in regards to death are for those closest to me, and especially those for whom I'm responsible.
I can sort of see why you found it less significant, but in monotheistic religions it is still pretty final. It is still the end of the one life you get, even if it is also the entry into something completely different and better.
I think it comes down to the sheer amount of pressure I felt within religion to be a certain way while also being told I could never be that way enough to achieve satisfaction in the eyes of god, and outside of religion I'm just another person in a flawed world trying to do my best.
--------
At the risk of being redundant, death within religion isn't an end, but yet another beginning. Eternal life is the reward for being a diligent disciple, where that means internalizing one's inherent flawed nature and inability to be redeemed but through death in devotion to god... which is a hell of a weight to carry throughout ones' life!
The Christian ethos is woven through with constantly being judged. And forgiven, yes, in theory, but still there is a constant undertone of "you cannot avoid making mistakes, and the mistakes you make are so offensive to god he wouldn't want you anywhere near him, but for magic religion reasons you've been redeemed by god doing something so terribly debased that it outweighs all the awful mistakes you've made."
Death (and "everlasting life") is no reprieve from this, but a form of stick that weighs heavy over you all through your days. You must work to save those around you, or they'll be eternally lost. You must cleave to the teachings of god, or at the very least belief in him, or you'll be eternally lost.
Since I left the church so many things of import that I felt I didn't understand now make much more sense; I struggled to comprehend how god could allow suffering, but now I see that the universe is just absurd and uncaring. While that may seem less comforting, I find the notions of bad things happening randomly less upsetting than there being an all-powerful being who cares about me but chooses to let me suffer for reasons that were never convincing, and as I've grown older sound more and more like an abusive relationship.
Through that lens, death is just a natural consequence of the world. Scary, yes, in the sense that I may not live up to all I want to be before my time is up, but I'm not pre-marked as eternally flawed and only redeemable through processes that do not make sense to me. Instead I know that I can only do my best, and that has to be enough, because I can't possibly do more.
I think the way we deal with death nowadays has more to do with arrogance or hubris, coupled with wishful thinking. We're used to thinking we control things, and can get anything we want. One thing useful from the religions was having a healthy sense of your own limitations, or you could say a sense of wonder or mystery or perspective. A reminder that you're not the most powerful thing in the universe. Which is true, and healthy to be aware of, whether any god exists or not.
Edit to add: There are few places where that hubris and certainty tend to be more pronounced than among doctors. Part of what this woman is grieving is probably the loss of certainty, of control or the illusion thereof.
It maybe a factor, but I do not think it was the main one. Death is still very hard to cope with, regardless of religious belief. There are other things behind religious belief, mostly experiences.
> I think the way we deal with death nowadays has more to do with arrogance or hubris, coupled with wishful thinking
Someone always rocks up to say this in these threads, and then never actually offers any suggestions of what they think an alternative should look like.
It's in the same vein as people who complain no one ever talks about serious subjects, and I'm just wondering why they think I want to get into discussing the meaning of life in the workplace cafeteria.
Seriously, what is the alternative meant to be? A celebration of death? Constantly reminding people that everyone will die and you'll be forgotten completely in about 3 generations? Why focus on the inevitable rather then actually living?
It's a broad observation about culture - there's no "alternative" to a well-established culture, no single forum comment will change society.
> Seriously, what is the alternative meant to be? ... Constantly reminding people that everyone will die and you'll be forgotten completely in about 3 generations?
I think you're on to something here; there's an inherent conflict between ruthless individualism that tells people they can do anything they put their mind to, and the stark, limiting reality of mortality. That's a bummer, so don't think or talk about it, or it'll mess with your grindset.
Collectivist cultures already embraces the idea that one's life is more than just about the individual, so grief and talking about death are far less radioactive. Religions that embrace ancestral spirits being presence offer comfort in continuity; her husband isn't really gone, and he may even watch ober their daughter, and even help her in math exams. In that light, dying is less of a big deal - more of a transition really - compared to oblivion, which is super heavy. I'm not saying these are better
+ Yes, allowing people to have a celebration goodbye party before they go
+ Allowing for medically assisted dying on a person's own terms
+ More open conversations about: directives, how people would like to be treated when they near death, wills, inheritances, funerals. These are all taboo topics
+ A natural part of life
In a less morbid area, I feel the same way about ADHD - "attention-deficit/hyperactivity disorder". For some people this is problematic, but others can function fine and happily with this.
