Finally, the DSM-V is coming in May. Since the DSM-IV (1994), the
DSM-IV-TR (2000), there are some changes in this standard diagnostic
manual for mental disorders by American Psychiatric Association.
As
one of my specialized areas is distinguishing normal bereavement and
pathological bereavement, including bereavement-related depression, I am
not really happy that the DSM-V removed "bereavement exclusion" item
from the diagnostic criteria for Major Depression Disorder.
Though
the DSM-V retains 2 months "grace period" for considering if certain
bereavement conditions are pathological enough to be major depression,
the exclusion of bereavement from the diagnostic criteria of major
depression poses danger of overpathologizing grieving persons -
especially clinicians tempted to make more money out of each patient!
All
mental health clinicians, including psychotherapists, like me, are
financially rewarded by putting DSM diagnoses on patients' insurance
forms. Further more, physicians are even much more lucratively rewarded
by prescribing medications to patients with certain diagnoses.
I
am afraid that that making grief look more like a mental disease with
this DSM-V change (by removing "bereavement exclusion" from the major
depression diagnostic criteria) can let greedy mental health clinicians
take advantage of grieving persons by pathologizing to be financially
rewarded by insurance and pharmaceutical companies.
In regard to
treating grieving persons as a mental health professional, I value
George L. Engel's 1961 seminal paper, "Is Grief a Disease?: A Challenge
for Medical Research" (Psychosomatic Medicine, January 1961 23:18-22)
more than DSM-V.
Below are important thoughts of Engel to be considered in the face of this DSM change on bereavement.
"If the actual or threatened loss of an
object so consistently disturbs the total adjustment
of the organism, then we have
identified an etiologic factor of such general
importance as to put it in the same
class as other major noxa, e.g., physical
agents, microorganisms, etc. Until—and not
until—much more is known about the biochemical,
physiological, and psychological
consequences of such losses, no one is justified
in passing judgment as to how important
this factor is in the genesis of the
disease states that seem so often to follow
close upon an episode of grief."( p.21)
"The concept of grief as a disease requires
that we keep in view and in perspective
aspects of the external environment
other than what we have been accustomed
to heretofore—namely, the environment
made up of the significant psychic objects.
This becomes one reason why the persons,
job, home, goals, etc., in the life of our
patients cannot be disregarded in our consideration
of illness, at least not until it has
been proven that the vicissitudes of object relations, including grief, the disorder consequent
to object loss, plays no role in the
pathogenesis of disease." (pp. 21-22)
"I close with a quotation ascribed to Albert
Szent-Gyorgyi: "Research is to see what
everybody else has seen and think what
nobody else has thought." To this I would
only add that Szent-Gyorgyi wisely refrained
from claiming that this necessarily implied
that the "new" thought is correct—at least,
not until tested."(p.22)
On
interview with Bloomberg News staff on March 6, James Scully, CEO of
American Psychiatric Association, admits that there is no objectively
verifiable test, such as a blood test, to assure the scientific evidence
to pathologize patient's grief at this time. Yet, his organization
goes ahead to make it more tempting for mental health clinicians to
diagnose bereavement as major depression by simply waiting for 2 months
from its initial onset.
I am afraid that Scully and his
collaborators in American Psychiatric Association have forgotten or have
never read George Engel's classic paper on bereavement.
http://www.bloomberg.com/video/the-implications-of-redefining-mental-health-NDj0iw6tTouJPa9r_SnmRw.html
http://www.psychosomaticmedicine.org/content/23/1/18.citation
Were you an Upward Bound counselor at SEMO?
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