Back when I was still working full time in corporate marking land, there was an article that I can’t find now talking about the new “grief diagnosis.” To make short of it, the criteria for depression are being reviewed by the American Psychiatric Association, for the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., the first since 1994. Basically, it’s the mental health guide book.

A new report contends that a proposed change to the Depression diagnosis would characterize grieving as a disorder.  More specifically, complicated grief disorder (CGD) is a proposed disorder for those who are significantly and functionally impaired by prolonged grief symptoms for at least one month after six months of bereavement. Of course, all these studies and literature refer to grief caused by a death, rather than adoption relinquishment and birthmother grief.

Depression from Grieving Doesn’t Count as Depression

The study mentioned in a  New York Times article , brings to light that while depression is counted as “Mood Disorders Work Group“, “normal” depression over loss due to  a death is currently not consider a mood disorder even though symptoms mirror frequently included depressive symptoms such as “sadness, difficulty sleeping, decreased appetite, fatigue, diminished interest or pleasure in usual activities, and difficulty concentrating on usual tasks”. While a diagnosis of depression is considered after two weeks of such symptoms,  it is seen that “bereavement related depression may resolve over time without treatment and may not have the chronic and recurrent course”. In other words, it’s totally normal to be sad and depressed after a death, but you get used to it and  life goes on.

It has been well documented that a birth parent that places a child for adoption experiences profound grief and loss (Condon, 1986; DeSimone, 1996; Deykin, Campbell & Patti 1984; Logan, 1996; Rynearson, 1982; Smith 2006; Wiley & Baden 2005; Winkler & Van Keppel 1984). But does our experience fall under a diagnosis of “grief disorder” and do we want  it to?

What is a Complicated or Prolonged Grief Disorder?

Complicated Greif Disorder  (CGD)  is considered for those who are significantly and functionally impaired by grief symptoms for at least one month after six months after the  initial loss.  Let’s look at the quick rundown of signs and symptoms of complicated grief as described by the Mayo Clinic. I took the liberty of changing the words deceased and bereavement to fit into the experience of adoption losses most specifically in relationship to a birthmother post relinquishment.

Signs and symptoms of complicated grief can include:

• Extreme focus on the loss and reminders of the loved one
• Intense longing or pining for the child
• Problems accepting the adoption
• Numbness or detachment
• Preoccupation with your sorrow
• Bitterness about your loss
• Inability to enjoy life
• Depression or deep sadness
• Trouble carrying out normal routines
• Withdrawing from social activities
• Feeling that life holds no meaning or purpose
• Irritability or agitation
• Lack of trust in others

Additionally, the Mayo Clinic reports that  those suffering from the above, might benefit from seeking professional help if we find that we:

• Can focus on little else but your adoption experience
• Have persistent pining or longing for the your baby
• Have thoughts of guilt or self-blame
• Believe that you did something wrong or could have prevented the adoption
• Feel as if life isn’t worth living ( suicidal feelings)
• Have lost your sense of purpose in life
• Wish you had died rather than relinquished

Do you see the experience as reported from many birthmothers as a whole in these lists? I really change very few words to make it fit. I mean, forget 6 months!  I personally consider a year after relinquishment to be barely over the tip of the iceberg.  Talk to me in ten years and tell me how you feel your adoption relinquishment loss has resolved.  It’s rather scary how well it seems to fit, but does that make it a “disorder”.

From what I am reading, it seems to me that or Prolonged Greif Disorder (PDG) is a more drastic side of CGD though some writings use these terms indiscriminately. What I find  interesting is that PGD has the added symptoms  identity confusion and feeling stuck in grief in addition to the above.  The identity confusion, as in what does it mean to be a be a birthmother, seems to ring true in regard to our struggles as well. Also to note; one of the diagnostic “nearest neighbors”  to PGD is Post Traumatic Stress Disorder, another medically unaccepted, but anecdotal known risk or infant relinquishment.

