Grief Could Join List of Disorders

[Celebration]

Good grief!

In coming months, as the manual is finalized, outside experts will intensify scrutiny of its finer points, many of which are deeply contentious in the field. A controversy erupted last week over the proposed tightening of the definition of autism, possibly sharply reducing the number of people who receive the diagnosis. Psychiatrists say current efforts to revise the manual are shaping up as the most contentious ever.

The new report, by psychiatric researchers from Columbia and New York Universities, argues that the current definition of depression — which excludes bereavement, the usual grieving after the loss of a loved one — is far more accurate. If the “bereavement exclusion” is eliminated, they say, “there is the potential for considerable false-positive diagnosis and unnecessary treatment of grief-stricken persons.” Drugs for depression can have side effects, including low sex drive and sleeping problems.

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In blogs, letters, and editorials, experts and advocates have been busy dissecting the implications of this and scores of other proposed revisions, now available online, including new diagnoses that include “binge eating disorder,” “premenstrual dysphoric disorder” and “attenuated psychosis syndrome.” The clashes typically revolve around subtle distinctions that are often not readily apparent to those unfamiliar with the revision process. If a person does not meet precise criteria, then the diagnosis does not apply and treatment is not covered, so the stakes are high.

......................................................

Many doctors and therapists approve of efforts to eliminate vague, catch-all diagnostic labels like “eating disorder-not otherwise specified” and “pervasive development disorder-not otherwise specified,” which is related to autism. But a swarm of critics, including two psychiatrists who oversaw revisions of earlier editions, has descended on many other proposals.

“What I worry about most is that the revisions will medicalize normality and that millions of people will get psychiatric labels unnecessarily,” said Dr. Allen Frances, who was chairman of the task force that revised the last edition.

All I have to say to this is

[enlightenment]

1. I'll join your eye rolls and

add my own. I haven't looked at a DSM for quite a while (at least one version's worth of time), but I seem to recall that the phrasing of the definition of depression did not exclude bereavement completely - it indicated that there was 'normal' bereavement, but if it continued beyond a reasonable period, it could fall under the classification for depression.

That sort of clarification is just common sense when dealing with life events. Even if you exclude bereavement as a causal factor, it doesn't prevent a diagnosis of depression. That diagnosis is based on a set of symptoms, not a particular 'cause'.

Good grief.

[Warpy]

7. People grieve on different schedules

Most people get used to the idea and get on with life within six months. A few people take a year or so. Anyone who is incapable of dealing with daily life due to grief after a year needs to be looked at for clinical depression and probably treated.

Grief is normal when there is any large life change, even a positive change like having that first child or moving to take a dream job. Something else always has to be left behind and sadness and a certain amount of cognitive dissonance will intrude.

It only rises to the level of disease when it persists.

[enlightenment]

9. I think that's what I was saying,

Warpy. Just not as clearly as you stated it.

[cbayer]

12. i would add one caveat to this.

It's not just length of time, it's also severity of symptoms. If someone becomes suicidal, loses so much weight that they are placing their lives in jeopardy, become psychotic or begin/escalate a substance abuse problem, a year is too long to wait.

[Jackpine Radical]

2. Allen Frances is a voice for sanity in the DSM world.

Frances has spent much of the last 4 years or so writing and speaking out against the inappropriate use of "junk diagnoses," with their inherent lack of reliability and no way to even test their validity, for purposes such as mental health commitment.

The whole endeavor of mental health diagnosis has become a politically corrupted mess, with some diagnoses now being proposed (e.g. Hebephilia, Paraphilic Coercive Disorder) specifically for the purpose of making it easier to subject sex offenders to (usually lifetime) commitment in locked treatment facilities after they have served out their prison sentences. This point could not be made more clear than by the fact that one of the "experts" on the Sexual Disorders committee is a prosecutor who specializes in sex offender commitment cases.

With the War on Drugs, we lost the freedom from unreasonable search & seizure. With the War on Terror, we lost a whole lot more rights, beginning with the right to unfettered travel and continuing through Habeas Corpus and the right to peacefully assemble. The Sex Offender laws are being used to establish precedent for preventive detention. The strategy is always to pick out the least popular members of society (drug dealers, "domestic terrorists," sex offenders) and pass laws that permit rights violations in these "special cases" only, and then expand the scope of the law.

