Grief

Grief (pronounced greef)

(1) Acute mental suffering or distress over affliction or loss; sharp sorrow; painful regret; deep or intense sorrow or distress, associated especially with the death of someone.

(2) A cause or occasion of keen distress or sorrow.

(3) In online use (especially in gaming and dating from the late 1990s), to behave in an un-sportsmanlike way or take pleasure in antagonizing other players (used as “to grief”, “griefing” or “be griefed” etc (and vaguely similar to the verb sense of troll)); to exploit a glitch or execute an online prank that diminishes or ruins a website or other online experience for other users.

(4) In idiomatic use, as “come to grief”, to suffer disappointment, misfortune, or other trouble; to fail:

(5) In idiomatic use as “good grief”, an exclamation of dismay, surprise or relief which can be used also to convey approval or disapproval, depending on context, verbal & non-verbal.

(6) In idiomatic use, as “giving me grief”, an expression of (usually mild) annoyance.

1175-1225: From the Middle English greef & gref (hardship, suffering, pain, bodily affliction), from the Anglo-French gref, from the verb grever (afflict, burden, oppress), from the Old French grief (grave, heavy, grievous, sad), from the Vulgar Latin grevis & gravare (make heavy; cause grief), from the Latin gravis (weighty, heavy, grievous, sad) (later influenced by its antonym levis) and ultimately from primitive Indo-European gréhus, gwere & gwerə- (heavy).  The general sense of “suffering or hardship” (Emotional pain, generally arising from misfortune, significant personal loss, bereavement, misconduct of oneself or others, etc.; sorrow; sadness) evolved between the early thirteenth and fourteenth centuries; a doublet of grave.  The alternative forms were greefe & griefe, both long obsolete.  The expression “good grief” appears to date only from 1912 but has been used in historical fiction which long pre-dates the twentieth century.

The circa 1300 adjective grievous was from the Anglo-French grevous, from the Old French grevos (heavy, large, weighty; hard, difficult, toilsome) and was formed directly from grief.  The term grievous bodily harm (the famous GBH) was first used in English criminal law in 1803.  The circa 1300 noun grievance (state of being aggrieved) was from the Old French grevance (harm, injury, misfortune; trouble, suffering, agony, sorrow) from grever (to harm, to burden, be harmful to) and was first used in reference to a cause of such a condition from the late fifteenth century.  The verb is now most commonly found in the gerund-participle griefing and the derived noun griefer; the past participle is griefed and the noun plural griefs.  The related terms include grievance, grieve & grievous and grief is sometimes used as a modifier (grief-striken, grief-tourism et al).  Words which often overlap with grief include agony, anguish, bereavement, despair, discomfort, gloom, heartache, heartbreak, melancholy, misery, moroseness, mourning, pain, regret, remorse, sadness, sorrow, trouble, unhappiness, woe & worry.

The DSM-5-TR, ICD codes and Prolonged Grief Disorder (PGD)

In March 2022, the American Psychiatric Association (APA) released a revision to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (2013)).  DSM-5-TR (text revision) includes some updated text and new references, clarifications to diagnostic criteria and updates to the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes which have changed since the DSM-5 was published in 2013.  A text revision to an edition of the DSM is released when a number of changes to the text that accompanies the description of disorders and their criteria are warranted by new evidence or the need for more clarity.  The text of the DSM-5 had since 2013 received some minor corrections but DSM-5-TR is a systematic text revision based on a review of the literature of the last decade (and some re-evaluation of some earlier material).  By contrast, a new edition of the DSM is released when there are thought to have been sufficient advances in the field to support the creation, substantive revisions, and elimination of multiple diagnostic criteria sets or disorders.  There has within the profession been some discussion of the implications of this and some have suggested there’s no indication of support for the need for a DSM-6, some speculation the APA might adopt the conventions of the software industry and work instead towards a version 5.1, the first number indicating a major release, the second the agglomeration of minor revisions, a format well suited to digital editions.

New ICD-10-CM codes have been added to flag and monitor suicidal behavior and non-suicidal self-injury and these can be used without the requirement of another diagnosis and in total there are over 50 coding updates for substance intoxication, withdrawal and other disorders.  The innovation in the use of the ICD-10-CM codes relation to suicidal behavior is interesting.  It’s long been understood suicidal behavior can be a useful tracking mechanism or flag for clinical attention and these codes are now available to all clinicians without the need for a mental disorder diagnosis.  The suicidal behavior codes can be applied to individuals who have engaged in potentially self-injurious behavior with at least some intent to die as a result of the act and the evidence of intent can be explicit or inferred from the behavior or circumstances.  Many suicide attempts don’t result self-injury and the changes reflect the analysis of the statistical data which indicated the previous focus on self-harm and injury meant the extent of the disorder was in many ways underestimated.  It should mean the always interesting phenomenon of “suicide attempts” undertaken in the in absence of suicidal intent becomes better understood or at least quantified.

