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DSM-5 Controversy Rages On in the Bereavement Community

How a diagnosis can help the bereaved person who struggles to cope

This post is in response to
More Than 65,000 Grievers Must be Heard and Should Be Heeded

With un complicated grief, you may crawl into a cave at first, overcome with shock, sorrow, and despair. But as the shock subsides, you can muster your coping skills and still function when necessary. Over time, you adjust to a "new normal", shed the pain, reengage with your life and the people around you, and even find peace. In short, you can grow and even experience personal transformation due to reordered priorities and new opportunities.

But what happens if you crawl into the cave of grief, and lose sight of the light at its entrance? What if you find yourself giving up in despair, stuck in the cave and perhaps falling deeper and deeper into the abyss?

This kind of debilitating grief is considered "complicated", and the American Psychiatric Association is proposing changes to the way grief is categorized and diagnosed, particularly after the death of a loved one. Two basic modifications will appear in the upcoming 5 th edition of the Diagnostic and Statistical Manual of Mental Disorders , or as it's commonly referred to, the DSM-5.

1.     A new diagnostic category will be added: Prolonged (Complicated) Grief Disorder . This diagnosis would apply to bereaved persons who experience significant impairment and distress that persists over an extended period of time. (e.g. some propose longer than 6 months, others 14 months) after the death of a loved one.

2.     The " bereavement exclusion " will be eliminated from the diagnosis of Major Depression, so that this diagnosis can be given to bereaved persons experiencing significant and pervasive symptoms of clincial depression after the death of a loved one, even during the first couple of months following the death.

1)     Far from being harmful or disrespectful, a diagnosis of Prolonged (Complicated) Grief Disorder or Major Depression  can benefit the bereaved who suffer from these very real conditions. Whenever a diagnosis is created, it gives a name to that particular kind of suffering. A diagnosis offers acknowledgement and validation to the sufferer. Receiving a diagnosis is often the first step in understanding and coping with what ails us. A diagnosis also leads to research and the development of evidence-based treatments. A diagnosis leads to appropriate treatment and insurance companies covering the cost. And a diagnosis leads to increased awareness and social support. In other words, depression and complicated grief aren't just normal grief that time will heal. And those who suffer deserve the respect of being recognized and treated for their particular wounds.

2)     These diagnostic revisions are not being cooked up in some Ivory Tower, by a clutch of theorizing intellectuals who are uncomfortable with emotional displays of grief. Nor are these revisions up for popular vote by the lay public. Rather, they reflect and accommodate new research findings and modern medicine's increased understanding of the effects of emotional trauma on the brain and the relationships between normal grief, prolonged or complicated grief, major depression, and PTSD.

4)     In the current DSM-4, a person can be diagnosed with depression within 2 months after any other significant loss or stressful life event besides the death of a loved one . But new research has found that any of these traumas, including death, can exacerbate or increase the risk of depression. In addition, if someone is assaulted or displaced by a house fire, and 5 weeks later is still emotionally debilitated, we would applaud his or her efforts to seek help. Why not offer the same permission, support, and assistance to the widower or grieving parent? Indeed,  if you are bereft and become clinically depressed in short order, such that you can't function or reengage with life even when necessary, you should be able to get the help and support you need to get back on track.

6)     I believe we can continue to rely on the professionalism and compassion of mental health practitioners. The fear that upon publication of the DSM-5, practitioners will start misdiagnosing prolonged/complicated grief, treating normal grief as clinical depression, or pushing medication is based on patently erroneous assumptions of looming incompetence. I assume quite the opposite:

b.    The DSM is not a set of laws that lumps all people together, but a set of guidelines that are to be applied  judiciously to each person as a unique individual. In other words, the DSM-5 will suggest-- not require--  any diagnosis.

c.     Likewise, effective practitioners will continue to tailor therapies and medications to the individual. And they will continue to offer unbiased information and guidance, and support their patients' treatment choices.

d.     Even without these diagnositic revisions, clinicians will continue to offer compassion and state-of-the-art treatment to those who struggle to cope and feel whole again.

7)     Even if you are diagnosed with major depression, no one can force you to take medication, much less fill a prescription.  (Anti-depressants have been shown to be ineffective for prolonged/ complicated grief.) However, bereaved persons who've taken medication for depression report that it can help-- without taking away their grief. Medication doesn't lessen the pain, but it does provide a floor to the abyss. So instead of feeling stuck or continuing on a downward spiral, medication can offer you the comfort of a good foothold , renewing your ability  to climb up and out.