Anne Murray Mozingo of York, ME, was a new mother, still nursing her 17-month-old son in the spring of 2000, when she woke one morning to find her husband, Bill, on the bathroom floor. He had died at 42 in the early morning hours from a brain aneurysm. Just like that, her best friend and life partner was gone, and she was left to raise her child alone.

Overwhelmed with emotions, Mozingo tried to shield her toddler from her sorrow. She would wait until he was asleep and pour out her anguish in private by screaming, crying, and punching pillows.

“I remember midnight being my time,” she says. “I would do this thing -- I would lock myself in a bathroom and pretend I was chopping down trees. It was a way to move really desperate, depressed energy out of my body.”

But after 8 months, Mozingo’s family members began wondering if she had been in mourning for too long.

“That was the first time the culture came in and said, ‘You should be better,’” Mozingo says.

Roadblocks to Relief

For a small but significant number of people, grief can cut so deep that getting through a single day seems impossible. They remain in the initial phase of shock and disbelief a year or more after their loss. This is especially true when there are complicating factors surrounding the death.

Though wounded by her family’s comments, Mozingo sought counseling. To her surprise, she had difficulty convincing prospective therapists that she had a problem. The first three were dismissive.

“One person said, ‘You’re fine. You got here on time, your blouse is ironed, and you drove yourself here.’ And I said, ‘My mother ironed this blouse, and she drove me, so (expletive) you.’”

One therapist told her she just needed to get a job and get out of the house.

“Wyatt was 2. That was a real big slap in the face because I thought I had the most important job in the world, raising him.”

The fourth counselor recognized how hard Mozingo was struggling. She diagnosed Mozingo with a condition called complicated grief. The grueling demands of solo parenting had left Mozingo little time to process her sudden widowhood.

“I was on deck all day with a human,” Mozingo says. “It wasn’t like I could slide at my job a little bit. I couldn’t take time off. I didn’t get to grieve hourly, daily, readily.”

New Diagnosis for the Bereaved

Complicated grief was first identified by researchers in 1993. Seven years later, the condition -- now called prolonged grief disorder (PGD) -- was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Prolonged grief disorder is when a person’s extreme longing or preoccupation with the dead prevents them from carrying on with their daily lives. The other eight symptoms are emotional numbness, intense loneliness and isolation, identity disruption (feeling like part of oneself has died), sense of disbelief about the death, avoiding reminders of the death, intense emotional pain (anger, bitterness, sorrow), difficulty reintegrating into daily life, and feeling that life is meaningless. PGD is diagnosed in adults if the functional impairment lasts along with at least three additional symptoms for more than a year. For children, it’s 6 months.

Some mental health practitioners were initially wary of the new DSM classification out of concern that it stigmatizes a natural response. But Amy McCarthy, a clinical social worker at Boston Children’s Hospital, believes it offers a framework for medical providers and family members to talk about grief. A clinical diagnosis also paves the way for insurance coverage.

“To submit a claim to insurance, you need to prove there is a medical necessity,” McCarthy says. “There is this argument that, of course people who are grieving can benefit from therapeutic support. But if we don’t have language to support that, then it’s much harder for those people to access help, and it’s already so difficult to gain access to mental health support.”

Not All Grief Is Equal

Natalia Skritskaya, a research scientist and grief therapist who co-founded Columbia University’s Center for Prolonged Grief in 2013, says prolonged grief can be “very disabling” and warrants treatment.

“Grief is universal and natural, I agree, but not prolonged grief,” Skritskaya says. “In a way, you could think about that argument applying to, let’s say, infection. It’s very natural to get a cold or flu. It’s universally human to get sick, but should we not do anything about it?”

Based on three separate 5-year clinical trials, the center has developed a treatment approach based on a mix of cognitive behavioral therapy, prolonged exposure therapy used for PTSD, attachment theory, mindfulness, and a variety of other techniques. It is a short-term, focused intervention that typically takes 4 months of weekly psychotherapy sessions.

Complicated Grief

You can’t know how you’ll respond to the death of a loved one until it happens. Donna George, a retired bereavement counselor in Ithaca, NY, knows from experience that the single most important determinant may be the state of the relationship you had or any unusual circumstances behind the death.

“There has to be mitigating circumstances that make it prolonged,” George, who worked in hospice for 25 years, says. “Those factors may be how the person died, if there was unfinished business with the person who died, the age of the person who died, and the mental health” of the survivor.

For instance, George led an online grief group last year for women who lost parents to the coronavirus. She saw their anguish at being denied the chance to say goodbye in person and to hold funerals.

“In our culture, we get through something like that by being around others and having people hug us and show us support,” George says. With the pandemic still raging, “I think we’re going to see more and more prolonged grief.”

Life After Loss

After her husband’s death, Mozingo feared her grief might destroy her. She eventually regained her emotional balance through medications, supplements, therapies, support groups, and a yearlong immersion in a study program of interdisciplinary spiritual practices. And Mozingo harnessed her hard-earned coping skills as a bereavement group facilitator for young widows.

Today, Mozingo is happily remarried. In 2021, her son graduated from Hofstra University with a degree in international finance. Long gone are the days of locking herself in the bathroom, pretending to chop wood to release her grief. But Bill is never far from her thoughts. She recently texted a friend a photograph of them at their wedding reception. It would have been their 27th anniversary. Mozingo cherished the bittersweet memory but didn’t dwell on it.

“Grief isn’t something you get over. Grief is something you learn to live with,” George, the bereavement counselor, says. But support and therapy “can give them permission to move forward and find joy in their life again.”

Show Sources

SOURCES:

European Journal of Psychotraumatology: “Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability.”

American Psychiatric Association: “APA offers tips for understanding prolonged grief disorder.”

The Center for Prolonged Grief, Columbia University: “Defining Grief.”

Anne Mozingo, bereavement group facilitator, York, ME.

Natalia Skritskaya, research scientist and grief therapist, co-founder of Columbia University’s Center for Prolonged Grief, New York.

Donna George, bereavement counselor and clinical social worker, Ithaca, NY.

Amy McCarthy, senior clinical social worker, Boston Children’s Hospital, Boston.

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