In those cases, why is it a "disorder"? Why can't it just be "how some people are"?
Maybe we should have a different diagnosis for those kinds of people entirely and leave ADHD to the folks who couldn't accomplish what they wanted to do even if they never had to work, go to school, or follow a schedule set by another person. In the end though, what you call it doesn't matter. Both situations are thankfully improved through the use of the same types of medications. Medications which are pretty safe and can mean the difference between being able to support yourself or failing to.
I'm okay with a wider spectrum of people falling under the ADHD umbrella even if some of them don't like being lumped in with people who really do have an executive function disorder. Odds are good those people wouldn't like whatever new label doctors came up with to describe them either. It'll pretty much always carry negative connotations because ultimately, it means that you don't have it in you to do what most people are able to do just fine.
It often is:
> It can be helpful to think of ADHD not just as a deficit or disorder but as a ‘difference’.
Especially as it seems to come with positive traits! It goes on to list focus, responding well in a crisis and creativity as common ADHD traits.
https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and...
In that case I would say it’s not ADHD, which as its name suggests is disordered. If the ADH part isn’t negatively impacting your life why would it require a diagnosis?
I guess your point is why does it require a label at all but science abhors a taxonomic vacuum, everything must be classified and if so I'd rather it be a disorder than a disease or illness.
Of course this opinion is just mine, I have no idea how other autistic or adhd people see this as I don't keep up with the neurodiverse community and what words are considered good or bad.
We didn't have much of a relationship. He had friends, but never close ones. He was weirdly mean or weirdly seclusive or weirdly awkward at times - and also incredibly intelligent and occasionally gracious and hilarious.
After he passed, I wondered if he might have been somewhere on the spectrum - but his peculiarities were simply ignored. A poor boy, in a poor urban neighborhood, with a dead father, being raised by an immigrant mother and immigrant siblings doesn't get diagnosed with much of anything - if they see doctors at all. And hey, he had a near photographic memory, and did great in school, so what's there to worry about?
It's always been "how he was", and that's probably ok, but I do wonder if he would have had a better or somehow different life if he knew more about _why_ he was the way he was.
This isn’t really your point, but this person lost their husband at 40. By some definitions, that is middle aged. In the general view of things, not young. That doesn’t really change much, but I was thinking of a mid-twenties before I realized who it was.
It's because we have a dearth of true elders right now.
Not in age, but in temperament and learning.
I got interested in story telling during COVID and managed to find a great author (K.M. Weiland) that went in deep on the archetypes of story.
Her hook was essentially: "What happens after the Hero's Journey/happily ever after?" And then she got real deep on her idea of the 6 phases of life. Her work is properly about how to write a plot, but man does it apply more broadly.
The pertinent one here is the 'Crone' stage of life [0]. You're no longer the 'King' of your little fief, you had to give up the power and make way for the next generation. But now what?
The journey of the Crone is essentially learning that Death is a part of Life, that Death is not Evil, Death is a Friend.
K.M. Weiland admits that less and less people ever make it through the stages as you go along.
But, I think right now in the West, we have a lot of boomers that never really progressed past the Hero stage, let alone the Queen or King stages. There should be more Crone and Mage people around, but the boomers were retarded in their development. Just look at RBG, Feinstein and Pelosi (to name but a few), grappling on to power like the Tyrants or Sorceresses (strong shadow archetypes of the Queen and King) and never letting go, to the classical harm of the kingdom/hearth that such stories tell.
Facing Death is hard, very hard. But is something that we all must do. Realizing that Death is not Evil, but a part of life, and one to be welcomed at times, that is something that very few of us can do.
[0] https://www.helpingwritersbecomeauthors.com/archetypal-chara...
-How the hell did they do it?
And
- What the hell were they thinking?
I'll echo the frustrations you're having. I have the exact same ones with my own folks
> Absolutely right. There is a certain cowardice in how we deal with death in the contemporary west.
This is one of my favourite topics.
I had forgotten to bring "cowardice" to the table when thinking about death (etc) I've mostly thought of it as some kind if vague unspecified fear, thank you for injecting this word and concept into my jumble of thoughts.
I've been using "dignity" to try and make my thoughts more clear, but cowardice clearly has a place at the table too.
When thinking about suicide I have thought of that way to die as potentially needing bravery (as in being able to do something you fear).
