Critics of the move counter that it will lead to unwarranted diagnoses and overtreatment. “It’s a disastrous and foolish idea,” says Allen Frances, who chaired the task force that produced the fourth edition of the DSM. He worries about how the DSM-5 may be used by sales representatives from pharmaceutical companies to urge doctors to write more prescriptions. Indeed, Frances believes that changes in the edition that he oversaw inadvertently sparked an unwarranted explosion of diagnoses for bipolar disorder in children. Prigerson, for her part, predicts a general backlash against the idea that mourners might ever need psychiatric treatment. “There will be vitriolic debates when the public fully appreciates the fact that the DSM is pathologizing the death of a loved one within two weeks,” she says.

In many ways, parsing the differences between normal grief, complicated grief and depression reflects the fundamental dilemma of psychiatry: mental disorders are diagnosed using subjective criteria and are usually an extension of a normal state. So any definition of where normal ends and abnormal begins will be the object of strongly held opinions. As Frances says, “There is no bright line—it is always going to be a matter of judgment.” 

This article was originally published with the title Shades of Grief.

4 Comments

1. 1. Howboy 01:09 PM 6/8/11

   I had my "Roberta Flack Moment" when I turned to page 34 (Shades of Grief) in your June 2011 edition and the article "was telling my whole life" there, in public. But I don't feel like it was 'killing me softly' with words - this was enlightenment.
   
   Since the sudden and shocking loss of my wife in April 2004 I've had trouble readjusting, and reading that others have already been where I am, and learned from it, has been a source of strength.
   
   The definining of 'complex grief disorder' is a good beginning. I hope that future consoulers are able to use this to shorten other people's losses.
   
   I had suffered three previous periods of depression in my life, and thought I had some understanding of it. One key thing was knowing it would end; yet I could not understand why my depression over the loss of my wife seemed to pass - and then quickly return, over and over. The concept of complex grief fits. I could have written the criteria without looking.
   
   Also, the nature of the way I found my wife, dying of brain anurysm, added a bit of traumatic shock to my particular case; throw in a three hurricanes and I had a few difficult years. Like any illness, I deal with the scars (for a while, strong winds put a chill down the spine, for instance).
   
   If you haven't listened to Roberta Flack's "Killing Me Softly With His Song" for a while, do. It is the best way to describe how I felt when I first read this article - jaw open, reading, glancing back and forth at the author's face "Does she know ME?"

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2. 2. Squeedle 06:15 PM 6/8/11

   I hope that it is not assumed that only those who lose a human being, or only those who lose someone through death are subject to this sort of grief. I've experienced this myself from the breakup of a relationship and I've seen other people have a very difficult time adjusting to their lives after such a loss, even of a beloved pet. Fortunately I was aware enough to obtain help and now I'm fine, but other people may be unaware that they are not going through a healthy progression of emotional states.

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3. 3. Asclepius 05:10 AM 6/9/11

   The special addition addressing traumatic grief has direct application to returning veterans. Additionally, if the practitioner also couples that diagnostic advice with DSM advice about guilt there could be a significant breakthrough in the treatment of what we class as PTSD.
   
   It is critical however, that the DSM be regarded and utilized as a supportive guide not as a diagnostic and treatment protocol.

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4. 4. verdai 07:49 PM 6/23/11

   Remember.
   It would be insane to forget.
   Live With It.

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