The new diagnosis of Prolonged Grief Disorder (PGD) has been added to the trauma- and stressor-related disorders chapter.  Noted for centuries, much recent research and clinical experience has indicated there are those who experience a persistent inability to overcome their grief for the loss of a loved one for at least a year or more, with intense yearning or preoccupation with thoughts or memories of the deceased person almost every day since the death (and it’s noted that in children and adolescents, this preoccupation may focus on the circumstances of the death), symptoms severe enough to impair day-to-day functioning.  As part of the diagnosis, the duration and severity of the bereavement reaction must clearly exceed what is expected based on standards related to the individual’s social, cultural, or religious background. This does not imply people feeling grief periodically one year or more after the loss of a loved one have the disorder but those with intense and impairing grief after one year may be considered for the diagnosis.  Prior to the fifth edition, the DSM did not distinguish between “normal” and prolonged grief but PGD may be considered an evolution given the DSM-5 did include a category of persistent complex bereavement disorder (known also as traumatic grief (TG) & complicated grief (CG)) as a “condition for further study” and the first draft of a proposal was in 2018 submitted to the DSM Steering Committee and the Review Committee on Internalizing Disorders, a white paper circulated for discussion before being approved by the Board of Trustees.

The DSM editors clearly were sensitive to suggestions the creation of prolonged grief disorder might have the effect of pathologizing grief and there has long be the criticism that psychiatry increasingly has attempted to list as disorders much that has for centuries been considered part of the “normal” human condition.  To clarity things, the editors note the diagnosis is not a medicalization of grief and the diagnosis is intended only for those individuals who meet the criteria: something dramatically different from the grief normally experienced by anyone who loses a loved one; a grief intractable and disabling in a way that typical grieving is not.  Grief continues to be thought of as something healthy but not if ongoing and it's dealt with in different ways.  In 2013 Lindsay Lohan revealed her 19 year old Maltese dog Gucci (which gained the name after chewing up a pair of prized Gucci boots) had died and to feel a form of grief is thought to be a natural reaction to the event but it shouldn't persist and in many cases it seems the best therapy to to replace the pet with another/

One internally significant technical change is also noted: there are now no unique DSM codes.  The codes that appear in DSM-5-TR are the ICD codes that are equivalent to the DSM diagnoses given the version of the manual and only ICD-10-CM codes are used because this is the version of ICD that is in effect in the United States.  Although based on the World Health Organization’s (WHO) ICD-10 codes, ICD-10-CM codes in DSM-5 (and thus DSM-5-TR) have been modified from ICD-10 for clinical use by the US Centers for Disease Control (CDC) and Prevention’s National Center for Health Statistics (NCHS) and provide the only permissible diagnostic codes for mental disorders for clinical use in the United States. In the United States, the use of ICD-10-CM codes for disorders in DSM-5-TR has been mandated by the Health Care Financing Administration (HCFA) for purposes of reimbursement under the Medicare system. Although it sounds nerdy, it’s an important advance in standardization which should improve record keeping, data collection, retrieval, and compilation of statistical information.

One change which was expected was the update to the terminology to describe gender dysphoria based on updated and more culturally sensitive language.  (1) desired gender is now experienced gender, (2) cross-sex medical procedure is now gender-affirming medical procedure” and (4)  the companion terms natal male / natal female are now individual assigned male / female at birth.  Whether these changes prove to be final remains to be seen; the whole area is one of shifting linguistic sand but what’s in DSM-5-TR reflects current thinking and the entire text of the Gender Dysphoria chapter has also been updated based on a review of the literature.

Also expected was the restructuring (again) of the diagnostic criteria of Autism, reflecting the view that Autism seems to be over diagnosed, a problem inherent in spectrum conditions.  Less anticipated was the creation of Unspecified Mood Disorder (UMD) which, ominously, does sound like the criminal charge of “unspecified offences” used in the justice systems of places like the DPRK (North Korea) but which seems to have been coined to permit clinicians some flexibility so that patients presenting with irritability, agitation and sadness (and for whom some diagnosis is clearly appropriate), don’t have to be labeled as “bipolar unspecified” or “depressive disorder unspecified’, both stigmatizing conditions, the presence of which in a medical record may have implications which last a lifetime.  It’s thus a legitimate diagnosis (which really is important to patients) to be applied until a more specific disorder is found but does raise two interesting technical points: (1) can any emo not be diagnosed UMD and (2) should all emos be diagnosed UMD?

Mourn

Mourn (pronounced mawrn or mohrn)

(1) To grieve or lament for the dead.

(2) To show the conventional or usual signs of sorrow over a person's death.

(3) To feel or express sorrow or grief over (misfortune, loss, or anything regretted); to deplore (now restricted mostly to literary or poetic use).

(4) To utter in a sorrowful manner.

(5) To observe the customs of mourning, as by wearing black garments (sables).

(6) In jousting, a ring fitted upon the head of a lance to prevent wounding an adversary in tilting (a charging with a lance).