The topic of death is dear to me me not only for personal reasons but I also think this relates to quite a few aspects of our societies and not only the obvious ones like how (if we can afford it) seem to overtreat people medically rather than give them proper palliative care and their close ones time and space to be there at this grand moment in life, that death ultimately is :)
It feels weird to use words like: bravery, cowardice, dignity and fear, they feel like from another era, possibly only a fictional era of knights, damsels and dragons.
And somehow I sense that that feeling of weirdness somehow is connected to the medicalisation of "everything" and also our longer work hours and expected increased efficiency. As if we hide and disallow the big important things in life only then will we agree to work the way we do.
But then in the other hand we can cure a lot of disease and I can type this on a tiny screen keyboard and post this to the internet, so...
I don't know, I only know that there is something wrong with death.
I think that's backwards. I think the problem is that we, the general populace, fear medicalization. The medicalization of grief specifically or other emotional issues generally is unrelated.
These sorts of diagnosis criteria are created for a reason. I highly doubt psychiatric medical practitioners are developing them to pack people up into bins so that they can be marginalized. They create these criteria to be able to have a shared language to speak about issues and try to develop treatment regimens.
And it's not their fault that the lay population takes it out of context and screams, "NO NO NO! I'M NOT BROKEN!" It's that reaction that is the problem. That reaction that, "someone who fits this criteria is by-definition broken", with "and broken people are irredemable" followed closely behind. It belies a belief that they feel this way about other people, too.
The truth is, everyone deals with issues that would fit some criteria in the DSM-5. It's just part of the human condition. Some people are able to manage these issues on their own and some people are not, and that doesn't make them broken anymore than the fact that some people can dunk a basketball and some cannot. But, if you're 5'9" and had a job to put a ball in a basket 10 feet off the ground, wouldn't you want to focus on learning to shoot rather than try techniques you've observed 6'9" people use with ease?
https://news.ycombinator.com/item?id=43020983 949 points | 7 months ago | 266 comments
I should not cry at work but damn, I want to.
Waking up from those is so painful but I am grateful I still get to see and hug him once in a while.
It took a couple of years after a good friend of mine died before I stopped texting him on occasion.
I think this is just incorrect. You are not obligated to seek treatment for most medical problems[1]. The point of medicalizing something is to draw a line between situations where it would be too soon for medical professionals to step in and when people enter a situation where they may need external help. One of the diagnostic criteria, which this article mentions, is that your grief is disrupting your life - but despite what this article claims they have misunderstood that criteria. Of course grief changes your routines and life. That change only becomes "disruptive" if you feel the change has somehow gone too far or you are struggling to undo it. This writer is doing neither and therefor does not meet the diagnostic criteria for disordered grief. They are grieving normally and the medical literate supports that understanding.
There are of course medical professionals who use diagnostic criteria as cudgels. Trying to force people to become patients in order to enforce their idea of what someone "should" want. This is a problem but it is a problem that the official diagnostic guidelines try to avoid. For those who are interested in this kind of problem with our medical system might look into the professional philosophy of doctors (generally arrayed around identifying and curing disease) and nursing (generally arrayed around making the patient comfortable as possible). I tend to think the nursing model is the more useful and sensible of the two - even though, of course, if one wants to cure a disease a doctor is helpful.
[1] There are very few diseases, such as tuberculosis, where you can be forced to treat the disease.
The problem is that medical diagnoses and therapy speak have spilled over into common language where they’re so diluted that they’re not accurate any more. For many there is no line drawn anywhere because they are self-diagnosing based on flawed understandings as soon as any feeling or symptom arrives.
This is scarily obvious when I’ve worked with college students and early 20s juniors lately: A subset of them speak of everything human nature in medical and therapy speak. Common human experiences like being sad about something or having a tough day are immediately amplified into full-blown medical terms like “I’m having a depressive episode today” (which is gone by tomorrow). Being a little nervous about something is “I’m having a panic attack”. Remembering an unpleasant disagreement at work “gives me PTSD”. When they’re procrastinating a task that is fun “my ADHD is flaring up today”.
This is only a subset of people, but it’s a rapidly growing percentage of younger people I work with. When someone falls into this mindset it only grows: The same people using these terms usually accumulate a lot of different self-diagnoses to cover every element of common human experience: They will claim ADHD, social anxiety, often some variation of Autism despite showing none of the signs, PTSD due to a previous relationship/boss/professor they didn’t get along with, and insomnia or delayed sleep phase syndrome. Many will have no formal diagnosis at all or even proudly claim that they don’t trust the medical system, they’re just diagnosing themselves.
