Back in December the American Psychiatric Association unveiled a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders. For those who don’t know, this thick tome is the bible of psychiatric diagnoses. Proposed changes to this latest version are always controversial and the latest is no different. An article in Wired sums the biggest controversy as it relates to grief and depression.
The change, contained in new revisions to the DSM-5, a set of standards used to categorize mental illness, eliminates the so-called bereavement exclusion, which exempts grieving people from diagnoses of depression for two months unless their symptoms are self-destructively extreme. Under the new standards, depression can be more easily diagnosed just two weeks after a death.
“Virtually everyone who is grieving has milder symptoms of depression. What the bereavement exclusion did is separate the normal responses from the severe ones,” such as feelings of worthlessness or suicidal impulses, said psychiatrist Jerome Wakefield of New York University, who studies bereavement and depression.
“This goes over a line. If you can pathologize this kind of feeling, any kind of suffering can be a disorder. It’s a disagreement over the boundaries of normality,” Wakefield said. “What kind of world do you want to have? One where intense, negative feelings we don’t like are labeled as disorders, or a world where people grieve?”
Defenders of the bereavement exclusion’s removal, officially announced Dec. 1 by the American Psychiatric Association, say worries of pathologized grief are overblown. They argue that though not all grieving is depressive, grief-related depression isn’t fundamentally different from what’s considered normal depression. As a result, they say the exclusion makes it unnecessarily difficult for clinicians to deal with bereaved people who legitimately need help.
“I think a good clinician can separate the two,” said Jan Fawcett, a University of New Mexico psychiatrist and head of the DSM-5 working group that authored the change, of normal grief and clinical depression. “We feel that clinicians have been making this judgment all along.”
In response to the criticisms, the DSM-5?s authors added a footnote instructing clinicians to take recent loss into account when evaluating mild depressive symptoms. To the critics, a footnote doesn’t provide the recognition of grief’s normality contained in the bereavement exclusion.
Many psychiatrists do, however, support the decision. They say distinguishing between grief-related depression and regular depression is illogical. “Defenders of the removal of the exclusion ask, ‘Why should people be denied the diagnosis if their stressor happens to be bereavement, whereas other sufferers whose stressor is job loss, for example, are not?’” said psychiatrist Richard McNally of Harvard University.
Considering how closely symptoms of grief and depression overlap, I don’t think this change is a good thing. Most people who go and see a doctor about depression know usually see their primary care physician or (in some cases) nurse practitioners—not a psychiatrist. In the rushed atmosphere of doctor’s offices, I have a hard time seeing doctors or nurse practitioners being able to determine two weeks out whether or not the person could benefit from medication or will recover just fine on their own. Had this rule been in affect when I lost my late wife, odds are I and many of my friends and family would have been a prime candidate for antidepressants and would have been for at least six to eight months after her death.
For most people there’s something helpful about going through the emotional roller coaster when you lose a loved one. For example, had I not hit the bottom emotionally, I don’t know if there would have been enough motivation to turn my life around as fast as I did. Most people recover and lead normal, happy lives after the death of someone they love and I have a hard time seeing how medicating an otherwise healthy person during this time would help them move on faster. While some people could benefit from antidepressants during this time, it seems to be that they would either be ones who have depression or might be predisposed to become clinically depressed.
As for those who are dating widowers, my concern is that being with someone who may not be adequate dealing with their grief because of medication might be in for a rude awaking once the widowers prescription comes to an end. But as I wrote this I realize that no one has ever mentioned whether or not their widower has taken antidepressants for grief or something else. I’m curious as to how that affected their relationship (if at all). Leave your comments on your experiences or thoughts regarding this proposed change in the comments below.