Grief, mental illness and psychiatry’s sad refrain

Scientific American covers a coming shake-up in how grief is defined in relation to mental illness as the forthcoming DSM-5 diagnostic manual aims to radically redefine how mourning is treated by mental health professionals.

It’s worth saying that the DSM-5 has yet to be finalised and will not appear until 2013 but the changes to how grief is classified seem quite drastic.

Two proposed changes in the “bible” of psychiatric disorders—­the Diagnostic and Statistical Manual of Mental Disorders (DSM)—­aim to answer that question when the book’s fifth edition comes out in 2013. One change expected to appear in the DSM-5 reflects a growing consensus in the mental health field; the other has provoked great controversy.

In the less controversial change, the manual would add a new category: Complicated Grief Disorder, also known as traumatic or prolonged grief. The new diagnosis refers to a situation in which many of grief’s common symptoms—such as powerful pining for the deceased, great difficulty moving on, a sense that life is meaningless, and bitterness or anger about the loss—­last longer than six months. The controversial change focuses on the other end of the time spectrum: it allows medical treatment for depression in the first few weeks after a death. Currently the DSM specifically bars a bereaved person from being diagnosed with full-blown depression until at least two months have elapsed from the start of mourning.

It is particularly striking that normal grief could be classified as a mental illness under the new proposals as this brings into question how we define mental illness itself.

Contrary to popular belief, there is not one ‘standard way’ of grieving and people’s response vary widely in response to losing a loved one. However, it’s true to say that being sad and withdrawn is certainly common enough for it to count as a normal reaction to loss.

This brings to mind psychologist Richard Bentall’s tongue-in-cheek proposal to classify happiness as a mental disorder due to the fact that it is “statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system”.

Perhaps we can also look forward to simmering anger, dashed hopes and unrequited love disorders for the DSM-6?

Link to SciAm article ‘Shades of Grief’.

16 thoughts on “Grief, mental illness and psychiatry’s sad refrain”

  1. Very interesting – thanks for this post. I think the happiness mental disorder should be called, Candide Syndrome. 🙂

    I hope that, when redefining grief as a disorder, they consider respective relationships. Surely, grieving must be unique depending on if it’s for a child, spouse, friend, coworker, etc.

    The oddest thing I’ve seen is that guardians seem to feel guilt when a pet dies, even when the pet had unavoidable heart failure or somethiing else that is no fault of the guardian. The social sciences have kind of done a lousy job explaining human-animal interaction anyway, so it’s no surprise that few take pet grieving seriously.

    1. Pet grieving may be part of another problem, the growing inappropriate relations between people and their pet. People are highly social yet many of us live in isolation and as take on pets as surrogates friends. As someone who likes dogs and cats I’m always dismayed when people take on pets as “part of the family.” Pets can’t challenge you, Know when to push you, know when to give space, or add fresh intellectual stimulations as a fellow human can. By all means take care of your pet, but respect the fact it is an animal. I feel many people who grieve over the loss of a pet blur this boundary.

      1. Anthony, I agree with you in that people often humanize pets as “babies”, which I find disturbing. Mostly because they do not respect the cat (dog, rabbit, etc) for what they are. Pets can challenge people if the person wants to understand the species at their own level. I’ve studied cats and Feliformes for years (both as a biologist and vet nurse). Pets can sometimes be seen as allies. Certainly plenty of humans have poor boundaries and do not give each other enough space; when people adopt an animal, it’s up to them to choose an animal based on good personality rather than how cute it is.

        I don’t think we can label something as “inappropriate relations” when anthorpologists have not even begun to understand human-pet relationships. There is some interesting research out there but it’s in its early stages, unless I’m missing something. Until we figure it out, we won’t even fully understand what we’re grieving.

    2. Emmy

      I agree with you that there is a bond between certain animal and human and I agree with you you that we should see the pet on its own level.
      I just returned from some time in South America and one thing that I notice is that people were always around other people, social isolation was extremely rare and people did not sentimentalize animals. Its just striking being back in the states where animal are personified.

