When normal experiences become pathological

The Diagnostic and Statistical Manual of Mental Disorders (DSM)—the primary reference tool for psychologists and psychiatrists—is undergoing a makeover. The DSM-5, set to be released in May 2013, may include a newer, more exclusive definition of autism, and the inclusion of the soon-to-be-defined absexuality and relational disorders. However, one of the more troubling of the proposed additions to the DSM is that grief following the death of a loved one can be classified as major depression. The current edition of the DSM excludes bereavement from the clinical definition of a major depressive episode. Reversing this decision medicalizes a common human experience and is only likely to muddy the waters of the DSM.

A possible explanation for the proposed addition is that the symptoms of grief usually mirror those of depression: listlessness, fatigue, inability to focus, and most obviously, profound sadness. However, there is one crucial difference: depression, as it’s currently defined, is a chronic condition and does not always have a direct environmental cause. Grief, on the other hand, has a direct cause, and in most cases, diminishes with time. Failure to adapt to the loss of a loved one may result in chronic mental disorders, but this is rare. 

Proponents of the addition may see an underrepresentation of resources for the grieving in society. Pulling oneself up by the bootstraps is, after all, the American way.  

Disorders listed in the DSM are conditions which lead to an unfulfilling or unhappy life. Grieving certainly fits the bill, but it typically fades relatively quickly compared to depression. Additionally, grieving is an unfortunate obligation of the human experience. Most people who live beyond the age of 30 experience the loss of a loved one. While the bereaved often describe such times as the hardest in their lives, humans and societal norms have evolved to adapt to this challenge, which is apparent in grief’s comparatively short duration.

The DSM is notorious for medicalizing conditions and providing vague definitions for many mental disorders. Defining grief in psychiatric terms implies the need for pharmaceutical treatment, but treating similar symptoms with similar treatments—typically antidepressants—is reactionary. Counseling and social support may be more appropriate. Professionals should determine appropriate treatments for grief, but the widespread use of antidepressants, which are not without strong side effects, may foreshadow medical treatments for a rough day or existential crises.

In the Holmes and Rahe Scale of Stressful Life Events, the death of a spouse is considered to be the most impactful event of the human experience. Death of a family member is fifth. Divorce, retirement, marriage, changing jobs, and pregnancy are all in the top fifteen. While all of these events are stressful and certainly life-changing, social practices have evolved to help people deal with these stressful events. Defining grief in psychiatric terms will exclude the many social ways to process grief. Certainly depression can follow some of these events, but the automatic classification of grief as depression broadens the definition of depression to the point of being meaningless. 

Both depression and grief can be seriously harmful to individuals, but unnecessary psychiatric diagnoses for common human experiences creates more confusion than good. Victims of grief often know that resilience and hope will get them through the grieving process, not abstract definitions of their experiences.

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