Pre 900: From the Middle English mournen & mornen, from the Old English murnan (to feel or express sorrow, grief, or regret; bemoan, long after and also “be anxious about, be careful” (past tense: mearn, past participle: murnen), from the Proto-Germanic murnaną & murnan (sorrowfully to remember)  It was cognate with the Old High German mornēn (to be troubled), the Old Norse morna (to pine away. also “to dawn (become morning)”), the Greek mermeros (worried), the Gothic maurnan (to grieve) and the French morne (gloomy).  The proto-Germanic was the source also of the Old Saxon mornon and was probably a suffixed form of the primitive Indo-European root mer & smer- (to remember).  The use to mean “to lament the death of” emerged late in the thirteenth century while the sense of “display the conventional appearance of grieving for a period following the death of someone” was in use by the 1520s.  The noun mourning (feeling or expression of sorrow, sadness, or grief) was in use in the late twelfth century and was from the Old English murnung (complaint, grief, act of lamenting), a verbal noun from the verb mourn.  The meaning “customary dress or garment worn by mourners” dates from the 1650s although mourning habit was in use in the late fourteenth century.  The North American mourning dove was named in 1820 and was so-called because of its soulful call.  The adjective mournful (expressing sorrow; oppressed with grief) came into use in the early 1600s.  The spelling morne was used during the fourteenth & fifteenth centuries.  Mourn & mourned are verbs, mourning is a noun & verb, mourner & mournfulness are nouns, mournful is an adjective and mournfully is an adverb; the noun plural is mourners.

Comrade Stalin (1878-1953; Soviet leader 1924-1953, far right) as chief mourner, carrying the coffin of comrade Sergei Kirov (1886–1934; Russian Bolshevik revolutionary & Soviet politician), Moscow 6 December 1934.

Although no documentary evidence has ever been found, most historians believe the execution was approved by comrade Stalin and in a nice touch, within a month, Kirov's assassins were convicted in a show trial and executed.  As the death toll from the purges of the 1930s accelerated, comrade Stalin stopped attending funerals; he just wouldn't have ben able to find the time.  Adolf Hitler (1889-1945; Führer (leader) and German head of government 1933-1945 & head of state 1934-1945) seems not to have appeared as a mourner at the funerals of any of those he’d ordered killed but he certainly issued statements mourning their passing.  Less ominously, UK Prime Minister Lord Salisbury (Robert Arthur Talbot Gascoyne-Cecil, 1830–1903; UK Prime Minister for thirteen years variously 1885-1902) remarked of the long, sad decline of Lord Randolph Churchill (1849–1895) that the deceased had proved to be “chief mourner at his own protracted funeral”.

Political mourning is a special class of lament and when some politicians are buried, their erstwhile colleagues are among the mourners only because such events are a nice photo-opportunity and a useful place for a bit of networking.  The Australian politician Pat Kennelly (1900–1981; senator for Victoria (Australian Labor Party (ALP)) 1953-1971) (who had a chronic stutter) once attended the funeral of a member of parliament (MP).  It was well-attended event with many mourners and later he was heard to observe: “It w-w-w-a-as a v-v—very s-s-sa-ad occasion.  H-h-his w-w-wi-wife and f-f-f-family were there.  There was not a d-d-dry eye in the ce-ce-cemetery.  E-e-everyone w-a-was in t-t-t-tears.  As I w-w-w-watched them f-f-file out of th-th-the ce-ce-cemetery I th-th-thought h-h-how s-s—sad.  Th-th-three h-h—hundred m-m-mourners with a s-s-single th-th-thought: ‘Wh-h-ho’s g-g-oing to w-w-win the pre-pre-pre-selection f-f-for his s-s-seat?’”

Potential gig: Lindsay Lohan in mourning garments (sables), Sohu Fashion Achievement Awards Ceremony, Shanghai, China, January, 2014.  Acting is of course a good background for a professional mourner and the career part is sometimes available to even the well-known because their presence at a funeral would be an indicator of the wealth of the deceased.

Culturally, the mourners at one’s funeral can matter because their measure in both quantity & quality greatly can influence how one is remembered and to some (and certainly their surviving friends & family), greatly that matters.  While it’s true that once one is dead, that’s it, the memory others have of one is affected by whether one drank oneself to death, was struck by a meteorite or murdered by the Freemasons and the spectacle of one’s funeral also leaves a lasting impression.  A funeral with a scant few mourners presumably says much about the life of the deceased but for those facing that, there’s the ancient tradition of the professional mourners (known in some places as moirologists, sobbers, wailers, or criers.  In South Africa, those after greater drama can hire someone hysterically to cry and threaten to jump into the grave to join the departed forever wherever they’re going (it’s said this is an “extra-cost” service).

There is reference in both the Old and New Testaments to the profession: In 2 Samuel 14 it was recorded: “…and fetched thence a wise woman, and said unto her, I pray thee, feign thyself to be a mourner, and put on now mourning apparel, and anoint not thyself with oil but as a woman that had a long time mourned the dead.”  It does seem the practice of paid mourning began in China or the Middle East but it was a thing also in ancient Egypt and Rome.  In Egypt, it was actually a formalized part of the ritual (at least for the urban wealthy) in that part of the order of service required the family to pay for the provision of “two professional women mourners”, there as representatives of the psychopomps ( conductors of souls to the afterworld) Isis (inter alia the guardian deity who protected her followers in life and in the afterlife) and her sister Nephtys (protector of the deceased and guardian of the dead).

