Grief to become a mental illness?

Ivor the Engineer

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http://www.scientificamerican.com/article.cfm?id=shades-of-grief

Sooner or later most of us suffer deep grief over the death of someone we love. The experience often causes people to question their sanity—as when they momentarily think they have caught sight of their loved one on a crowded street. Many mourners ponder, even if only abstractedly, their reason for living. But when are these disturbing thoughts and emotions normal—that is to say, they become less consuming and intense with the passage of time—and when do they cross the line to pathology, requiring ongoing treatment with powerful antidepressants or psychotherapy, or both?

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.

Comment here:

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 However, it’s true to say that being sad and withdrawn is certainly common enough for it to count as a normal reaction to loss.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?

Anecdotally, I'd estimate that it took me 2-3 years to get back on track after my father's death.

Why is the mental health community so obsessed with defining what the "normal" durations and ranges are for human behaviour?
 
Something can be normal in a particular situation and still may need treatment. For example a broken leg can be a normal response to falling off your bike, but that doesn't mean that you don't need a plaster cast.
 
"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."

I just wanted to second this.

There was a good article in the New Yorker a few months ago that discussed this. It made the point that some people take longer, and some don't grieve much at all. Both groups have to face the possibly well-meaning alarm of friends and folk-psychologists who have learned the Kubler-Ross model, the "five stages". The article criticizes this model as something that was just made up.


eta: here:

http://www.newyorker.com/arts/critics/atlarge/2010/02/01/100201crat_atlarge_orourke

http://www.newyorker.com/online/blogs/backissues/2011/02/grief.html


http://www.newyorker.com/online/blo...change-ruth-davis-konigsberg-on-grieving.html
 
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To some extent, the symptoms of normal grief are already treated. I was recommended to go to a bereavement support group, and was given sleeping tablets to help with my problems sleeping in the early weeks after my loss. None of this implies that the symptoms were in any way abnormal, just that they are unpleasant and difficult to cope with.
 
Something along these lines...

Despite the lack of consensus on underlying causation, advocates for specific psychopathological paradigms have nonetheless faulted the current diagnostic scheme for not incorporating evidence-based models or findings from other areas of science. A recent example is evolutionary psychologists' criticism that the DSM does not differentiate between genuine cognitive malfunctions and those induced by psychological adaptations, a key distinction within evolutionary psychology, but one widely challenged within general psychology. wiki

Personally, learning what depression, anxiety and mania biologically are helped me conquer those states for good. "Controversy :rolleyes: " over modern evolutionary hypotheses in psychology is absolutely holding back the species imho
 
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Anecdotally, I'd estimate that it took me 2-3 years to get back on track after my father's death.

I had a similar experience. It was about two years before I finally sought psyciatric help. There's no telling where I would be today if I hadn't done that.

Why is the mental health community so obsessed with defining what the "normal" durations and ranges are for human behaviour?

My question is: Why should people suffer needlessly when there is help available? Is it "good" for them?


ETA:
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.

This describes precisely what I went through after my father died 15 years ago...but words can't do justice to the mental anguish I experienced.
 
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http://www.scientificamerican.com/article.cfm?id=shades-of-grief



Comment here:



Anecdotally, I'd estimate that it took me 2-3 years to get back on track after my father's death.

Why is the mental health community so obsessed with defining what the "normal" durations and ranges are for human behaviour?

Pragmatic reasons; in many cases the differences between 'normal' and 'abnormal' are quantitative rather than qualitative, so there is no way to categorise something as 'abnormal' without reference to the 'normal' range on a continuous scale (e.g. duration).
 
Every time they revise the DSM, there is controversy in the mental health care community, as well as in the population at large.

From Psychiatric News (The APA, who publishes the DSM):

Don't Confuse Depression and Grief, Author Advises
Aaron Levin
Kay Redfield Jamison, Ph.D., who has endured mental illness and her husband's death, realizes that depression is destructive and alienating, but that grief acts to preserve the self and draw people together.
http://pn.psychiatryonline.org/content/45/22/17.1.full

While Jamison is a Ph.D, I believe she is well respected by MDs.

From Psychiatric Times:



From Psychology Today:

DSM5 in Distress
by Allen Frances, M.D.
(Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke)
http://www.psychologytoday.com/blog/dsm5-in-distress
 
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http://www.scientificamerican.com/article.cfm?id=shades-of-grief



Comment here:



Anecdotally, I'd estimate that it took me 2-3 years to get back on track after my father's death.

Why is the mental health community so obsessed with defining what the "normal" durations and ranges are for human behaviour?

Um, psst, it i already in the DSM. What is the big deal?

Bereavement. 296.80

It is part of communication and functional analysis, why stress test materials to see when they fail?
 

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