Monday, May 21, 2012

Grief: You'd Better Suck It Up After Day 13

I have blogged previously about the American Psychiatric Association's controversial revision of its Diagnostic and Statistical Manual, the promised DSM-V--most recently:

Critics have charged with what appears to be good reasons that the APA has launched an effort to reclassify many states that have previously been viewed as normal into mental illnesses, with no base in the scientific evidence, but with vast opportunities for Pharma to get wealthy selling psychoactive drugs for all these newly "discovered" diseases.

To primary care physicians like me, one of the most egregious reclassifications rumored to be included in the new DSM-V is grief. We have long been taught that while depression is a disease, grief is normal. Treating grief with antidepressants at best does not help and at worst simply postpones the normal healing process. Social support and psychotherapy is almost always the right treatment for grief, except in the few cases of abnormally prolonged or intense grief which have to be addressed as a special set of cases. But in any event, after loss of someone very close, something in the range of 9 to 15 months would be seen as a normal grief reaction.

Dr. Richard A. Friedman of Weill Cornell medical college in New York, writing in last week's New England Journal:
--contrasts this standard wisdom about grief, which was how the existing DSM-IV categorizes the condition, with that of the working groups designing the new DSM-V. They intend to reclassify grief as a depressive disorder and suggest that after 2 weeks of mild depressive symoptoms, a bereaved person has crossed the line over into depression and should be treated as such. Dr. Friedman notes that there are zero scientific data to support this reclassification.

I have not been able to track down a source for this rumor, but I have heard murmurings that if the APA proceeds to issue the new DSM-V (apparently scheduled for next year) with this reclassification, some of the primary care physician organizations, including my own American Academy of Family Physicians, might vote formally to dissociate their members from DSM. This would be an unprecedented move as up till now, starting at least with DSM-III, all medical specialties have been willing to accept as gospel the disease classification proposed by the APA-- which by the way makes a ton of money from selling DSM as its proprietary product. But it is precisely due to the APA treating the DSM as its own private property and cash cow--along with the too-friendly association of leaders in psychiatry with the drug industry over many years--that has led to the present mess.

1 comment:

Altostrata said...

And don’t forget to sign the Open Letter to the DSM-5 at