Pathologizing Grief–Just For Starters: The DSM-5 and My Tripartite Expression of Displeasure, Part II

Posted on April 8, 2012 by

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You cry into your pillow silently at night, reaching across to that empty expanse of the bed where, for 30 years, you’d always felt your partner’s hand reaching, in turn, for yours. Sleep eludes you due to the pain, and you are exhausted during the day, wondering, at times, if you’ll have the energy to even get off the couch.

Your former interests and passions can’t hold your attention–you wonder how you ever engaged in book club, why you should ever knit again when it seems so pointless, and your favorite afghan-user has left you suddenly, to face the world alone.

For decades you’ve prepared dinner to be ready just as your husband returned home from the final leg of his commute. But why bother now, when you won’t ever sit together with him to partake of it again? And, really, you don’t feel hungry–eating just doesn’t seem worth the effort.

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Anyone who has suffered the loss of a loved one, or watched someone who has suffered such a loss, will be familiar with the psychological devastation that follows the death, and the responses may very well look like those described above.

The crying, the fatigue, the insomnia, the lack of appetite–these are standard symptoms of bereavement, the manifestations of deep and often unspeakable pain. It is normal to exhibit such patterns of behavior; they are part of the landscape of bereavement.

Or, shall I say, it was normal to be symptomatic in this way right after the death of the loved one.

In the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5), if you’re still exhibiting such behaviors two weeks after your crushing loss, welcome to your new diagnosis: Major Depressive Disorder.

One day, it seems, if the DSM-5 follows through with this proposal, you are appropriately grieving for the death of a loved one. The next. . .well, you’ve earned yourself a pre-existing condition, should you get treatment for it and then try to change insurances.

The psychological community is up in arms about doing away with what is called ‘the grief exclusion.’ Under the current definition of depression, diagnosis requires a person to exhibit at least five of nine symptoms for two weeks or more. Up until now, bereavement grief, which often shares symptomatology, has been specifically excluded.  The proposed new definition of depression would no longer include this exclusion. Thus grief symptoms become synonymous with depressive ones, and, well, a number of people aren’t happy with the corollary to that.

With passions running high on both sides, alarmists off to the races. You’ll find warnings that you could possibly have difficulty keeping your job if your diagnosis is discovered, or might have a harder time getting full-time custody of your children, due to having a mental disorder.

Some of this seem a bit extreme. But there is concern, even in the medical community, about what short-cutting the normal grieving process and pathologizing grief can lead to.

Allen Frances, MD, wrote back in the March 2010 edition of the Psychiatric Times, in hispiece “How To Avoid Medicalizing Normal Grief In DSM5:”

. . .an inaccurate and unnecessary psychiatric diagnosis could have many harmful effects. Medicalizing normal grief stigmatizes and reduces the normalcy and dignity of the pain, shortcircuits the expected existential processing of the loss, reduces reliance on the many well established cultural rituals for consoling grief, and would subject many people to unnecessary and potentially harmful medication treatment.

 And it is most certainly one that deserves to be processed individually–without hasty labels and unproven treatments.