Monday, March 26, 2012

Of Course I’m Depressed: My Best Friend Died
For the past few weeks, the world has weighed in on a debate that could potentially affect us all.

The American Psychiatric Association’s DSM-5 – the Bible of psychiatric disorders – could include grief as a form of severe depression.
There is little debate that elements of grief are consistent with mild depression: mood swings, inability to sleep or enjoy normal activities. It can be difficult for seasoned professionals to differentiate between the two.

A diagnosis of clinical depression is not something to be taken lightly. And normal grief can spiral into clinical depression. There are already protocols in place to deal with severe depression.

But turning normal grief into something that requires therapy and/or medication after two weeks…well, to me that’s going too far.
A March 23 article in Huffington Post quotes Dr. Joanne Cacciatore, of the Center for Trauma and Loss:

Open Letter to the Board of Trustees of the American Psychiatric Association and to the DSM 5 Task Force
Two weeks ago, I wrote a blog opposing the DSM 5's proposal to reduce the DSM IV bereavement exclusion.

This blog has since gone viral in the most incredible way -- 100,000 readers within its first few weeks. It seems that this proposal is experienced as an outrageous insult by the very people it is intended to help.

I have more than sixteen years experience dealing with tens of thousands of grieving people whose children die or are dying at any age and from any cause. To my knowledge, there is no empirical standing for the arbitrary two-week time frame, and thus this proposal not only contradicts good common sense but also rests on weak scientific evidence.

One thing in which the literature is clear: long-term psychological distress is common in this population and other populations suffering traumatic deaths. In my experience both as a researcher and clinician in the field and also as a bereaved parent, the DSM 5 proposal is radical, unnecessary, challenges what it means to be human, and for some may be dangerous.

Those with severe depressive symptoms distinguishable from normal grief can already be diagnosed as soon as is needed using the DSM IV criteria. In contrast, DSM 5 would require a distinction between normal grief and mild depression shortly after the death of a loved one that is often impossible to discern for even the most experienced clinicians. The DSM 5 may well create problematic false positives -- and thus cause further harm, to an already vulnerable population. There are many more reasons we oppose these changes, many of which are outlined in my blog.

Our international organization (MISS Foundation) has 77 chapters around the world and has helped countless grieving families and the professionals who serve them. All our services are free and we are a volunteer-based organization. Our website gets more than one million hits per month and we have 27 online support groups. We oppose this change with our minds, with our hearts, and with our numbers.

I speak on behalf of the MISS Foundation's grieving families: Should the DSM 5 stubbornly ignore the evidence and the mounting professional and public opposition, our last alternative will be to call for more direct action -- in the short term, our organization will rally the support of Congressional leaders; in the longer term, we will have no choice but to join a concerted boycott against the use of the DSM 5 in treating bereaved families facing the death of a child.

…On behalf of hundreds of thousands of bereaved people around the world, I implore you to reverse this poorly conceived and unnecessary decision. My more than 100,000 readers and I hope to hear from you soon.

What do you think? Is two weeks long enough for “normal” grief? Should those grieving longer than that be referred to a psychiatrist for severe depression?
I’ll be at the ADEC (Association for Death Education and Counseling) conference later this week. I look forward to hearing more opinions on this.



kathleen pooler said...

I think defining "normal" grief as having a two-week window is ridiculous. When my friend Eileen who lost her 33 year old husband three months after losing her mother in 1977, she told me the second year was harder than the first as the shock had worn off. Depression has its own criteria and I don't think grief should be wrapped up in it. People grieve in their own way and in their own time. If they are manifesting signs of depression as per DSM-5, then they need treatment. My cousin (my Aunt Rose's son) is experiencing extreme grief over the terminal condition of his mother. His siblings have recommended a grief counselor. He is already being treated for depression which we all expect will exacerbate. That's a special case. I'm rambling..but I get frustrated when I think of the natural grief process being regulated by time frame. Grief is a normal, though unpleasant part of life. We need to provide supportive services but not necessarily medicate it away. You really got me going with this post!

Friend Grief said...

Kathy, I had the feeling you would weigh in on this!
I'm of the position that if someone who is grieving is presenting symptoms of clinical depression, then it's clinical depression. A trained professional can identify this. But most people who grieve don't fit that description. Grief shouldn't have any more of a stigma than it already has.