I’ve been offered helpful links to TikTok ADHD influencers to help me understand them, because that’s where they think the best information comes from. 20-something engineers confidently tell me they know more than their doctors about ADHD and how to treat it (usually after their doctor refuses to increase their dose of Adderall again or denies them some other controlled substance they think they need like ketamine or perpetual daily Xanax). There’s also a growing culture of casual drug abuse and misuse that gets justified as self-medication, but that’s a topic for another post.
I guess we'll know when they turn 40 and are still saying things like "I had a panic attack" and "I'm literally shaking rn".
Similar to how some people look at raw stats of autism diagnoses and think hugely more people are becoming autistic when in reality it's that we've got better at diagnosing autism; I think we (society, in at least some countries) have got better at being honest about mental health conditions. Meaning that more people, especially younger people who've grown up around less mental health stigma, will talk about having an actual genuine problem even without more diagnoses or more exaggeration. I think studies would be needed (that I'm not aware of) to figure out how many more people are using labels that don't really fit, vs how many more people are being honest about actual serious conditions.
When I was in my 20s, if I needed a day off work because of depression I would always use a bullshit excuse to avoid mentioning the actual reason. I don't any more, most of my colleagues know what issues I do or don't have. And the younger generations are starting from that place, rather than having to grow into it.
Why couldn't you say: "I'm sick and won't be at work today."
- Access to mental healthcare here is HEAVILY gate-kept by a combination of it often costing quite a lot of money, generally having longer waits than most healthcare services, heavy variability in availability by location, and insurance coverage runs the gamut between great or utterly absent, sometimes even in the same policy depending on what you need. Self-diagnosis is for many people the only diagnosis they have access to, and even if it's wrong, you can often use whatever diagnosis it is to find coping mechanisms that help you, or substances that will help you self medicate.
- Naming something medically is the only way to get institutions to pay attention to it, which can mean a number of things by itself, from getting appropriate accommodations at work or school, to getting certain kinds of coworkers or authority figures to treat you in a way that's more amenable to your mental state.
And I don't think its wrong to make it part of your identity either. Some definitely take it to a weird, unhealthy place, and also most of those people are teenagers. Teenagers do tons of stupid shit, I did tons of stupid shit. It's just part of growing up. But ultimately... it is part of you that you're going to be dealing with probably forever, so, some amount of identifying with it is probably healthy.
Edit: Also not sure how to read you calling this "oversharing?" Like I guess it could be depending what it is, but I dunno, my wife has BPD and a touch of Autism, she doesn't announce it when we meet someone but it isn't a secret either.
I think some of it comes from the value the culture places on underdog stories and some of it comes from the oversaturation of everything in modern life.
I guess my thoughts on the trend you're critiquing is that it happens almost entirely outside of the medical community. As you describe the people who are most impacted by this often find actual medical treatment unhelpful and un-validating and turn to self-medication or other "medically inspired" coping techniques. I think the people who actually don't have these conditions and are applying medicalized treatments and explanations are opportunistically drawing on medical language because people often respect it socially. But also there are lots of people who engage in self-deception (or just normal deception) for social advantage and I don't know that people who use medical language are better or worse? A word is just a word and unless that word is actually on a medical record somewhere it only has the power you give it.
The flip side of this is of course that the medical establishment has many well-studied and documented biases. They offer poor treatment to overweight people, black people, people with mental health diagnoses, basically every vulnerable population that's been studied gets worse service from medical professionals. That very reasonably leads to people distrusting "the system" and searching for coping mechanism outside of it. I think that is generally pretty harmless and helpful - as long as it doesn't get into the realm of serious self-medication like you describe. Basically if you like using a medical term to describe your experience ("I'm being really OCD today") I don't think there's much harm in it and you may find coping mechanisms for people with ODC helpful as a bonus.
I was with you up until this point. My wife has C-PTSD, Bipolar type 2 and ADHD, along with what her psychologist describes as "Social OCD". I can't tell you how many times I've had to explain to other people that her mental illnesses are real and some days she and I just can't hang out because she smelled a smell that gave her flashbacks. Because people have normalized the language, they think "triggered" just means upset. For someone with real PTSD, it doesn't mean upset, it means their mind has come unstuck in time and they don't know who to trust or sometimes even what is real. Sometimes this lasts 5 minutes, sometimes it lasts almost all day. She just loses that time, and all I can do is try to calm her down and try to get her to take medication to re-stabilize her.
