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.
Category Archives: Discussion
I found this on a self-help website and decided to start a collection of mysterious graphics of grief. Why is yearning before depression? Why are outbursts the low-point on the curve and not sadness? Of course, there’s no sourcing for it, or even a designer credit. It ranks up there with the “grief wheel” in abstruseness. One of the widows I interviewed for my book was given the wheel to put up on her fridge by a well-meaning relative. But as she observed, “It’s a wheel. You go around and around on the damn thing, but how do you get off?!”
Novelist Joyce Carol Oates’s memoir about the death of her husband Ray Smith is coming out in February, part of which was excerpted in the December 13 issue of The New Yorker. Even though the book, A Widow’s Story, is 400 pages long, it only spans the first six months after his death, portraying the most intense period of grief and omitting the good news that she has since remarried. And while it is described as the story of ”one woman’s struggle to comprehend a life absent of the partnership that had sustained and defined her for nearly half a century,” Oates frequently mis-generalizes about all widows. She even describes predictable stages, such as the numbness she experienced gathering Ray’s belongings to take home from the hospital. “In this very early stage of widowhood—you might almost call is “pre-widowhood,” for the widow hasn’t yet “got it,” what it will be like to inhabit this free-fall world from which the meaning has been drained—the widow takes comfort in such small tasks, the rituals of the death protocol, through which more experienced others will guide her, as one might guide a doomed animal out of a pen and into a chute by the use of a ten-foot pole.” It reminded me of the false note in the play adaptation of The Year of Magical Thinking, when Joan Didion projected her experience onto all womankind. ”It will happen to you,” wrote Didion. “The details will be different, but it will happen to you. That is what I’m here to tell you.”