There was a good opinion column in the NYT today by professor of psychiatry emeritus, Allan Francis, who calls to task those who want to treat grief as a mental illness and treat it with medication. From “Good Grief:”
A startling suggestion is buried in the fine print describing proposed changes for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — perhaps better known as the D.S.M. 5, the book that will set the new boundary between mental disorder and normality. If this suggestion is adopted, many people who experience completely normal grief could be mislabeled as having a psychiatric problem. Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, can’t sleep well and don’t feel like going to work. In the proposal for the D.S.M. 5, your condition would be diagnosed as a major depressive disorder.
Excuse me, but this is nuts. Grief not only allows us to work through the trauma of loss, but it honors those we have loved, as Francis notes. I mean, how awful would it have been, if when my father died, I had merely shrugged and said, “Oh well, it was nice knowing him,”? But I think Francis missed an important point when he discussed why this is happening:
It is not that psychiatrists are in bed with the drug companies, as is often alleged. The proposed change actually grows out of the best of intentions. Researchers point out that, during bereavement, some people develop an enduring case of major depression, and clinicians hope that by identifying such cases early they could reduce the burdens of illness with treatment.
That may be true, but it is the shallow end of the pool, I think. What seems to be really going on is our growing raw fear of suffering–even of suffering that allows us to move past the loss. This suffering phobia is becoming a societal neurosis, for example, some of us wanting so badly to avoid suffering that we agree a good answer to it is the elimination of the sufferer. Indeed, as I pointed out here, some have even supported prophylactic suicide as a legitimate answer to the fear of grief.
Huxley predicted it in Brave New World: As soon as one of the dehumanized minions experienced a wrinkled brow, they’d pop the pill. Normal grief is good for us. Such suffering can and should be mitigated by loving family and friends by paying special attention to the griever. But eliminate it? No. That would make us less than human. Good for Francis for seeking to block the way.
August 15th, 2010 | 9:18 pm
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August 16th, 2010 | 1:24 pm
There was a response to this article in Psychiatric Times. What’s actually being proposed in DSM-V is a removal of the “bereavement exclusion” when diagnosing a major depressive illness so if an individual meets the criteria for a depressive disorder she is accorded the diagnosis even if she has suffered a recent bereavement. This is not an attempt to medicalize grief: it is an acknowledgement that (1) a grieving person might have a pre-existing case of clinical depression and (2) the death of a loved one could precipitate a major depressive illness (something rather different from “normal grieving”).
Access to the full article requires registration (free).
http://www.psychiatrictimes.com/display/article/10168/1523978
August 16th, 2010 | 6:05 pm
This is an excerpt of my message to the New York Times public editor as I have given up trying to have a letter to the editor published:
“I am incredulous at the article on page 9 of Week in Review today by Dr. Allen Francis. His oversimplification of the “complicated grief” debate for the DSM-V is beyond comprehension because he knows the research inside and out. There must be some ideological reason behind this because the author has published other articles in professional journals which make it very clear that he does have a much better understanding than what comes across today.
…The “complicated grief” diagnosis discussion is so much more complex than the NYT article today. The point I am making is that publication [by this newspaper], just based on certain abstract credentials, does not yet make for a valid article. And that a bit more research by the editors of the subject addressed could prevent confusing the public even more.
But death clearly is a subject where even very educated and informed individuals literally “lose it.” Hence I am grateful to Dr. Katherine Shear (NYT, 9/29/09, Fran Schumer, “After Death, the Pain That Doesn’t go Away) because she is one of the very few experts out there who are on top of the subject and aware of the limitations of their own knowledge and research. I think it takes something else, whatever this may be, to be as objective as possible. And those of us who have been there have no choice because we KNOW vs. those who are hypothesizing only, even with the best of intentions.
One good thing: the public debate has finally moved at least somewhat away from the “just get a life and get over it” or “leave it to God because death is part of life” level which continues to predominate but is now under more pressure.”
August 28th, 2010 | 3:00 am
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