Is Grief An Illness?

Clinicians have been arguing whether grief is an illness for decades. The latest round in the debate is over whether what’s known as the “grief exclusion” should be taken out of the criterion for major depression in DSM-5, the upcoming edition of the diagnostic manual used by mental health professionals. In the current edition, the grief exclusion states that someone who was bereaved within the last two months is not eligible for a diagnosis of major depression. (Bereavement also makes an appearance as a “V code” in the section in the back of the manual for disorders that are not reimburseable by insurance.)  In an Op-Ed in the New York Times, Allen Frances, a professor emeritus of psychiatry at Duke University who has become a vocal critic of DSM-5, warned that eliminating the grief exclusion would lead to the ”wholesale medicalization of normal emotion.” The doctors in charge of the decision  responded that “most bereaved individuals do not develop major depression, although they may feel terrible sadness. Major depression—the clinical syndrome—is quite different from feeling sad and blue. It also involves marked, peristent changes in function like sleep, appetite and cognition, and sometimes suicidal thinking. ” This confusion is common, but perhaps even more so in the case of bereavement. Ever since Kübler-Ross made depression one of her five stages, people see it as a normal reaction to grief. Let’s hope that the Mood Disorders Work Group for DSM-5 can help clarify the distinction.

One Response to Is Grief An Illness?

  1. Jerry null Lobdill

    My wife died suddenly on 12/26/99. Her death came after 14 years of marriage. We both had more than one previous marriage, but neither had lost a spouse to death. Our marriage had begun on a rocky road that became smoother with time. We had gone through many tribulations together, and had emerged as a strongly committed couple.

    I was 62 when she died and knew nothing of the grieving process. At my sister’s suggestion I attended a 6 week workshop sponsored by a church. At first I seemed to be following the five stages, but when I got into the anger stage my response to that anger was to make a subconscious decision that life was dear and growing shorter, and damned if I was going to be miserable for two years. I had come through 14 years of losses of life savings, career, income potential, all because of uncontrollable external events, and I did not intend to spend the next two years wallowing in grief regardless of my then present sense of loss of my wife.

    I went to a program called “Discovery” in Dallas, and in two months I lifted myself out of my paralyzing grief. By August 2000 I had met a new love, a widow, and we have now been blissfully married since January 2005.

    I am living proof that no matter how paralyzing grief is, it can be overcome in less than a year. Had I blindly accepted the pronouncement I had been given in the grief workshop I would have wasted God only knows how much of my remaining life wallowing in misery.

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