In Rome, it was more an expression of conspicuous consumption and the more rich or more illustrious a celebrity someone had been while walking the Earth, the better attended and more ostentatious would be the funeral procession, professional mourners making up usually a goodly proportion of the count.  They earned their money because the cultural expectation was they were expected to cry and wail, look distraught, tear at their hair and clothes and scratch their faces with their fingernails, the drawing of a little blood a sign of grief; the more professional mourners in a procession, the higher the implied status of the deceased.  Historically (and apparently cross-culturally), professional mourners have tended to be women because such displays of emotions from them were accepted in a way that wouldn’t have been accepted if exhibited by a man.

Plangent

Plangent (pronounced plan-juhnt)

(1) Resounding loudly with an expressively plaintive sound (associated especially with the chiming of bells).

(2) Any loud, reverberating sound (now rare and probably obsolete).

(3) Mournful music (regardless of volume).

(4) By extension, in literature and poetry, text which is plaintive, mournful, a lament etc (now used loosely).

(5) By extension, in casual use, a state of mind somewhat short of melancholy.

(6) Beating, dashing, as in the action of breaking waves (obsolete except (rarely) as a literary or poetic device).

1822: From the Latin verb plangent- (stem of plangēns), the present participle of plangere (to beat (in sorrow more than anger)) and third-person plural future active indicative of plangō (I beat (my breast); I lament), from the primitive Indo-European root plak- (to strike).  The origin of the idea was in the “breast-beating” a demonstrable form of grief noted by anthropologists in cultures far removed from European contact so apparently something which evolved independently and possibly inherited from our more distant ancestor species.  Plangent is an adjective, plangency is a noun and plangently is an adverb; the noun plural is plagencies.

Plangent was adopted in English to mean “a loud sound which echoes and is suggestive of a quality of mournfulness”.  It was originally most associated with the bells sounded during funerals or memorial ceremonies.  By the mid-late nineteenth century additional layers of meaning had been absorbed, notably (1) sorrowful or somber music and, (2) prose or poetic verse evocative of such feelings.  So it was linguistic mission creep rather than a meaning shift that saw “plangent” a word to use of sad songs and maudlin poetry.  In the technical sense, the original meaning still resonates; the “haunting peal of a church bell” can be called plangent and a poem which as text on the page may seem emotionless can be rendered startlingly plangent, if spoken in a certain tone and with a feeling for the pause.  In the jargon of some military bands, “the plangent” remains the instruction for the use of percussion to produce the slow, continuous and atonal beat used for funeral marches or somber commemorative ceremonies and this recalls the original use in English: “beating with a loud sound”, from the Latin plangere, (to strike or beat), the idea in antiquity an allusion to the “beating of the breast” associated with grief.  From this developed the general sense of “lament” which has survived and flourished.  The adjectival sense of anything “loud and resounding” is probably obsolete.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

Suffering ranging from mild displeasure to dark despair being clearly an inescapable part of the human condition, the synonyms of plangent are legion, the choice dictated by the precise nuance one wishes to capture, the forms including: aching, agonized, anguished, bemoaning, bewailing, bitter, deploring, doleful, dolorous, funereal, grieving, heartbroken, lamentable, longing, lugubrious, mournful, plaintive, regretful, rueful, sorrowful, sorry, wailing, weeping & woeful.  Take your pick.

Long Distance II by Tony Harrison (b 1937)

 Though my mother was already two years dead
Dad kept her slippers warming by the gas,
put hot water bottles her side of the bed
and still went to renew her transport pass.
 
You couldn't just drop in.  You had to phone.
He'd put you off an hour to give him time
to clear away her things and look alone
as though his still raw love were such a crime.
 
He couldn't risk my blight of disbelief
though sure that very soon he'd hear her key
scrape in the rusted lock and end his grief.
He knew she'd just popped out to get the tea.
 
I believe life ends with death, and that is all.
You haven't both gone shopping; just the same,
in my new black leather phone book there's your name
and the disconnected number I still call.

Shortly before he died, the poet Stephen Spender (1909–1995) wrote that Tony Harrison’s series of elegies for his parents “...was the sort of poetry for which I've been waiting my whole life.”

Compunction

Compunction (pronounced kuhm-puhngk-shuhn)

(1) A feeling of uneasiness or anxiety of the conscience caused by regret for doing wrong or causing pain; contrition; remorse; sorrow.

(2) Any uneasiness or hesitation about the rightness of an action.