  2. “Pet grieving” is just as severe as, say, “uncle grieving”. Pets ask less and give more than many human family members. Of course we miss them when they go!

    1. I know what you’re saying, I’m just not sure that pets feel the way most of us think they do. I mean, it’s not as though they have any choice. Some pets run away the first chance they get. And dogs who are credited with “saving” a family from a burning house – as one behaviorist says, of course the dog wakes up the family – how else could the dog get the door open to escape? One blogger seems to understand dogs pretty well, though.

  3. Grief that lasts for “more than 6 months”….what a comment on the strength of human affections!

  4. Quite a flippant reaction!

    Consider this: an 11 year old girl’s mother dies.

    Less than one year later, her father marries his mistress, and the girl “resides” in what becomes quite an abusive home.

    31 years later, the girl experiences what is diagnosed as “Clinical Depression.” Now the woman herself defines her life being “depressed since I was about 11 years old,” yet not a classic case of Depression.

    No, I’m not a mental health professional. Life is simply far more complex than you apparently realize.

  5. Reminds me of this article about “long-term grief” that I recently re-read:

    “Suddenly the problem was something entirely different than it first seemed to be. I asked if she had worked on her grief very much. With a tiny smile at the corner of her mouth she said, “Oh yes, a lot of really famous therapists have tried to help me.” While apparently pleasant, the woman had a subtle, implicit anger in her manner. If you listened closely, her words carried a stubborn, challenging undertone.

    On one level Carol and I had been suckered. The woman was up in front of the audience in a beside-the-point attempt to fortify an absurd and neurotic position she had taken. She was punishing her friends and children for having expectations of her while refusing to take responsibility for the passive-aggressive way that she resisted them. She was stuck in cement and trying to stay that way. She was inviting us to try to change her against her will. Once we inevitably failed she would have a new plate in her defensive armour.”

  6. I guess there are people who “Claim Grief,” and others who are relieved to discover the issue is Grief, albeit complex.

    As usual, it depends on one’s honesty to oneself.

  7. Allowing MEDICINAL treatment within a month of bereavement is an injustice to the people who are suffering from their grief. I absolutely think that treatment in the form of counseling or CBT is appropriate even within a week of bereavement, but drug treatment is inappropriate within such a short period of time UNLESS symptoms are extremely severe (suicide attempts or what have you). (that is my opinion) Anti-depressants aren’t going to help a person learn how to cope with loss – it will just numb them to the pain they are experiencing.
    I hate to be one of those, “Now I can tell my story!” kind of people, but when my Daddy passed away I grieved intensely for at least a year. Crying often (like every day), lack of concentration, etc. etc. But I did eventually pass out of that phase – however, I would have been considered to be disordered!
    I think disordered grieving is easy to diagnose in people who, for example, lost a family member ten years ago and still live in this world of grief where the feeling of loss is so intense that they may even try to pretend the person is still alive to lessen that feeling. I understand the desire to create a starting point of being able to diagnose that kind of disorder… but six months is ridiculously short.

  8. “Whenever people say, ‘We mustn’t be sentimental,’ you can take it they are about to do something cruel. And if they add, ‘We must be realistic,’ they mean they are going to make money out of it.” Brigid Brophy.
    “…people did not sentimentalize animals.” – I dare say the upshot of this “non-sentiment” is the same as the “personifying” – i.e., the animals get it in the neck.

  9. Having been raised in an abusive household , my brother being my hero and protector and best friend for all my life. He was taken from this world 19 years ago, exactly one month to the day my dad was also killed…Six months didnt even afford me relief to drag myself from my bed…19 years ago..And much much grief later, i have came to terms with my brother’s quick exit from this life.. I know he is ok because he communicates with me when he is able..I was just dianosed as schitzophrenic…

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