A Diagnosis for Grief - Missing the Point
I'm going to discuss another controversial change in the DSM-V - removing the bereavement exclusion for depression.
In DSM-IV, if you meet all the criteria for depression, but your symptoms began shortly after the death of a loved one, you are excluded from a depression diagnosis. (With some exceptions - if it lasts too long or is atypically severe, you still get diagnosed with depression.)
However, this is changing in DSM-V. They will soon be allowing diagnosis of depression in anyone who meets criteria, regardless of what precipitated the symptoms. If you are depressed because your husband recently died, according to DSM-V, that still counts as depression.
A lot of people seem to be very upset about this. They say we're 'pathologizing' grief. They say that grieving is normal. They say that we shouldn't be treating normal emotions as a sickness.
Grief is normal. This is entirely true. It's also completely irrelevant, because they've missed the whole point of the DSM.
The DSM is not here to police the 'Holy Norm'. That's not it's purpose. It's not designed to stamp a label of 'sick' on someone, so people can tell who they should shun and discriminate against. If that was its purpose, that would be a serious breach of human rights, and would extend far beyond the issue of whether a widow is depressed.
You want to know what the real purpose of the DSM is? I'll tell you:
To identify people who need psychiatric help.
That's it. Not to label you as sick or wrong or deviant. Just to say you need some help because you're having trouble coping with life.
You can be normal and still need help.
Your reactions can make sense in context, and you still need help.
Ideally, you can get the help you need from family and friends and community support - just like the guy in my church whose wife recently died of cancer. But if you don't have that social support, psychiatry is here to tell you that you don't need to be alone in your pain. You can hire someone to talk to about your feelings, someone who has received special training in how to be supportive.
And if people think there must be something wrong with you for you to need psychiatric help, well, they're just bigots.
In DSM-IV, if you meet all the criteria for depression, but your symptoms began shortly after the death of a loved one, you are excluded from a depression diagnosis. (With some exceptions - if it lasts too long or is atypically severe, you still get diagnosed with depression.)
However, this is changing in DSM-V. They will soon be allowing diagnosis of depression in anyone who meets criteria, regardless of what precipitated the symptoms. If you are depressed because your husband recently died, according to DSM-V, that still counts as depression.
A lot of people seem to be very upset about this. They say we're 'pathologizing' grief. They say that grieving is normal. They say that we shouldn't be treating normal emotions as a sickness.
Grief is normal. This is entirely true. It's also completely irrelevant, because they've missed the whole point of the DSM.
The DSM is not here to police the 'Holy Norm'. That's not it's purpose. It's not designed to stamp a label of 'sick' on someone, so people can tell who they should shun and discriminate against. If that was its purpose, that would be a serious breach of human rights, and would extend far beyond the issue of whether a widow is depressed.
You want to know what the real purpose of the DSM is? I'll tell you:
To identify people who need psychiatric help.
That's it. Not to label you as sick or wrong or deviant. Just to say you need some help because you're having trouble coping with life.
You can be normal and still need help.
Your reactions can make sense in context, and you still need help.
Ideally, you can get the help you need from family and friends and community support - just like the guy in my church whose wife recently died of cancer. But if you don't have that social support, psychiatry is here to tell you that you don't need to be alone in your pain. You can hire someone to talk to about your feelings, someone who has received special training in how to be supportive.
And if people think there must be something wrong with you for you to need psychiatric help, well, they're just bigots.
posted by Ettina at 8:48 AM
1 Comments:
Thank you, Ettina!
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