1350–1400: From the Middle English compunccion, from the Old French compunction (from which in the twelfth century Modern French gained compunction), from the Late Latin compunctionem (a pricking) & compūnctiōn- (stem of the Ecclesiastical Latin compunctiō) (remorse; a stinging or pricking (of one’s guilty conscience)), the construct being the Classical Latin compūnct(us) (past participle of compungere (to sting; severely to prick), the construct of which was (com- (used as an intensive prefix) + pungere (to prick; to puncture) (from a suffixed form of the primitive Indo-European root peuk- (to prick)) + -iōn- (stem of –iō and a suffix forming nouns, used especially on past participle stems).  The origin of the meaning in Latin (transferred from the element pungere (to prick; to puncture)) was the idea of “a pricking of one’s guilty conscience” which could induce some feeling of regret although, like many injuries cause by pin-pricks, recovery was often rapid.  The adjective compunctious (causing compunction, pricking the conscience) dates from the late sixteenth century.  Compunction & compunctiousness are nouns, compunctious & compunctionless are adjectives and compunctiously is an adverb; the noun plural is compunctions.

The Ecclesiastical Latin compunctiō (and compunction in other forms) appears frequently in the texts of the early Church, used in a figurative sense originally to convey a more intense sense of “contrition” or “remorse” than that familiar in modern use.  Contrition and remorse were of course a thing vital for the Church to foster, indeed to demand of the congregation.  The very structure of Christianity was built upon the idea that all were born in a state of guilt because the very act of conception depending upon an original sin and this was what made Jesus unique: the virgin birth meant Christ was born without sin although centuries of theological squabbles would ensue as the debate swirled about his nature as (1) man, (2) the son of God and (3) God.  That was too abstract for most which was fine with the priests who preferred to focus on the guilt of their flock and their own importance as the intermediaries between God and sinner, there to arrange forgiveness, something which turned out to be a commodity and commodities are there to be sold.  Forgiveness was really the first futures market and compunction was one of the currencies although gold and other mediums of exchange would also figure.

Sorry (Regretful or apologetic for one's actions) was from the From Middle English sory, from the Old English sāriġ (feeling or expressing grief, sorry, grieved, sorrowful, sad, mournful, bitter), from the Proto-West Germanic sairag, from the Proto-Germanic sairagaz (sad), from the primitive Indo-European seh₂yro (hard, rough, painful).  It was cognate with the Scots sairie (sad, grieved), the Saterland Frisian seerich (sore, inflamed), the West Frisian searich (sad, sorry), the Low German serig (sick, scabby), the German dialectal sehrig (sore, sad, painful) and the Swedish sårig.  Remarkably, despite the similarities in spelling and meaning, “sorry” is etymologically unrelated to “sorrow”.  Sorrow (a state of woe; unhappiness) was from the Middle English sorow, sorwe, sorghe & sorȝe, from the Old English sorg & sorh (care, anxiety, sorrow, grief), from the Proto-West Germanic sorgu, from the Proto-Germanic surgō (which may be compared with the West Frisian soarch, the Dutch zorg, the German Sorge, and the Danish, Swedish and Norwegian sorg), from the primitive Indo-European swergh (watch over, worry; be ill, suffer) (which may be compared with the Old Irish serg (sickness), the Tocharian B sark (sickness), the Lithuanian sirgti (be sick) and the Sanskrit सूर्क्षति (sū́rkṣati) (worry).

Johnny Depp & Amber Heard saying sorry in Australia and Johnny Depp deconstructing sorry in London.

Sorry indicates (1) one is regretful or apologetic for one’s thoughts or actions but it can also mean (2) one is grieved or saddened (especially by the loss of something or someone), (3) someone or something is in a sad or regrettable state or (4) someone or something is hopelessly inadequate for their intended role or purpose.  Such is human nature that expressions of sorry in the sense of an apology are among the more common exchanges and one suspects something like the 80/20 rule applies: 80% of apologies are offered by (or extracted from) 20% of the population.  So frequent are they that an art has evolved to produce phrases by which an apology can be delivered in which sorry is somehow said without actually saying sorry.  This is the compunction one fells when one is not feeling compunctious and a classic example was provided when the once (perhaps then happily) married actors Johnny Depp (b 1963) & Amber Heard (b 1986) were in 2015 caught bringing two pet dogs into Australia in violation of the country’s strict biosecurity laws.  Ms Heard pleaded guilty to falsifying quarantine documents, stating in mitigation her mistake was induced by “sleep deprivation”.  No conviction was recorded (the maximum sentence available being ten years in jail) and she was placed on a Aus$1,000 one-month good behavior bond, the couple ordered to make a “public apology” and that they did, a short video provided, the script unexceptional but the performances something like a Monty Python sketch.  However, whatever the brief performance lacked in sincerity, as free advertising for the biosecurity regime, it was invaluable.  Mr Depp later returned to the subject when promoting a film in London.