My wife has been in therapy with a PhD psychologist for 11 years, and only just this year has gotten to the point where it seems like she could probably hold down a job and keep her trauma compartmentalized like most people do all the time. People normalize the language for these debilitating full-blown disabilities and then don't understand the gravity of the situation when somebody with a legitimate mental illness of that sort of degree comes along.
Co-opting medical language for sub-disorder level dysfunctions is bullshit. And that's fine, when you're just bullshitting with your friends or whatever, but how is someone like my wife supposed to be seen or understood, let alone properly accommodated for when everybody thinks they know what a panic attack is but has never in their adult life been so panicked they became nonverbal?
I'm not saying that the problem isn't ableism, it absolutely is, just that the co-opting of the terms is still harmful in that it uses up spoons and makes it harder to communicate clearly, especially with those who are stuck on the pop-culture meanings instead of actual medical meanings.
In fairness, I believe that people who make jokes and light of disability suck in that I also believe this is an ableist activity. And I fully believe you that this kind of uwu-ification of disability is used as justification for ableist people to behave shittility towards your loved one.
I don't think the position of "Having more accurate pop culture depictions of mental health issues and disabilities would enable better understanding from non-disabled people" is an entirely crazy one, and you haven't really made any arguments as to why we shouldn't do that.
We have an epidemic of not taking psychological conditions seriously. As my depression has worsened I've understood better the depth to which someone can fall and re-thought when it makes sense to say that I'm having a "depressive episode." I think there's a real issue of people mis-understanding diagnoses (in the way the comment I was replying to spoke about) and describing themselves as having them when their symptoms would not rise to the level of a diagnosis. Un-restrained by medicine and popularized by social media, watered-down understandings of disorders proliferate.
> Co-opting medical language for sub-disorder level dysfunctions is bullshit.
However, this I disagree with. Someone invoking PTSD or Bipolar to characterize their experience is not the same as claiming that label for themselves. I am not bipolar, but I mention the condition to talk about cyclic moods that I do experience (that are neither major depressive or manic but impact me). I think it's common to talk about a disease condition with the understanding that the condition has a range of severity.
I have a friend who was institutionalized for depression for a time. I don't think I am co-opting them to talk about my much less serious case - even though there's a similar "flattening" effect. If people hear my mental health journey first they might assume my friend is putting on airs about their situation. My friend has constantly had people imply or accuse them of overplaying their condition to get special treatment, which is gross.
> how is someone like my wife supposed to be seen or understood, let alone properly accommodated for when everybody thinks they know what a panic attack is but has never in their adult life been so panicked they became nonverbal?
My hope - and it is just a hope - is that on balance the social spread of broad and vague understandings of mental disorders is a net positive overall. The alternative feels like locking these terms away in the medical field - where when your wife (or anyone) says they're having a panic attack and the person who's there to help her has never heard of it. People are often shitty when you are going through a serious illness through ignorance and selfishness and I think medical conditions are the same as physical[1] in this case. I do not think that talking or identifying less with disorders is a net-positive.
All of these conditions have a spectrum of severity and, I believe, many people have sub-diagnostic versions of medical conditions. Those people will often improve their lives by recognizing patterns in their lives and using coping mechanisms developed for people with more severe cases. On balance I think that practice increases empathy for more severe conditions - because once people recognize a trend outside normative experience I think they often can extend it. I've also known far too many people who had life-changing adult diagnoses of conditions ("you mean this isn't what everyone is dealing with") to be set against the popularization of considering if you have a diagnosis.
[1] Mental conditions are, of course, also physical conditions but the dichotomy is widespread.
I'm deaf. When I tell people this, one of the most common response is "Oh, don't worry. I'm a little bit deaf too." Now not to go policing people on their identities but -- no you're not.
Like what do I need to say? Clinically deaf. Severe-profoundly deaf. Cannot hear a fire alarm without hearing aids?
It's one thing when it's an elderly person. Yes maybe they are in fact a bit deaf too. But for all the people in their 30s or 40s who have said it to me -- the odds they all have moderate or worse hearing loss is nil! Most of the people who are saying it presumably have normal hearing. I understand that they're trying to identify with and not alienate me. But it's such a strange dynamic.
