Elements of the Proposed DSM 5—From Travesty to Potential Tragedy
Speaking out on behalf of millions of unsuspecting grievers
Posted Nov 04, 2011
The intent of this blog post is to encourage you to read and sign a petition titled, Open Letter to the DSM-5. We are particularly focused on the proposed change in the bereavement exclusion which is one of the major protests in the petition. You can skip the blog and go directly to the petition: http://www.ipetitions.com/petition/dsm5/
From Travesty to Potential Tragedy
The Dangerous DSM-5 Bereavement Exclusion Train Must Be Derailed BEFORE It Causes Permanent Harm To Unsuspecting Grievers
We are: John W. James and Russell Friedman, co-founders of The Grief Recovery Institute Educational Foundation, and co-creators of The Grief Recovery Method®. We are also co-authors of The Grief Recovery Handbook and When Children Grieve [both published by HarperCollins] and Moving On [M. Evans].
Our experience: Over the past 30 years we've had direct contact with more than 100,000 grieving people, the vast majority of whom contacted us because of the impact of the death of someone important in their lives. Through our books—which are translated into 15 languages, and our media and public appearances, millions more have seen and heard us talk about the fact that grief is the normal and natural reaction to loss, and that recovery from significant emotional loss is actually possible. Additionally, through our network of more than 5000 Certified Grief Recovery Specialists®, our Method has helped more than 500,000 grieving people.
Frankly, we don't know of any other individuals or organizations that have the practical experience in listening to and helping grieving people. Therefore, in the matter of the proposed changes to the bereavement exclusion to be included in the DSM 5, we believe that our voices should be heard.
The topic at hand relates to one of the proposed changes from the current DSM IV to the next version, DSM5 scheduled for publication in May of 2013. In particular, we are gravely concerned about the proposal that would endorse and condone diagnosing a newly bereaved person—within the first two weeks, post loss—as having a Major Depressive Episode [MDE] when they are exhibiting normal bereavement reactions.
For those of you who are not familiar with the topic, we are talking about the proposed changes to the Diagnostic and Statistical Manual of Mental Disorders-and therein lies the problem.
"Grief is the normal and natural reaction to loss. Of itself it is neither a pathological condition nor a personality [or mental] disorder." [From page 47 of The Grief Recovery Handbook.]
An Explanation By A Former DSM Contributor
Here's a simple explanation about the DSM 5 bereavment exclusion debacle according to Dr. Allen Frances:
"So the test case is someone who has lost a spouse or child and has just two weeks of sadness and loss of interest, appetite, sleep, and energy. Such a person would have to be diagnosed with MDE if we were to follow the DSM 5 suggestion to simply remove the Bereavement exclusion."
[Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke. He has many other bones to pick with the DSM-5. Read more about them on his Psychology Today blog - http://www.psychologytoday.com/blog/dsm5-in-distress/201110/psychologists-start-petition-against-dsm-5 ]
The Grief Recovery Institute's Reaction
For us, when a book devoted to Mental Disorders refers to the normal and natural reaction to grief-producing events as pathological, we are up in arms. Granted we have disagreements with our friends and colleagues about if and when grief ever becomes pathological, and what to call it, but we are in total union with them in opposing the proposed change in the bereavement exclusion.
We speak out here, not for ourselves, but on behalf of millions of unsuspecting grievers who will be diagnosed as having had a MDE and placed on an array of psychotropic drugs within two weeks of the death of someone who had meaning in their life. This will happen solely because they may have mentioned that they had any of the normal and natural reactions to that death, and not because they have exhibited or been tested for any signs of clinical depression.
This is insanity—and worse. Keep in mind that we're talking about a trusting citizen who goes to a doctor or mental health professional, tells the truth about how he or she feels, and then has that trust betrayed by being falsely diagnosed as depressed and then placed on meds. Those meds will essentially cover up the normal and natural feelings that might be helpful in effectively communicating about the natural emotions triggered by the loss.
Real Life Example
Imagine a brand new widow or widower whose spouse of 50 years has just died. Think about what it might feel like after 18,250 consecutive days of living with, eating with, sleeping with that person, and he or she is no longer there.
Does it make sense that that person would have some emotional and physical reactions to that incredible change in their personal universe? Think about it from an even more logical perspective. Does it make any sense at all that that person would NOT have a reaction to the death? After all, their universe is upside down, so it only makes sense that they might be sad, confused, have a hard time concentrating, struggle with eating or sleeping patterns, and be on an emotional roller coaster.
What the hyper-pathologically focused folks at the DSM 5 don't get is that the symptoms of normal and natural grief tend to be parallel to the symptoms of MDE. They are: sadness, confusion, lack of concentration, eating and sleeping issues, and wide ranging emotions.
The tragedy is that we have to remind the DSM people of that basic truth, and tell them not to confuse the two and diagnose normal bereavement responses as clinical depression.
Studies Say Guidelines Encompass Many Who Are Just Sad
A study of 8800 clients established that a large percentage of the grieving people diagnosed as depressed and placed on antidepressant drugs are NOT clinically depressed. The study suggests that those people would benefit far more from actions [like those of Grief Recovery-our comment] which can keep many of them from developing full blown depression. [National Comorbidity Study, Archives of General Psychiatry, volume 64, April, 2007, Wakefield, Schmitz, First, Horwitz, et. al.]
A more recent study concluded: Bereavement-related, single, brief depressive episodes have distinct demographic and symptom profiles compared with other types of depressive episodes and are not associated with increased risk of future depression. The findings support preserving the DSM-IV bereavement exclusion criterion for major depressive episodes in the DSM-5. [Bereavement-Related Depressive Episodes - Characteristics, 3-Year Course, and Implications for the DSM-5 , Ramin Mojtabai, MD, PhD, MPH, Archives of General Psychiatry, Vol. 68 No, 9 September 2011.]
You Can Participate—Sign An Open Letter Petition To The DSM-5
Between us, John W. James and I have devoted nearly 60 years of our lives to helping grieving people. A major part of our efforts is to protect grievers from anything that can hurt them or limit the possibility of recovery.
We know that the incorrect diagnosis of depression coupled with the prescription of psychotropic drugs, tends to remove grievers from their feelings and from access to the very emotions that can most help them.
The battle is waged and you can add your voice. There is a petition you can sign that will be send to DSM 5. Please take the time to go to http://www.ipetitions.com/petition/dsm5/
We want to thank our friend, Allen Frances, for leading the good fight.
From our hearts to yours,
John W. James