Psychiatry’s New Rules Threaten to Turn Grieving Into a Sickness
2012-12-12 0:00

By Brandon Keim |

A controversial change to official psychiatric guidelines for depression has raised fears that grief over the death of loved ones will be classified as clinical depression, turning a basic part of what it means to be human into a recognized sickness.

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.”

The DSM, or Diagnostic and Statistical Manual of Mental Disorders, represents American psychiatry’s official tool for deciding between mental disorders and normality. First drafted in 1952, it’s now known euphemistically as psychiatry’s Bible, used by doctors, insurance companies, the legal system, and most any social institution that deals formally with mental health.

The DSM has been revised four times since its original publication, with the latest changes developed over the last seven years and culminating in the recent approval. These have been perhaps the most controversial changes ever, partly because they’re the first made in the cacophonous media environment of the internet age, but also because of the changes themselves. New conditions include hoarding, severe pre-menstrual syndrome, binge eating, temper tantrums and everyday forgetting among the elderly. Critics say these represent a tendency in modern psychiatry to medicalize the normal range of human experience.

Far and away the most controversial change is eliminating the bereavement exclusion, which discouraged clinicians from diagnosing as depressed grieving people whose symptoms were actually part of a normal, necessary emotional process, though in other people they’d be considered formal grounds for depression.


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