Good Grief

[groovedaddy]

A startling suggestion is buried in the fine print describing proposed changes for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — perhaps better known as the D.S.M. 5, the book that will set the new boundary between mental disorder and normality. If this suggestion is adopted, many people who experience completely normal grief could be mislabeled as having a psychiatric problem.

Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, can’t sleep well and don’t feel like going to work. In the proposal for the D.S.M. 5, your condition would be diagnosed as a major depressive disorder.

This would be a wholesale medicalization of normal emotion, and it would result in the overdiagnosis and overtreatment of people who would do just fine if left alone to grieve with family and friends, as people always have. It is also a safe bet that the drug companies would quickly and greedily pounce on the opportunity to mount a marketing blitz targeted to the bereaved and a campaign to “teach” physicians how to treat mourning with a magic pill.

It is not that psychiatrists are in bed with the drug companies, as is often alleged. The proposed change actually grows out of the best of intentions. Researchers point out that, during bereavement, some people develop an enduring case of major depression, and clinicians hope that by identifying such cases early they could reduce the burdens of illness with treatment.

http://www.nytimes.com/2010/08/15/opinion/15frances.html?th&emc=th

[Warpy]

1. Grief can become pathological

when it persists. The time frame is different for all of us.

I can't imagine any psychiatrist treating someone for clinical depression a week after a loss. Numbing out with benzos only prolongs the grief process. I can see them treating someone who is still paralyzed with grief months later, to the point that they've neglected everything in their lives.

Perhaps this is just to give them some discretion in noting when the process has moved from normal shock and loss into major depression. The timetable really is different for all of us.

[groovedaddy]

2. That's why grief COUNSELING is so important...and hats off to those organizations who

(i.e. Hospice) who remind people of its importance. And, yes, people grieve differently.
I remember my German grandmother telling me that in the "old country" when a family experienced a loss, there was usually no outside contact with the family for a year (no holiday, birthday parties or cards).
I also remember when my brother was killed in Vietnam and that the only "counseling" came from the parish priest, who really wasn't much help. My dad damned near drank himself to death. No one recommended using any sort of professional counseling service, not that we could have afforded it. But extended family and friends did help considerably. Still, people who are trained in dealing with such situations, know the signs to look for in determining what sort of help a person may need.

[HuckleB]

3. Spot on.

I tire of the usual onslaught of "psychiatry wants to turn every day behavior into pathology" routine. At the end of the day, as part of every diagnosis, the patient must be experiencing serious functional deficits due to the symptoms he or she is experiencing. Somehow journalists ignore this factor.

For patients dealing with grief, there is no great way to separate the apparent trigger for the depression in question. This appears to be a method of doing just that.

[xchrom]

4. that very thing was of particular interest to the gay male community

at the height of the epidemic -- where there was an epidemic within the epidemic of survivors sero-converting.

it was an appalling time.

the grief and fear really took on a life of it's own.
anti-depressants helped a lot of my friends at that time.

[Warpy]

5. I have a friend who totally withdrew

His world was a night job, his bed, and his television. He barely used the rest of his apartment and mostly just walked through it on the way to bed.

He's still physically healthy, but he never did fully recover from that period.

I often wonder if I have. There's got to be some element of PTSD among all the other reasons I'd rather have my teeth pulled with tweezers than go back to nursing.

That period can't be described to anyone who wasn't there.

[xchrom]

7. it's got to be like ptsd -- and if you were nursing -- oy such a thing. nt

[dixiegrrrrl]

6. Major depressive d/o is already in the DSM.

As a former Mental health therapist, I find the article very vague on the exact nature of the
"change that is buried in the fine print".
All symptoms listed in article are already in the DSM for Depressive D/O.

My assumption is that one of the examples they have added is "grief", but hard to parse that out via the article.

[Jim__]

8. The author appears qualified to draw the conclusion he draws.

But, a suggestion in the fine print leaves open questions as to what exactly he's talking about. In the situation described, does the DSM mandate this diagnosis? I don't have a medical background, but I've always thought that the physician makes the final determination on the diagnosis and not the manual.

[groovedaddy]

9. Psychiatric diagnosis can be extremely difficult to make. There are also times

when a team may level a diagnosis - i.e. treatment teams in psychiatric hospitals, typically comprised of Psychiatrists, Psychologists, Pyschiatric Social Workers, etc.
A loved one of mine went through the system (I was with her through quite a bit of the ordeal).
On the second visit to the emergency room, I asked the pychiatric nurse about a diagnosis. She said:
"They're difficult to make. She could see 5 different psychiatrists on 5 different days and get 5 different diagnosis." Not exactly reassuring.
Generally, people in an acute stage of an emotional, psychological illness aren't in a position to educate themselves about what's going on. They need an advocate, preferably one who knows or is a quick study. I did it for my loved one. I was fortunate to have a friend who is a clinical social worker dealing with psychiatric issues of children. He gave me a list of questions to ask the treatment team at the hospital. They really perked up when I asked these, with all but the shrink treating me with a fair amount of deference. I learned a lot in the process. NAMI can be an excellent resource.

[supernova]

10. Read this several days ago

The writer seems to suggest that the DRM now lets MDs make the call that what can be a normal grief reaction for some is now major depression in need of medication.

I'm leery of this.

I think the problem here is who is to say that you are grieving *too much* for your dead child or your life partner? There seems to be an implicit idea that there is a time or emotional limit on grief when there really isn't, IME. You learn to live with it and incorporate it into your experience, and at some point resume the regular pace of daily living. But you are never the same afterwards. The world really does look different. This process can take years to come back around to feeling whole again.

Although, the six month mark is more generous than that typically offered by society at large. IME after a month or two, people at work and less personal acquaintances start to tire of your downbeat presentation. These are the people who change the subject and don't want an honest answer when they ask how you are. As they say, it's a time in your life when you realize who your real friends are.

Re: Hospice grief counseling - My experience with them was IIRC, three sessions right after my mother's death. My impression was that they were just looking for me not to want to cut my own wrists. Other than that, no other counseling was offered. I'm highly sensitive, so I found it to be a big intrusion rather than a relief, sort of "this is just for our records, nothing to do with you." But I suppose they needed to do their job. Other than that, I have nothing but good things to say about Hospice. Their treatment of and care for my mother was fabulous.

[groovedaddy]

11. Maybe that veries from Hospice to Hospice community (on recommending grief counseling). The biggest

danger in grieving is becoming trapped ALONE in the experience. Same with combat veterans (and probably grief related), in that so many report this feeling of aloneness, that people wouldn't be able to relate to their experience. The most cathartic experience for most of these vets is when (and if) they can get into a group of other vets and share their experiences.
And you're absolutely right that there is no set time span for grieving. I mentioned in a post above about my brother being killed in Vietnam and my Dad falling big time into alcohol. After several weeks of this, his boss showed up begging my Dad to come back to work as things were falling apart without him (not sure that was true). It worked. My dad tappered off the drinking and went back to work.
I remember feeling really sad for about 2 years. I kept dreaming the same dream of my brother coming home. I'd answer the door and he'd be standing there smiling. I said: "We thought you were dead"
and he would just smile at me. One morning, I awoke after having the dream and felt very serene, like my brother was okay - somewhere (not in the realm of the living). The sadness only came back rarely after that and I never had the dream again.