[caraher]

3. Ugh

I think this is basically a move to sell antidepressants. Grief is just... normal. Unless someone goes completely off the rails it should not be medicated.

[tridim]

4. My parents think I'm depressed..

And I keep telling them I'm not, and that depression is a chemical imbalance in the brain, which I don't have.

I am stressed for a very specific, real-world reason, because I can't find a job (and I'm broke). That isn't depression, that's a natural reaction to reality. I'd almost say it's the opposite of depression. However I guarantee that a doctor would immediately prescribe me anti-depressants. I've seen it happen with friends. Of course I would refuse, but there lies the problem.

[dixiegrrrrl]

5. And you can feel depressed in a perfectly normal way, for normal reasons.

Up until the 1960's "introvert-ism" was considered a mental illness.
It was one of the "diseases" and "genetic conditions" that qualified for state mandated sterilization!!

I worked in Mental Health for many years, and became very suspicious of how and why DSM diagnosis were changed.

[Odin2005]

15. We have Freud to thank for Introversion being seen as pathological.

Freud was an extrovert and, partially out of ignorance and party out of spite towards Jung and Adler (both of whom were introverts), he popularized a bigoted notion that equated Introversion with Narcissism.

Jung explaining that Introversion (Introversion and Extroversion were terms he invented in his book Psychological Types) is not pathological was probably his greatest contribution to psychology.

[MineralMan]

6. Grief is not a disorder. It is a natural response to loss.

Medicating for grief is rarely necessary. Some kind counseling is often helpful, but it's not an illness.

[cbayer]

8. I think it is important to distinguish normal grief from pathological grief.

While someone experiencing grief may meet the current, technical criteria for depression, they have been excluded from that diagnosis and recognized as undergoing an entirely normal process.

The problem arises when normal grief becomes pathological grief. If the symptoms become too severe or last too long, placing a person in jeopardy of harming themselves or others, then they may need psychiatric evaluation and treatment. Because they are currently excluded from the diagnosis, they may have difficulty accessing or getting reimbursement for appropriate care.

Suicide rates and overall death rates are significantly higher in surviving spouses. Some of these people may be dying of pathological and treatable grief reactions. Normal grief does not result in death.

That, in my understanding, is what this is all about, and it seems like a good move to me.

[enlightenment]

10. There is no need for a new criteria though, is there?

If someone has reached a state of pathological grief, they are probably suffering extreme depression. The cause may have initially been an external factor, but it has progressed to something that could certainly be labeled as acute or even chronic depression.

Why create a new category?

[cbayer]

11. I think, but I am not sure, that the current criteria make it difficult to actually assign a code.

Insurance companies are probably denying payment for treatment if there has been a recent loss. It looks to me like it may just be closing a loophole that excludes some patients in need of care. Sometimes the APA needs to revamp categories and criteria in order to make sure that patients in need of treatment actually get it.

[enlightenment]

13. I'll take your word for it -

I'm just not up to speed on the DSM these days!

[Odin2005]

14. Now that's just stupid.

Grief is NORMAL. This is the result of the whole "if you are not happy all the time there is something wrong with you" self-help mentality.

[HuckleB]

16. "Could" is the key word.

I'm tired of poor science journalism, where every time something is assessed, MSM decides to make it into some pretend horror.

[Celebration]

17. how is this being reported as a "pretend horror"?

It is merely reporting proposals, and the controversy surrounding the proposals.

Please point us to your specific objection to this article. Thank you.

[HuckleB]

18. Please read the article: It does exactly that.

It's trying to stir up emotional responses over something that hasn't happened, and very well may not happen.

The responses to the OP, as well as the OP's response, make the success of the attempt very clear.

[Celebration]

19. just as I thought

You pointed to absolutely nothing specific in the article, just a generalized "don't like the tone" thing.

Sorry, but this was completely accurately reported. If you disagree you are going to have to be more specific.

[HuckleB]

21. It's ridiculously obvious.

I'm a fan of honesty. How about you?

[Celebration]

23. What is dishonest about the article?

They made it abundantly clear that these were in the proposal stage. Where in the article did they suggest otherwise? The only thing that would satisfy you is if they didn't write the article at all.

[cbayer]

20. Totally agree. The intent always seems to outrage without educating.

The brouhaha over the Autism redefinition is a classic example, as is this.

[HuckleB]

22. +1