The synonyms for “sorry” (as in an apology) include regret, apologize, compunctious, contrite, penitent, regretful, remorseful & repentant (which is more a subsequent act).  Practiced in the art of the “non-apologetic” apology are politicians (some of whom have honed it to the point where it’s more a science) who have a number of ways of nuancing things.  Sometimes the excuse is that simply to say “sorry” might subsequent legal proceedings be construed as an admission of liability, thus exposing the exchequer and there was some basis for that concept which has prompted some jurisdictions explicitly to write into legislation that in traffic accidents and such, simply to say “sorry” cannot be construed as such an admission.  That of course has had no apparent effect on the behaviour of politicians.  Even when there is no possibly of exposing the state to some sort of claim, politicians are still averse to anything like the word “sorry” because it’s seen as a “loss of face” and a victory for one’s opponents.

There are exceptions.  Some politicians, especially during periods of high popularity, worked out that such was the novelty, saying sorry could work quite well, especially if delivered in a manner which seemed sincere (and the right subject, in the right hands, can learn such tricks) although some who found it worked did overdo it, the repetition making it clear it was just another cynical tactic.  An example was Peter Beattie (b 1952; Premier of Queensland 1998-2007) who found the electorate responded well to a leader saying sorry but such was the low quality of the government he headed that there was often something for which to apologize and having set the precedent, he felt compelled to carry on until the sheer repetitive volume of the compunctiousness began merely to draw attention to all the incompetence.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

The other exception is the set-piece event.  This is where a politician apologizes on behalf of someone else (a previous government, hopefully the opposition or something a vague as the nation in some dim, distant past) while making it clear that personally it’s nothing to do with them personally.  There has been a spate of these in recent decades, many apologizing for egregiously appalling acts by white men against ethnic minorities, indigenous populations, the disabled or other powerless groups.  Again, some of the apologies have been in the form of “personally sorry it happened”, thereby ticking the box without costing anything; people like and indigenous population apparently deserving words but not compensation.  For the rest of us, ranging from the genuinely sincere to the cynically opportunistic nihilistic psychopaths, the most obvious tool is the adverb: to say “I am so sorry” can be more effective than “I’m sorry” provided the tone of voice, inflections and the non-verbal clues are all in accord.  Sorry is recommend by many because it so easily can be made to sound sincere with a ease that’s challenging with compunctious, contrite, penitent, regretful, and remorseful, the longer words ideal for one politician “apologizing” to another in a form which is linguistically correct while being quite contemptuous.

Lament

Lament (pronounced luh-ment)

(1) To feel or express sorrow or regret for.

(2) To mourn for or over.

(3) An expression of grief or sorrow.

(4) A formal expression of sorrow or mourning, especially in verse or song; an elegy or dirge.

1520-1530: Ultimately, the noun was from the Latin lāmentum (plaint) and the verb from the Latin lāmentārī (to wail, moan, weep, lament), a derivative of lāmentum (a wailing, moaning, weeping).  In English, lament was a backformation from lamentation or else from the fourteenth century Middle French lamenter (to moan, to bewail" or directly from the Latin lāmentārī (from lāmentum).  The other formation in Latin was lāmentor (I wail, I weep”), from lāmenta (wailings, laments, moanings), the construct being la- (thought likely imitative) + the formative –mentum in the sense of “to project”.  

Lindsay Lohan and her lawyer in court, Los Angeles, 2011.

The adjective lamented in the sense of "mourned for" is from 1610 and the use as a form of mourning or lyric poetry dates from the 1690s.  Given the nature of man, the adjective unlamented, attested since the 1590s, is often used.  Lament & lamenting are nouns & verbs, lamentations & lamenter are nouns, lamentable and (the unpleasingly rare) lamentful are adjectives, lamentingly is an adverb and lamented is a verb & adjective; the common forms of the noun plural are is laments & lamentations.

Destruction of Temple of Jerusalem (1867) by Francesco Hayez (1791-1882).

The Old Testament’s Book of Lamentations (from אֵיכָה‎, (‘Êykhôh) (how) in the Hebrew), written probably during the sixth century BC, commemorates in five poems the destruction in 586-587 BC of Jerusalem by the neo-Babylonians.  By this time, the language of lament already enjoyed a rich tradition in the writings of the Israelite religion, borrowing from a genre known in ancient Mesopotamian practices and continuing to late biblical times.  Lamentations is a bleak work which documents undeserved suffering and focuses on the dead and those who mourn their loss.  It seems clear that for those forsaken by God, hopes of redemption are scant although, despite it all, it’s clear that even if God has tired of Israel, the Israelites must keep the faith and hope one day for His grace.  There’s an exploration too of guilt, the Book of Lamentations drawing from ancient texts the teaching that the destruction of the holy city was God’s retribution for the sin and wickedness of the inhabitants.

The biblical message thus is: (1) There are consequences for sin and if repentance is refused even if offered time and again, God will deliver the appropriate judgment.  (2) Lamentation is the way to express grief and one good for the soul for in life there must be sadness. (3) Beyond despair there is always hope.  Although the people of Judah had defied God, committed idolatry, been adulterous and performed abominations and thereby deserved their just punishment, even in his judgment, God offers hope with the dawning of each new day.

Charlotte Brontë (1816–1855).

