In a case of old news getting new attention, a proposal from the American Psychology Association (APA) to change the definition of grief in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM for short) has just regained attention in the mainstream media.
In the last two editions of the DSM--the DSM-III and DSM-IV respectively--have contained what's called the "bereavement exclusion" in the description of Major Depression. That is, the symptoms of depression were not considered eligible for treatment if they were thought to be caused by a "recent bereavement." In 2011, the workgroup for the upcoming DSM-5 (due out in 2013) proposed to eliminate the "bereavement exclusion," making people who have symptoms of depression as the result of a significant loss in their lives would now be eligible for a medical diagnosis of Major Depression and eligible for treatment such as counseling and anti-depressant medications.
According to this release in Psychiatric News, dated October 21, 2011, the Workgroup argues that research has shown clinical depression and severe grief show no difference in response to treatment. The group points out that often a major depression follows a challenging life event.
The news was met by criticism in 2011, with people claiming the change would "medicalize normal human emotion." As Dr. Allen Frances wrote in an August New York Times Editorial, "grieving is an unavoidable part of life--the necessary price we all pay for having the ability to love other people." It continues to stir up strong reactions in people, with a more recent article from the New York Times delving into the potential harms and benefits of the change.
The APA Work Group continues to defend its proposal, stating that some people who experience bereavement go on to a major depressive episode. The question is, when do you draw the line between the normal symptoms of grief, and the symptoms of major depression?
I am undecided on this issue myself. I do have concerns that grieving people could seek medical help, and especially anti-depressant medications, just to make it all go away. Grief is a normal human emotion, and the sadness associated with it helps us to honor the memory of our loved ones. On the other hand, there is the potential for anyone who has experienced a loss to go on to depression which can be debilitating.
It is completely normal to feel sad, and experience physical symptoms like difficulty sleeping, loss of appetite, and low energy. However, if your symptoms continue for a long time, if they interfere with your ability to return to your normal activities, or if you experience thoughts of harming yourself or someone else as a result of your feelings, you may be experiencing depression. Call your provider for help, and if you are thinking about harming yourself or someone else, seek immediate, emergency help. Go to the Emergency Room or call 9-1-1.
For More About Grief and Depression, please read:
When Miscarriage Grief Becomes Depression
The Five Stages of Grief After Pregnancy Loss
How To Decide When to See a Mental Health Professional After Miscarriage
Image © Richard Dunstan