"She had taken care of her husband for the last eight years of his life through his blindness through cancer and heart failure. After he died in  she sold the Long Island house theyd loved and shared finding it too filled with memories and moved to their country home in upstate New York. Friends thought Anne Schomaker was coping well with her loss she recalled. I volunteered to get myself out and doing things to fill the gaps she said. I had many interests. She traveled and even tried dating again. But I wasnt really doing well said Ms. Schomaker . I had terrible pangs of sadness and despondency. I was missing my husband so badly. Even after seeing a therapist which helped she suffered from nightmares and couldnt bear to hear arias from their favorite operas. The pain just didnt go away she said. The death of someone beloved often brings deep sadness. Usually however the intense grief of early mourning begins to ebb as months pass and people alternate between continuing sorrow and a growing ability to rediscover lifes pleasures. What distinguished Ms. Schomakers suffering was its sheer duration. She had been mired in grief for nine years when she saw an announcement from Columbia University where researchers who had developed a treatment for complicated grief were seeking participants in a study. Maybe this new approach could help Ms. Schomaker thought. Complicated or prolonged grief can assail anyone but it is a particular problem for older adults because they suffer so many losses  spouses parents siblings friends. It comes with bereavement said Dr. Katherine Shear httpsocialwork.columbia.edufacultykatherineshear the psychiatrist who led the Columbia University study. And the prevalence of important losses is so much greater in people over . In a review in The New England Journal of Medicine earlier this year Dr. Shear listed several symptoms characteristic of complicated grief http intense longing or yearning preoccupying thoughts and memories and an inability to accept the loss and to imagine a future without the person who died. Often mourners with these symptoms are convinced that had they done something differently they might have prevented the death. Severe and prolonged compared with typical reactions complicated grief impairs the mourners ability to function.  Adapting to loss is as much a part of us as grief itself said Dr. Shear who directs the Center for Complicated Grief httpcomplicatedgrief.org at the Columbia University School of Social Work. With complicated grief something gets in the way of that adaptation she said. Something impedes the course of healing. How common is this prolonged grief An epidemiological study of more than  people conducted in Germany in  put the proportion at nearly  percent and at  percent among those over age  http George A. Bonanno http director of the Loss Trauma and Emotion Lab http at Columbia University Teachers College said the real figure might be closer to  to  percent. Dr. Bonanno author of The Other Side of Sadness http What the New Science of Bereavement Tells Us About Life After Loss argues that resilience is the typical response to the death of loved ones. Yet he notes we always see a group of people who dont recover. The problem appears more likely when a death is sudden or violent when the person who died was ones spouse romantic partner or child and when the bereaved person has a history of depression anxiety or substance abuse. Defining this sort of grief has engendered some professional disagreement. What criteria distinguish complicated grief from depression or anxiety When does normal grief become prolonged Researchers disagree on even the conditions name. The American Psychiatric Association http in the latest version of its Diagnostic and Statistical Manual http of Mental Disorders declined to classify complicated grief as a mental disorder and instead included persistent complex bereavementrelated disorder in an appendix for further study. The fifth edition published in  sets  months as the point past which continued symptoms of intense grief may constitute a disorder although Dr. Shear and other researchers had proposed a threshold of six months. Some experts have argued that the available evidence doesnt support a clear distinction between longerthanaverage grieving and mental illness httpjournals.lww.comjonmdAbstractShould_Prolonged_Grief_Be_Reclassified_as_a_Mental..aspx. Does psychiatry need to continually label the range of normal human emotions as disorders Jerome C. Wakefield httpsocialwork.nyu.eduourfacultyfulltimejeromecwakefield.html a professor of social work and psychiatry at New York University said in an interview. By diagnosing complicated grief just six months after a death he said youll get a lot of normal people receiving treatment they dont need including drugs. Dr. Shear also worries about pathologizing normal emotions. But when a woman remains unable to leave her home or answer the phone four years after the death of her adult son as was true of one patient something has clearly gone wrong. If youre worried about what youre experiencing if youre not getting more engaged in life and people around you are saying Honey stop wallowing in it why not get some help Dr. Shear said. Complicated grief therapy developed by her center showed greater effectiveness among older adults than interpersonal psychotherapy in a clinical trial. Subjects including Ms. Schomaker were given a scale with statements measuring responses to loss like I think about this person so much that its hard for me to do the things I normally do and I feel that life is empty without the person who died. Their high scores indicated complicated grief. Close to half of the  subjects average age  had lost a spouse or partner and more than a quarter had lost a parent. More than three years had elapsed on average since the death. Most subjects reported that they had thought of suicide. They were randomly assigned to undergo  weekly sessions of complicated grief therapy  which focuses specifically on bereavement symptoms and incorporates memories photographs and recordings  or interpersonal psychotherapy. Both treatments helped but in the group receiving complicated grief therapy more than  percent were found much improved or very much improved httparchpsyc.jamanetwork.comarticle.aspxarticleidresultClick in the severity of their symptoms and impairment compared with  percent in the standard psychotherapy group. A larger foursite study completed but not yet published showed similar effectiveness Dr. Shear said. To make its method more widely available the Center for Complicated Grief has published a manual and offers training workshops for therapists staff members consult with and answer questions from patients and therapists around the country. Darlyn Reardon of Ross Township Pa. for instance sought complicated grief therapy at the University of Pittsburgh Medical Center in . After her husband of  years died of cancer it was like I lost my life too she said. Seven years passed and I didnt take care of myself she said. I didnt go to the doctor. I stopped going to church. We had a circle of friends and I stopped seeing them. I stopped everything. Ms. Reardon  will always miss her husband John who was a firefighter. But she can take pleasure now in a regular movie and lunch with her cousin in an affectionate pug named Lovey in her teenage grandchildren. Ms. Schomaker too feels substantially recovered. A volunteer and museumgoer with an active social life she is grateful for the complicated grief therapy she received. It gets you thinking about your loss in a different way she said. It encourages you to move on because theres happiness ahead of you."