Some anthologies include Charlotte Brontë’s poem Life (1846) among the laments but that may be the lingering effect of Elizabeth Gaskell's (1810–1865) 1857 biography, a very Victorian work which managed to portray the author of the deliciously depraved Jane Eyre (1847) as the doomed, saint-like victim of the circumstances which crushed her and the consumption which stalked her.  Gaskell’s crafted miserabilia of course created a legend of its own, a kind of death cult for those for whom victimhood isn’t quite enough so she’s long been on the emo reading list.  She deserves better.  Life is a poem which notes why one might lament the vicissitudes of existence but doesn’t long dwell on it and one suspects Charlotte Brontë found life on Earth enchanting.  As one might gather from Jane Eyre, she thought it better to better to lust for life than long lament losses.

Life (1846) by Charlotte Brontë

Life, believe, is not a dream
So dark as sages say;
Oft a little morning rain
Foretells a pleasant day.

Sometimes there are clouds of gloom,
But these are transient all;
If the shower will make the roses bloom,
O why lament its fall?

Rapidly, merrily,
Life's sunny hours flit by,
Gratefully, cheerily,
Enjoy them as they fly!

What though Death at times steps in
And calls our Best away?
What though sorrow seems to win,
O'er hope, a heavy sway?

Yet hope again elastic springs,
Unconquered, though she fell;
Still buoyant are her golden wings,
Still strong to bear us well.

Manfully, fearlessly,
The day of trial bear,
For gloriously, victoriously,
Can courage quell despair!

Proctology

Proctology (pronounced prok-tol-uh-jee)

(1) The branch of medicine dealing with the pathology of the colon, rectum and anus.

(2) Historically, the branch of medicine dealing with the surgery of the colon, rectum, and anus.

(3) In modern use, colorectal surgery as a specialty inside (as it were) proctology.

(4) A department or building so named in a hospital, university or clinic etc.

1896: The construct was procto- +‎ -logy or proct- + -ology.  Procto was from a Latinized form of the Greek prōktos (anus), from the primitive Indo-European prokto-, the source also of Armenian erastan-k' (buttocks).  The suffix -ology was formed from -o- (as an interconsonantal vowel) +‎ -logy.  The origin in English of the -logy suffix lies with loanwords from the Ancient Greek, usually via Latin and French, where the suffix (-λογία) is an integral part of the word loaned (eg astrology from astrologia) since the sixteenth century.  French picked up -logie from the Latin -logia, from the Ancient Greek -λογία (-logía).  Within Greek, the suffix is an -ία (-ía) abstract from λόγος (lógos) (account, explanation, narrative), and that a verbal noun from λέγω (légō) (I say, speak, converse, tell a story).  In English the suffix became extraordinarily productive, used notably to form names of sciences or disciplines of study, analogous to the names traditionally borrowed from the Latin (eg astrology from astrologia; geology from geologia) and by the late eighteenth century, the practice (despite the disapproval of the pedants) extended to terms with no connection to Greek or Latin such as those building on French or German bases (eg insectology (1766) after the French insectologie; terminology (1801) after the German Terminologie).  Within a few decades of the intrusion of modern languages, combinations emerged using English terms (eg undergroundology (1820); hatology (1837)).  In this evolution, the development may be though similar to the latter-day proliferation of “-isms” (fascism; feminism et al).  A physician specializing in proctology is a proctologist although some may prefer the punchier construction Bart Simpson (from the cartoon TV series The Simpsons), used: “butt doctor”.  The noun proctalgia (pain in the anus or rectum) existed in the medical literature as early as 1811 while the first known use of “proctologist” dates from 1897.  Proctology & proctologist are nouns and proctologic & proctological are adjectives; the noun plural is protologists.

In 1974, The British Medical Journal (BMJ) used the term “guitar nipple” to describe “the irritation to the breast that can occur from the pressure of the guitar against the body.”  In the same spirit, two years later a contributor to the Journal of the American Medical Association (JAMA) was more imaginative still, coining “hot pants syndrome” when documenting cases in which a burn to the skin had been induced by a patient carrying a battery-powered transistor radio in the pocket of their trousers.  There was also in 1978 the New England Journal of Medicine's (NEJM) “disco digit” which referred to “a sore or infected finger caused by too much finger snapping while dancing.”  These terms were indicative of the trend in the English-speaking world for newly-identified (and in some cases novel conditions) to be constructed with English elements, rather than the Latin historically used.  In the fields of proctology, the historic terms (of discomfort in the region) were:

Rectalgia (pain in the rectum), the construct being rect- (a clipping of the New Latin rectum, itself a clipping of the Latin rectum intestinum (literally “the straight intestine”), neuter of rectus (straight) +‎ -algia (from the New Latin -algia (pain), from the Ancient Greek ἄλγος (álgos) (pain).

Proctalgia (pain in the anal or rectal region), the construct being proct- (a New Latin combining form, from Ancient Greek πρωκτός (prōktós) (anus).+‎ -algia.

