DSM5 in Distress

The DSM's impact on mental health practice and research

2 Weeks Post Newtown- Gun Control, Mental Health, and Grief

If not now, when?

The holiday season is always an especially tough time for grievers- heightening painful feelings and emphasizing the hole that has been left by the lost loved one. And this holiday season has made grievers of us all, as we mourn the victims of this latest shocking instance of our national epidemic of mass murder.

In the midst of sorrow, three issues demand discussion. First and foremost, we must return to a saner gun control policy and finally overcome the political paralysis caused by the bullying of the National Rifle Association. Allowing almost free access to ridiculously powerful firearms will lead inevitably to ever recurring massacres of the innocent. Guns do kill people and military grade automatic weapons kill quickly, indescriminantly, and with such brutal efficiency.

Second is understanding the role of mental illness in violent crime. The NRA would have us focus exclusively on the psychological problems of the killers to distract us from the compelling need to control their easy access to guns. The mentally ill as a group are only slightly more violent than the general population and account for only a small proportion of all violence. And we will never be able to predict who will become violent and when- this is an inherently insoluble search for the small needle in the very large haystack.

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But we can and must provide adequate mental health services for those who most need them. Instead, we have a chaotic nonsystem, hampered by a combination of inadequate funding and badly misallocated resources. Under pressure from aggressive drug company marketing, the not-ill and not-so-ill get far too much treatment, while budgets for treating the really are cut repeatedly by cash strapped state governments. The simple message- we need to provide the mentally ill much easier access to treatment and no access at all to guns.

Third, we must oppose the recently approved DSM 5 change that will medicalize normal grief by mislabeling it as Major Depressive Disorder. The Newtown shooting occurred two weeks ago today. If we followed the new DSM 5 rules, grieving survivors could now be mislabeled clinically depressed if they still feel sad and have reduced interest, energy, sleeping, and eating. Of course, this is nonsense- experiencing these expectable symptoms for just two weeks is a completely normal and necessary reaction to having lost precious loved ones.

So, three unavoidable lessons emerge from this tragedy. Let's give grief the dignity it deserves- not mislabel it as depression. Let's provide better and more accessible care for the severely mentally ill. And, most urgent, let's finally pass common sense gun control laws that will protect innocents from violent death inflicted by killers armed with weapons of mass destruction. If not now, when?

 

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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