According to the last edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), “normal” grief lasts for only two months. After that time it is classified as an aberrant medical condition. But the upcoming DSM V proposes a further change, to no longer give the depression often associated with grief an exemption and declare it an illness.

The new subcategory of adjustment disorders recommends a new category of Bereavement Related Disorder.

Since the death at least 1 of the following symptoms is experienced on more days than not and to a clinically significant degree:
1. Persistent yearning/longing for the deceased
2. Intense sorrow and emotional pain because of the death
3. Preoccupation with the deceased person
4. Preoccupation with the circumstances of the death

The diagnosis of the disorder largely hinges on the persistent longing for the dead loved one, intense sorrow or preoccupation with the deceased. In fact any one of those pretty much labels the experience a mental disorder.

Understandably there’s been much debate about the new disorder in both the psychiatric profession and within the community. The medicalisation of grief is a hot topic, with programs such as SBS Insight covering the debate well.

The reality is we all grieve in different ways and in our own time. It’s often a long and painful life event but not a disease. Previously the DSM acknowledged that “uncomplicated bereavement,” was not major depression. While meeting much of the criteria for depression, the circumstances absolved the necessity to medically treat. So why the sudden change?

Alice G. Walton in a recent Forbes article suggests that classification will result in more scripts for antidepressants being written and ultimately financial gain for both psychiatrists and the pharmaceutical industry.

Medicalising grief will no doubt result in many more prescriptions for antidepressants. “Its ubiquity,” says Kleinman, “makes grief a potential profit centre for the business of psychiatry.”

A look at recent medical research on bereavement makes interesting reading. A 2008 study concludes that the depression associated with grief is no different to that precipitated by other stressful life events, such as divorce. The authors argued that many of those suffering depression after these life events fitted the DSM depression-exemption criteria (bestowed only on the bereaved) better than those actually grieving. However the authors noted that their conclusion differed greatly from previous research. In fact the 2007 study by Wakefield noted the symptoms of intense bereavement-related sadness may resemble those of major depressive disorder but may not indicate a mental disorder. They even suggested that other stressful life events should be included into the then DSM exemption that was afforded to grief. Guess which study was funded by the pharmaceutical industry?

To date most mental health professionals advise talk therapy for grief before medication is considered, despite the DSM V proposal. However anecdotal reports, and as illustrated by a number of the Insight participants, suggest some GPs are quick to reach for their prescription pad when confronted with a grieving client in a busy medical practice. It is unclear if the proposed ‘Bereavement Related Disorder’ will result in more prescriptions for antidepressants.

While there is no right or wrong way to grieve, the Insight program demonstrates the different needs of those in the grips of bereavement, experienced over many years not months. Even couples experiencing the same loss of a child are often in a different stages of grief, needing diverse approaches to navigate the process. While one mother seemed to be in a state of almost blissful acceptance, her husband looked on anxiously, often with tears in his eyes. Another couple faced with a similar loss depicted a husband needing total isolation, while his wife craved the opposite. It’s unlikely that the panel of experts behind the DSM V would classify many of the show’s participants as normal or mentally healthy. Yet to anyone who has experienced grief, they seemed to accurately representations of the different phases of bereavement.

But that’s not to say that grief cannot become “complicated” or unhealthy. Maintaining a prolonged state of rage, depression, apathy or social withdrawal potentially creates its own pathology. But how long is too long: two months, six or one year or two?

If the new DSM V guidelines are accepted, the medicalisation of grief is inevitable.

Resources
Forbes on medicalising grief and who gains from this.

Insight (SBS), Good Grief and the episode on YouTube.

The Lancet: a beautiful, personal essay on grief.

A heartfelt article from a woman facing her own death, “How do you speak to a friend who’s dying? Truthfully, deeply, unsparingly and all the time. ”

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