I think that is just people being people, and that's the first "acceptable" thing that pops into their mind when they hear that. They are just trying to relate to you. They are socially conditioned to not say things like, "that's too bad", or "I'm sorry", etc.. They were probably prepping to say something about the latest weather trends or something equally banal, and now you've hit them with something out of left field that they've never encountered before. How would you like people to respond? I am a migraine sufferer, and get the same types of responses, like "oh, I get headaches too", and "my sister in-law cured her migraines with mint oil!". I mean, most of the things that most people say are rather dopey.
The thing is, many people have valid reasons not to trust the medical system. Not so long ago:
1. Homosexuality was considered a mental disease
2. Forced sterilization of minorities was good medical practice
3. FDA ignored warnings about pesticides being potentially harmful because that would be bad for business
4. FDA ignored warnings about pesticides being potentially harmful because that would be bad for international politics
5. Entire field of psychiatry was just basically random shit, it's not until very recently that we have any actual scientific knowledge
6. Pregnant women were presribed medicine that fucked up their fetuses
Not to mention that most likely when you go to a doctor you're not getting state-of-the-art diasgnosis, most likely the doctor is just a random guy doing his job, sometimes better sometimes worse. Personally I don't trust medical system with my mental health because medical system is a product of a society that made me have mental problems in the first place.
The term Asperger syndrome was only removed from the DSM in 2013.
For autistic children something called Applied Behavior Therapy is still the most common treatment. It is the same thing they use in gay conversation camps. Yes, literally. It can be super traumatizing to autistic children.
The way we treat neurodivergent people is absolutely abhorrent.
That said, the main issue people don't get a diagnosis is not lack of trust but lack of access. Most people can't afford it or are not able to jump over the bureaucratic hurdles to get it.
On the subject of Asperger syndrome, after learning about the history I was surprised that there are people previously diagnosed with Asperger's syndrome who were (and still are) very angry about the term being removed resulting in them being lumped in with everyone else diagnosed as autistic.
Being labeled as "autistic" could mean anything from seeming a bit strange but being highly intelligent and perfectly capable, to being totally non-communicative, being drastically intellectually and emotionally underdeveloped and being unable to function requiring 24 hour care. Some "Aspies" saw Asperger's as a very convenient way to differentiate their particular flavor of autism. Convenient enough that the usefulness of that distinction far outweighed the shadow of the terrible origin of the name itself and also the fact that it hilariously sounds like "ass burgers".
Personally, I'm glad that Asperger's was removed but I have to agree with the Aspie crowd that they got screwed over when no new term was given to replace what they had. The still grossly overbroad "3 level" system is trash. The spectrum of autism is so wide that the term is nearly useless.
No, everyone that is diagnosed under ASD has some sort of care needs. If you are just a bit strange and it is not disabling in any form, then you are just strange.
People see autistic people on the internet and seem to miss that video editing exists and that the they are seeing just a very specific and carefully chosen part of this person. They are seeing the highlight reel not daily life that can look very differently.
One of the fears with removing Aspergers was indeed that some people diagnosed under Asperger might not be diagnose under ASD as it is arguably stricter.
> to being totally non-communicative, being drastically intellectually and emotionally underdeveloped and being unable to function requiring 24 hour care.
The problem is that many people see things as single line from low care needs to high care when in reality it is multi dimensional. Just being non-verbal does not mean that one is not intelligent, that is a huge stigma that non-verbal autistic people suffer. Many autistic people struggle with sensory issues but some don't. You might struggle heavily in one area but not so much in another.
If you know one autistic person, you know one autistic person.
> The still grossly overbroad "3 level" system is trash.
It is a step in the right direction because it realizes that care needs can change over the course of a persons life. You are born autistic but how disabling it is for you can change depending on how much help you get. It can get better or worse depending on your life situation.
Otherwise you have a current situation where people assume it isn't worth giving a non-verbal autistic child a proper education because they they think that they will never be able to life on their own anyway, acting like their outcomes are already predetermined. Or when someone with Asperger is assumed to never have serious care needs.
That said, people that have been diagnosed as Asperger, I don't correct them if they cling to their diagnosis. It is the diagnosis they have identified with for years or decades and if it what works for them then that is fine.
Still the new system is a good step in the right direction. Not perfect but better.
"Truth hurts, don't it" is a very true phrase. It's a very sick trend affecting Millennials and Gen Z alike, and contributes to other worse mental health and criminal outcomes.
It's not even new.
