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Is Grief a Mental Illness?

When is depression just a feeling?

When Meg’s* boyfriend told her that the relationship was over, she could not stop crying. “It was like a kick in the stomach. Like someone I loved told me that they were critically ill. And now I feel like someone has died.” She lost weight and had no energy for or interest in any of her usual activities. Her brother came to stay with her and finally insisted that she go to see a therapist.

The therapist told her that she was depressed and sent her to a psychiatrist for medication. The psychiatrist, however, said that he thought she was in mourning. “It is like someone died,” he said. “And it’s important to go through the mourning process. You should keep working with your therapist, talk about what happened and what you’re feeling. And you need to push yourself to eat and get out a little bit. Get your therapist to help you with that, too. You should start feeling better soon, but it can take six months to a year to really get over something like this.” He suggested they meet again in a month to assess how she was doing at that point, but he told her it could take six months before she “felt like her old self.”

There are a number of clinicians who would take issue with that recommendation. Taking it to one extreme is Jonathan Alpert, who, in an article in the New York Times , criticizes long term psychotherapy and suggests that 5-10 sessions are all it should take to get better; on the are the authors of the planned fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), who are saying that not only is depression a mental illness, but so is grief.

My PT colleague Eric Maise l, who has just published a book called Rethinking Depression: How to Shed Mental Health Labels and Create Personal Meaning and is making a virtual “blog stop” on my site today, believes we would be better off not using the term “depression” at all. He writes, “The word depression is a corruption of language, and the more society uses it, the further it will push us all toward unhappiness. Pathologizing unhappiness creates unhappiness.”

For his “stop” at this blog today, I asked Eric to say more about that idea. He replied, “I used to employ the expression “existential depression” because that seemed to me clearly not to connote anything biological or anything like a mental disorder. So it seemed safe. But now I am an advocate for getting rid of the word “depression” altogether until we clean it up and make much better sense of it. So, no, I don’t think it does serve any purpose—except that not using it makes it very hard to communicate with the hundreds of millions of people who are using it! So what I do nowadays is use it but I always put it in quotation marks, to indicate that I am using the word “depression” so that we can communicate but that I am using it with huge reservations.”

On the other hand, he said, “I think we have a common sense understanding of what the word ‘grief’ means—it is our whole-body, tremendously painful reaction to large loss. It is surely not a ‘mental disorder.’”

Although I agree with Eric that grief is a normal and necessary emotion, I’m perfectly happy for the DSM 5 to include grieving under the rubric of depression, if it means that insurance companies will pay for therapy to help people cope with the stresses that often accompany loss. But I too am distressed by the idea, also described by Dr. Alan Horwitz and Dr. Jerome Wakefiled in their book The Loss of Sadness , that in a society where we already run from strong feelings, we’re now going to see sadness and grief as a sickness.

As a psychotherapist who has practiced “talk therapy” for thirty years, my own non-scientific survey matches the findings of a growing number of researchers: talking about these feelings to another person can help them dissipate. (If you want to read more about this idea, take a look at The Talking Cure by Susan C. Vaughan).

Like Eric, I believe that feelings, even painful feelings like depression and sadness, have an important role to play in our lives. They have something to tell us, although it may not always be something we want to hear. Meg was grieving because she had lost someone who was important to her. That meant that she had the capacity to love and feel connected. Of course, it also meant she also had the capacity to be hurt. She needed to find ways to soothe herself after this psychological and emotional injury, just as she would have if she had been physically injured. She also needed to find ways to help herself heal. But it was important that she listen to the message she was giving herself, to go slowly, take care and nurture herself.

Six months later, to her surprise, she was indeed feeling better, although she still wasn’t fully back to her old self. One night she went to a lecture with a friend. And at the coffee hour afterwards, she started talking to a nice guy. And she realized that slowly, almost without realizing it, she had re-connected to herself, to the world, and to her life. When the nice guy asked for her phone number, she was ready to give it to him.

*names and identifying information changed to protect privacy

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