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Hopsice: Grief, Depression and the DSM -- Take Two

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As Shakespeare said in Much Ado about Nothing, "Everyone can master a grief but he that has it."

When you are in the midst of grieving for a loved one, there is no such thing as mastery. There is no right or wrong way to grieve. It is not something you get over, it is not a luxury, and it is not a medical condition.

Last year, editors revising the Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative psychiatric guidebook, set off a firestorm of criticism by considering that the diagnosis of major depression could apply to someone exhibiting certain aspects of grief within weeks after the death of a loved one. (See particularly moving recent columns by Allen Frances and Joanne Cacciatore.)

Along with many colleagues, I posited that such a revised diagnosis could undermine bereavement as a universal, normal, if profoundly painful experience. We were concerned that medicalizing grief and commingling it with diagnoses of clinical depression could encourage the bereaved to avoid the natural process of grief rather than working through it, which is critical to healing. My colleague Dale Larson satirically envisioned a pill called GriefAway, which might be prescribed to someone diagnosed with grief-induced depression.

Based on an outpouring of public response, the doctors working on the new edition, DSM 5, have reevaluated their proposed revision. In a new draft proposal just released, the panel seeks to differentiate between normal bereavement associated with a significant loss and a diagnosis of a mental disorder. The panel, selected by the American Psychiatric Association to draft the revised manual, wrote:

Many commentators noted the previous criteria erroneously implied that bereavement could be assumed to only last two months and we wanted to correct that misunderstanding and provide more information on how bereavement and other loss reactions differ from Major Depressive Disorder.

The new proposed diagnosis includes a note that reads, in part, "The normal and expected response to an event involving significant loss (e.g., bereavement, financial ruin, natural disaster), including feelings of intense sadness, rumination about the loss, insomnia, poor appetite and weight loss, may resemble a depressive episode," but, absent certain other symptoms, may not be.

The DSM is now asking for final public input on the current draft of the influential manual. Public comment will run from May 2 through June 15.

My input, for starters, would be: Thanks for listening. It is important that we continue to see -- and treat -- bereavement as a universal experience that is an integral part of life.

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