Pathologies of Grief


Photo Credit: Mike Cygan

The American Psychiatric Association has stirred up controversy again with its proposal to add grief to the impending fifth addition of the Diagnostic Statistical Manual (DSM-5). The DSM-5, the anticipated official diagnosing guide employed by virtually every mental health professional in America, will be released in March 2013. While some professionals believe that this new classification will help grieving people recover more easily, many other people believe that this classification is insensitive to mourners and even an unnecessary money making scheme.

In the upcoming DSM-5, grief will specifically be classified as an adjustment disorder related to bereavement. In clinical settings, this disorder would be compared to a Major Depressive Episode—symptoms of which include feelings of sadness, insomnia, poor appetite, and weight loss [3]. While those are symptoms one should have valid concern about, they are a normal part of the grieving process. In order to be diagnosed with an adjustment disorder related to bereavement, one must be intensely mourning a loved one with unmitigated symptoms for at least 12 months.

Dr. Allen Frances, MD vocalizes a widely held concern about the inclusion of grief in the DSM-5: “Medicalizing [sic] normal grief stigmatizes and reduces the normalcy and dignity of the pain, short-circuits the expected existential processing of the loss, reduces reliance on the many well established cultural rituals for consoling grief, and would subject many people to unnecessary and potentially harmful medication treatment” [2]. This may be construed as an insensitive approach to ending bereavement, devaluing the cultural and religious traditions surrounding grief, which have continually proven to help grieving people find strength in desperate situations. Medication and psychoanalysis may not always be the right method of helping an individual overcome grief. One must remember the familiarity and comfort that people find in their own cultures.

Grief is a normal, healthy part of human life. By eventually acknowledging people’s emotions and lost attachments by undergoing regular stages of grief, such as those exhibited in the Kübler-Ross Grief Cycle. The majority of human beings will inevitably experience the loss of a loved one at some point in their lives. By framing grief as a mental disorder, a significant part of the country will potentially qualify as having a mental disorder. One could say that additions to the DSM-5 such as this are “pathologizing” America.

Any medication used to quell bereavement would be comparable to a pill that numbs feelings: precluding coping and emotional health, but allowing for a medicated façade of oneself in order to increase one’s productivity that might have been diminished due to a loss. Everyone has his or her own pace in the grieving process. The length of time that someone should grieve doesn’t account for the circumstances of the loss and the impact that the loss had on an individual.

However, I do believe that it is important to be aware and clinically confront symptoms associated with grief that borderline on psychosis. If one’s intensity of grief worsens into bereavement or full-on traumatic grief, psychotic symptoms comparable to post traumatic stress disorder, panic disorder, generalized anxiety, substance abuse, major depressive disorder, and even suicidal intentions might be noticed in an individual’s behavior.

 

 

Not everybody’s grief will worsen so extremely, such is critical to consider in this controversy. Perhaps one should not be diagnosed with an adjustment disorder related to bereavement based on length of mourning period, but based on the intensity of the consistent, potentially psychotic symptoms. This would minimize the stigma of “pathologizing” America, and seek out the people who are clinically suffering in their grief, rather than overcoming a difficult emotional journey.

Even though there is not much that we can do about clarifying the presentation of grief in the DSM-5 at this point, it is imperative to realize that grief in and of itself is not a mental disorder. While the fact that its counterparts are being considered mental disorders may serve a latent function of pathologizing the normal state of grief, we must not get caught up in labels. It is okay to grieve, and doing so does not automatically mean that an individual has a mental disorder.
 

 




Melissa McSweeney

The Writer

Melissa has a strong interest and background in psychology. She works as a research assistant for a Harvard University laboratory conducting studies in developmental psychology at the Museum of Science. Her academic heroes and constant sources of inspiration are Edward Gordon Craig, Carol Dweck, Martha Nussbaum, and Bonnie St. John.
 


Mike Cygan

The Photographer

Mike Cygan is a first-year at the “ever prestigious [sic] University of Missouri,” studying Photography and Media-Communications. His hobbies include perusing the countryside, photography, and even you!
The photo from this article is available for sale here.

 


Attribution

[1]: http://astridvanwoerkom.wordpress.com/2011/07/23/adjustment-disorder-and-bereavement-in-dsm-v/
[2]: http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1538825
[3]: http://psychcentral.com/disorders/sx39.htm

Image Credit

Cover Photo: Mike Cygan
Grieving Angel Headstone:
Infographics: Blake J. Graham


  • Tramalfadorian

    I can see why this is controversial, but isn’t the APA a medically ethical group with patient’s best intentions in mind? Are you attacking the classification or the APA itself? Have they a history of decisions like this? Will it change the way psychiatrists practice? 

    • mmcsweeney

       @Tramalfadorian I am not trying to attack anything, I’m just trying to inform people about how this new classification might be confusing and I want to offer some clarification. Though I can’t speak for the APA, I believe that they’re doing their best to help a wider range of people by including this disorder (as well as altering other pre-existing disorders, which I’ll get into momentarily). By doing so, people who really need psychiatric help with a bereavement disorder will be able to receive treatment, but a large number of people who are simply going through a healthier version of grief that lasts longer than 12 months may also qualify for such psychiatric treatment, even when they aren’t actually in need of it. The DSM-5 specifically has been a prominent point of contention in the mental health profession. In addition to classifying a form of grief as a mental disorder, it will also remove Aspergers and instead classify it as an Autism Spectrum Disorder. This is controversial, because while Aspergers still shares some symptoms of autism, it is not as severe of a condition, and many people are concerned that young people who have Aspergers will be receiving more “special benefits” in academic settings (such as longer extensions of standardized testing) to the extent that young people with autism should receive this extensions. Additionally, the DSM-5 will decrease the number of symptoms required to be diagnosed with ADHD if the patient is 17 or older, which may help some people who truly suffer from the symptoms of ADHD, but may also provide an easy way to receive unnecessary medication because the criteria is so minimal. These are only a few examples of the changes that the DSM-5 will have in comparison to the current manual, the DSM-IV-TR. As of right now, I cannot say whether or not it will change the way psychiatrists practice, as that implicates a broad spectrum of possibilities. It will certainly require psychiatrists to become familiar with the changes that the DSM-5 has made in the diagnostic field. Maybe because of this, questionnaires that apply to specific mental disorders will have to be slightly altered. That is just a speculation, though.