ADHD is something you are born with it. If one biological parent has ADHD there is a 40% chance the child will have it as well. We already know there is a strong genetic link. It is NOT caused by trauma.
There is a huge overlap in symptoms between ADHD and complex PTSD. Yes, one needs to be careful to not confuse the two. That is why when I was diagnosed with ADHD, I was also checked for trauma or any other conditions that could explain my symptoms better. This is the recommended and required procedure for diagnosis.
Furthermore many ADHD people also often have (C)PTSD because living with ADHD can in itself be very traumatic, especially when undiagnosed. And neurodivergent people are also more likely to be victims of abuse.
ADHD is not caused by "abusive households" because again, you are born with it. Also getting an ADHD diagnosis is probably harder to get than an PTSD diagnosis because most psychologists will expect trauma and is quite normal and expected to talk about trauma in therapy. In fact the whole field of Psychoanalysis that is the second most common therapy method after behavior therapy is based on working through childhood experiences.
Somewhat unrelated, but I complain about the same thing in software parlance. Our work gets divided up into "sprints". A SPRINT is traditionally something you do a handful of times in your life, like when you're fleeing for your life, pursued by a bear. And then when you're a safe distance away and the adrenaline wears off, you collapse from exhaustion and rest. The idea that your employer would use that term to describe how they envision their employees structuring every day of the rest of their lives is either painfully tone-deaf, or even worse, is a brutally honest view of how they regard employee burnout.
But your point about misleading terminology is correct. That's why modern methodologies such as Scaled Agile Framework (SAFe) have adopted the more neutral term "iterations" which doesn't imply anything about velocity.
https://framework.scaledagile.com/iterations/
apparently, any time that you need to politely smile when you dont feel like it is "masking"
To be fair, giving you an example of someone else who performatively pretends to have a mental illness is a great way to understand them.
I mean, our industry is filled with people of all ages with ADHD (arguably because it’s one of the few industries where you can succeed while having severe ADHD), GenZ folks are just more likely to admit it in public where older millennials are more likely to either be quiet about it or ignore the fact that they are subject to it.
What they're saying is that as a culture, we reason about grief using the tools and concepts of the medical industry. Because it's part of our culture, this is so automatic that it's almost hard to conceive of any other way. But it is indeed a choice to describe grief as a sort of labeled pain which can be explored using falsifiable scientific experiments, is amenable to treatment by medical professionals, is a problem representing a delta between a "normal healthy human" and their current state, etc.
We could just as well have a culture that treats grief as a normal part of the human experience. We could consider a person currently grieving as exactly as healthy and normal as someone playing the saxophone. We could (and some do) consider that the most appropriate people to offer help for grief be spiritual counsellors.
I'm not saying we should handle grief differently. I'm just trying to point out that what the author's saying is that it's a cultural choice the way we present and work through it socially. (But, for what it's worth, I do think we should handle it in a less medical way.)
That said, if that's what the author was trying to talk about, I think they are doing so in a way that unfairly indicts the medical system for assertions it doesn't make. They say "Apparently, that’s a disease", but as I said I do not think it is. I think they've misunderstood what makes a disease under the diagnostic criteria they list.
> We could just as well have a culture that treats grief as a normal part of the human experience.
That culture does exist. Even in this article there is an experience of grief that's considered normative in the medical community. Including, I would argue, the authors' grief. I would argue that the medical approach to grief is actually better than other western treatments of grief.
I agree that western cultures (and US culture in particular) is horrible about grief. We want people to be robotic and predictable and not make us think about loss and be sad in private and a whole mess of awful, inhuman things. But I don't think that pressure either comes from the medical community or is furthered by how the medical community talks about grief.
Edit: I specifically think it's wrong to say we medicalize grief because we fear it. We medicalize it because some people would like a medical intervention with their grief. It's great and right that the author does not want that - but also they shouldn't write in a way that suggest that medical interventions in grief are wrongheaded.
By making the criteria reasonably loose and readily met, such a definition also minimises the number of individuals who would benefit from treatment who are excluded from being able to do so. This would include those who are very much unable to function or face larger grief-related risks.
We medicalise grief not because we fear it, but because there are genuinely useful therapies which may be of use to some, and denying them that merely compounds suffering.
And yes, absolutely, grief ultimately is a lifelong experience. You never stop missing that which you've lost, so long as you have the capacities of memory, reason, and feeling. That is not what the clinical definition is about.
That said, the writing really resonated with me and i wish Bess well.
