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See Inside June 2011

Shades of Grief: When Does Mourning Become a Mental Illness?

The new edition of a psychiatric manual called DSM-5 tackles what to do when mourning becomes complicated or leads to depression

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.” 

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