WASHINGTON, February 22, 2012 – When something senseless is being done in the field of psychology, how can a writer, who is also a therapist, resist jumping into the fray of words?
The senselessness is the inclusion of grief in the forthcoming DSM-5* diagnostic criteria for Major Depressive Disorder.
Maybe after the new manual is in use, the presumed problem of many people being prescribed antidepressants for the loss of a loved one will not pan out. Doctors and clients may prove to have more sense than to fall for that, but humans have fallen for numerous other ill-reasoned ideas.
Maybe there should also be a diagnosis of Dependency on Good Sense in the new DSM. Why not make “thinking clearly” a mental illness? Then when people become incensed by what makes no sense, they can get a prescription for medication to calm down or cloud their thinking.
Creators of DSM-5
What makes this topic so interesting is that the people creating the new DSM-5 were not picked at random out of a crowd at the mall. They are experienced and knowledgeable professionals that are likely very likable individuals. Until someone proves the writers are being slipped money by the pharmaceutical companies, they are presumed innocent and doing their utmost to create a good diagnostic tool.
Thinking of them is a reminder, though, of how protective people can be over something they have had a hand in; especially something creative. It’s really disheartening when you put heart and soul into a project and are pleased with your own effort and skill, only to be puzzled, hurt, and angry (grief?) when others find fault with it. That makes it very difficult to let go and make changes.
Depression vs. Grief
One bothersome thought is that anyone who has experienced both severe depression and intense grief knows they are not the same thing. A grieving person might become depressed, but that means they were not depressed to begin with. It is doubtful antidepressants would do much for grief anyway.
Grieving is the sometimes excruciating process of adjusting to a life without the presence of someone or something precious to us. Would a little more serotonin among our neurons make that any easier to bear? There seems to be a purpose to grief. It is a universal human experience that carries people along until they slowly move forward while looking back less often.
Depression does not carry a person anywhere. It is more like a sink hole. Symptoms of depression create a stasis situation, and maybe stasis of energy is what depression is. Time does not relieve or heal it. However, there is a more compelling reason not to medicate sorrow.
Someone grieving might naturally fall into a temporary depression as a reprieve from intense emotion and painful thoughts. Our body, in its wisdom, may “shut down” into a depressive state as a form of rest. If that is the case, an antidepressant would negate its purpose.
Defenders of the DSM-5 make the point that just because someone meets the criteria for depression does not mean that person will be treated or medicated; those are only options. True, but it is already possible for a grieving person who has become depressed to get treatment and medication.
DSM-5 defenders also point out that the depression criteria applies only in the death of a loved one or spouse. It will not apply if your nosey neighbor two doors down passes away. (One wonders, though, if they include pets as loved ones.) The new criteria does not consider the intense grief people might experience after a divorce, or losing their home to a hurricane or foreclosure.
If we make grief a mental problem, what difference does the reason for it make?
Therapists frequently see people who have had the same symptoms for years but have had a half dozen (or more) different diagnoses. This is pointed out not to disparage those that diagnose, but to illustrate how blurred the diagnostic criteria already is.
Add to that the fact that diagnosis is not just science, but an art as well.
It seems the more complicated that diagnostic criteria gets, the more it overlaps, and the less it distinctly describes an illness. Maybe the DSM-5 is an inevitable reflection of our crazy world.
To learn more about the symptoms of major depression and bipolar depression, and find information about treatment and symptom management, go to Healthline.
*DSM = Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association; now in its 5th revision.
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