The issues surround the “new  grief diagnosis” are also relevant to our population; if grieving is normal, who is to say that prolonged grieving, especially after adoption loss, isn’t? Will a diagnosis make our sadness become “a problem” in a society where we are already very uncomfortable discussing or accepting anything that isn’t rainbows and butterflies. Is this just another reason to prescribe “happy pills” to make birthmothers seem more acceptable to others? Indeed, already the pharmaceutical companies might be coping at the bit. The transformation of bereavement into a mental disorder will create a new global market for antidepressant therapy.

Of course, all of that would hinge on whether or not a birthmother’s grief is included as a cause or factor in CGD. Right now, again, it’s all about death.

More Specifics of Birthmother Greif and CGD Risks

I find it interesting, again, that the known predictive characteristics for CGD are also rather specific to the birthmother population.  Are we just damned from the get go? These are considered risk facts of CGD:

• Female; 100% without question we are all female
• Pessimistic
• Previously diagnosed with a mood disorder; I have heard many state other mental health issues as a reason to support the relinquishment
• Low self-reported social support; again this goes hand and hand with adoption relinquishment
• An insecure attachment; parental control, partner dependence, or perhaps the belief that the adoptive parents are more deserving?
• High stress: like say, an unplanned pregnancy and then the living on eggshells of an open adoption?
• A positive caregiving experience and dependency on the (deceased) baby; carrying a child for 9 months inside is a pretty positive dependency

In addition, even for the general population, some evidence suggests that the grief associated with the loss of a child may be more intense and may last longer than any other types of grief.  A 2008 study looking into grief as a result of childhood cancer states  as a conclusion “parents who have not worked through their grief are at increased risk of long-term psychological symptoms as well as impaired physical health, sleep disturbance, and increased health service use.”

Someplace, I have studies that suggest that the grief experiences from adoption relinquishment are considered “greater” than the losses from child death and may actually increase in intensity overtime. Personally, I believe  that is because we never really get back what we have lost, but as the years go by more loses are added. The grief experienced by birthmothers is continuous grief. We might be adjusting to mourning the loss of our babies, but then; the child is a toddler and THAT relationship is also gone. We must factor in that we might not have “normal” uncomplicated relationships with our grown children, even after a successful reunion or ever regain our place as “grandma” to the next generation.

What Do We Know of Birthmother Grief?

Well, no matter how much they might pooh-pooh us and tell us to “get over it” or “stop thinking so negatively” there HAVE been studies done and the research shows:

“Descriptive written words are an inadequate means  to convey the birth parent’s emotional and mental anguish and experience of separation and child relinquishment.   The grief reactions of birth parents have been described in the literature as being composed of psychological, physical and social-interpersonal reactions (Henney, Ayers-Lopez, McRoy & Grotevant, 2007).  Yet still, the breadth, depth and uniqueness of the grieving process of a birth parent is poorly understood, and even less acknowledged and legitimised (Condon, 1986; De Simone, 1996).

Several clinical studies have documented the persistent, negative effects birthmothers  have experienced after placing a child for adoption.  These have included unresolved,  prolonged, unacknowledged and complicated grief, shame, guilt, negative self image,  difficulty in intimate relationships, challenges parenting future children, fantasies of reunion,  anxiety and trauma (Condon, 1986; DeSimone, 1996; Deykin et al., 1984; Kelly, 2005; Logan, 1996; Rynearson, 1982; Smith 2006; Wiley & Baden 2005; Winkler & Van Keppel, 1984).”

Of course, the question remains, we are we supposed to do with this life we have? Tempting as it might be, I don’t think I want a pill or a treatment to make it all go away. I think tomorrow I’ll follow up with my more personal feelings on how to manage the grief especially when new.

I close with this  quote from Psychology Today:

As long as we as humans are able to form interpersonal attachments we will grieve those attachments when they are lost. Our attachments enrich our lives, and in a sense they define who we are. When we lose someone we love, we lose a part of ourselves. To say that it is “abnormal” to grieve such a loss for longer than two weeks seems to fly in the ace of what it means to be human.

May I add; to say it is “abnormal” to get over the loss of your child seems to fly in the ace of what it means to be a mother.

Further recommended reading:

BIRTH PARENT GRIEF AND LOSS RESOLUTION IN OPEN ADOPTION