Anodynia (anal pain; anorectal pain), the construct being ano- (from the Latin anus) + -dynia (an alternative (used when the preceding morpheme has a terminal vowel) form of -odynia (a New Latin combining form, from the Ancient Greek ὀδύνη (odúnē) (sorrow, grief, anguish, unhappiness).

Confusingly though, because terminology evolved often independently an in parallel, medicine contrived to use anodynia also to mean “the absence of pain in a previously painful region” and in that case the construct differed, being an- (from the Ancient Greek ἀν- (an-); a doublet of un- and in- (used her in the sense of a negation) +‎ odynia (a New Latin combining form, from the Ancient Greek ὀδύνη (odúnē) (sorrow, grief, anguish, unhappiness).  So for the non-medically trained, confusion could arise given anodynia can mean either “pain in the butt” or “pain has gone away” although because it’s a word unlikely much to be seen by other than the medically trained, instances of this have presumably been rare.  But in the context of “butt pain” there would seem to be some overlap in meaning between rectalgia, proctalgia & anodynia but while all are used to refer to “pain in or around the rectal area”, in the profession there are distinctions in use, particularly in clinical and diagnostic work 

Rectalgia is used to describe pain localized in the rectum and tends to be used as general term for the condition and often without specifying a cause.  Conditions associated with rectalgia include anorectal abscesses and fissures.  Proctalgia encompasses pain in the anorectal region (both anus and rectum) and is commonly used of proctalgia fugax, a specific condition characterized by sudden, severe, and brief rectal pain with no obvious underlying cause.  As the etymology suggests, proctalgia’s remit is broader than that of rectalgia because it includes both anus and rectum.  Whether or not related to the duality of meaning, anodynia is now not in general clinical use but historically it referred to pain in the vicinity of the anus.  The modern terms for that are “anal pain” & “anorectal pain”.  So, although lay-readers might be forgiven for thinking they could be used interchangeably, clinicians applied them based on anatomical location: rectalgia (rectum), anodynia (anus) &, proctalgia (anorectal region).

In the thoughts of Kellyanne Conway: A protologist's ultrasonic rectal probe (available in 140 & 200 mm (5½ & 8 inch) length versions) by the Electro Surgical Instrument Company (ESI (1896)).

Protology and pains in the butt do feature in idiomatic use in English.  Kellyanne Conway (b 1967; senior counselor to the US president, 2017-2020) when discussing the “Muller probe” (an investigation by special counsel Robert Mueller (1944) into Donald Trump (b 1946; US president 2017-2021; president elect 2024) and the matter of alleged Russian interference in the 2016 US presidential election) told a press conference the whole project was “a political proctology exam.”  She clearly liked the imagery because later, when Mr Muller handed down his report, she told the assembled press pack it was the “best day” since Mr Trump’s (2016) election, repeated the phrase “political proctology” and, sticking with medical allusions, said the verdict delivered “a clean bill of health.”

PITB (and its variations) is widely used.

Kellyanne Conway in hoodie: Miss January, Clare Boothe Luce Policy Institute's annual Conservative Women Calendar (2009).

So like Mr Trump, Ms Conway would have found the Muller probe a (metaphorical) pain in the butt but “political proctology exam” was both a more polite and elegant way of saying it.  The saying “pain in the butt” belongs to a class of such expressions (all meaning “a nuisance; a source of trouble or annoyance”) which variously are used according to the need for politeness, the hierarchy of rudeness (in ascending order) being: “pain in the neck”, “pain in the brain”, “pain in the back” (all about equal), “pain in the rear”, “pain in the bum”, “pain in the ass” & “pain in the arse” (the choice between “ass” & “arse” dictated by linguistic tradition).  All are often used as initializms (PITN PITB, PITR, PITA) and PITA seems the most popular while in oral use “pain in the neck” and “pain in the ass (arse)” vie for popularity although some do like “pain in the brain” for the rhyme.

First edition (hardcover, 1956) of Soranus' Gynecology, published by Johns Hopkins University Press, translated and with an introduction by Owsei Temkin MD (1902-2002).

Quite when the idea of “specialists” in the modern sense of the word came to the practice of medicine isn’t certain but long before such things were formalized by the creation of colleges or specialist qualifications, it’s likely the early physicians did tend to develop particular areas of expertise and would have had certain patients referred to them, much as is the modern practice.  Probably, this emergence of specialties would have happened organically, based on geography: a physician in a fishing community on the sunny Aegean coast would have encountered a different patient profile than one who worked in the cold of the mountains.  Thus, while it’s not known who can be though the “first proctologist”, medical students everywhere will probably nominate Soranus of Ephesus, a Greek physician who practiced in both Alexandria and Rome during the first & second century AD.  His four-volume treatise on gynecology still exists so he probably deserves to be remembered as an early gynecologist but, as many medical students will confirm, his name is pronounced sawr-ey-nuhs so a proto-proctologist he must be.  Such things do happen: Winston Churchill’s (1875-1965; UK prime-minister 1940-1945 & 1951-1955) neurologist was Russell Brain (1895–1966).