We are always at risk of medicalizing discomfort. Allowing oneself to be miserable for a while can be therapeutic alongside patience, forgiveness, and compassion.
Edit: after a re-read I noticed that she says she feels most of the symptoms daily a year later. That does feel pretty disruptive on its own but the definition is a bit tautological in that case.
Regardless, what she's going through sounds really hard.
Closing your Jira tickets on time is the order. Therefore grief by preventing the closure creates disorder.
Stop reading HN and work on your next Jira.
My dad died of cancer when I was 26, and I had very frequent dreams where it felt like he was real and present, though never speaking or interacting directly with me. The grief persisted for years.
Nearly 25 years later, my mom passed away this summer, and it's been a totally different experience. The grief was just as intense as when my dad passed, but contained to a few weeks.
Our bodies and brains are complicated.
They never fought at all. There was zero conflict. It wasn't that they just "hid it from the kids"—there was simply nothing to fight about. They were truly each other's very best friend, and intensely so. My dad tried dating again a few years after her death, but I think he soon realized there was no way anyone could capture the kind of companionship he had with my mom. Some people are able to love more than one partner over the course of their life; I think he decided he could not.
He's a very private person, but I know he constantly thinks about her every day, and I suspect he's pushing off retirement because he doesn't want to be at home without her. They would have just hit their 40th anniversary if she were still alive.
https://orphanwisdom.com/die-wise/
Dying is a skill, both for the person doing it and the people around them.
Indeed. We used to have religion to help us deal with it. In our modern world driven by science, death is just the absence of life. Since all (physical, chemical) reactions have ceased, science has nothing more to say about it. In trying to deal with the ills of organized religion, we may have also disposed of its benefits.
Very sorry for your loss.
Science has also given us time machine surrogates - photos and videos. I understand this doesn’t work for everyone and can sometimes make things harder, but for me, seeing our common past brings back the smile to my face.
There is a dumb part of me that wants to believe, "Oh, he probably faked his death to get out of debt." He was such a schemer, if anyone would, he would. It was an open casket funeral. I know he is dead.
It's not a disorder. I just have mental pathways built that lead to a person who was integral to my life for many years, a person who does not exist on this plane anymore. I want him back in my life. Death is just difficult.
He was a genuine source of both encouragement and constructive criticism the likes I have had not had before or since. I miss you, Meka.
I still miss that guy, though.
It's one of only two conflicts I've ever encountered online, and it's been inactive for over a decade, but I can't claim it.
https://www.the-independent.com/news/uk/home-news/family-sho...
I don’t believe, completely in the narrative of American men not taking stuff out, but it is a factor. The underlying issue for not talking stuff out is ensuring you feel understood. That you are not alone in this experience. That grief is okay, normal. That you have been taught a life philosophy that encompasses grief. That it can exist without consuming all. It helps anchor these powerful emotions. There are other ways to achieve this, everyone will have their own strategies. I do think you have to have a philosophy and process to handle grief however you do it.
I believe in acknowledging grief and practicing Stoic style thinking to stay present. It really helps me to acknowledge the moment is precious. Wrenching on a car with a buddy. Sitting at the dinner table with your family. Acknowledge how special that is. That it won’t last forever. Cannot. Tell them and yourself how special it is. Visualize life without that moment anymore. Bring a little grief to the every day and present as a part of our human condition. It is okay! It is not spoiling the moment if you are using that emotion to fully experience the present.
Grief as many people experience and process it is almost always the past. Even simply acknowledging it as the powerful force in our mind can help tame it. Observe the grief so to speak, see it as an observer. I am glad you found your way. Everyone should think about grief and talk about it. Just part of us.
I wish I was half as articulate as they are and could say something that might provide even a modicum of comfort to her or others struggling with their grief.
https://news.ycombinator.com/user?id=jseliger
I'm still sad sometimes, but I have much more to look forward to now.
Grief still occasionally hits me. Not so often these days, it’s a long time in the past, but after some reminders of that time of life on social media a couple of years ago, I felt the unfairness of it all like a knife twisting in my gut again.
All of which is to say I can’t imagine what it must be like to lose a spouse who you had a life and a child and plans with, and I don’t believe that everyone grieves the same, or that it should just be over when someone tells you that’s ‘normal’ or expected of you.
And also, as said in the blog post, if you’re functioning, if your grief isn’t actually stopping you from living your life, then who is to say it is disordered?
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