Should Grief Be Considered A Mental Illness?

When my mom died over a dozen years ago, I remember my dad telling me his doctor had prescribed an anti-depressant for him. I don’t remember if my dad even filled it, but his reaction—which I shared—was that it seemed absurd to prescribe an anti-depressant for something so thoroughly normal and expected in his situation as grief.

In Good Grief! Psychiatry’s Struggle to Define Mental Illness Goes Awry, TIME health writer, Maia Szalavitz, writes about the upcoming DSM-5 including a provision to classify grief as depression. Not only would that make grief not good—it would make it pathological. For anyone who doesn’t know, The DSM is the Diagnostic and Statistical Manual, sort of the bible of diagnosing mental illnesses. If you get therapy or medication for any psychological issue, you can bet there’s a numerical code and diagnostic criteria for it that came from the DSM. While it’s an important tool in the diagnosis and treatment of mental illness, mental illness criteria are notoriously controversial, so the DSM has undergone many revisions, including this upcoming 5th edition.

Grief is a miserable experience, no doubt about it, but is it really a disorder? As one who has been been tagged with a code from that manual (I won’t say which one just yet), I take it sort of personally when it looks like normal human experience is getting classified as a disorder. For one thing, no matter how much we might wish it were otherwise, mental illness is stigmatized, so once you get a code from the book, there tends to be some sense of “broken” or “crazy” that you either feel, or get treated as by anyone who knows you’ve been diagnosed. It doesn’t really matter if you even agree with the diagnosis – it’s a ball and chain that you’re stuck with. For another, these diagnoses often lead to treatment consequences, which means pharmaceutical interests have a financial incentive to lobby for inclusion of conditions that make money – say…something that might get a prescription of an anti-depressant – and exclusion of conditions for which there’s not known treatment or cure that can be sold in drug form. I have a hard time seeing a benign intent to categorizing a standard human reaction to profound loss as a mental illness. It seems to me like a case of inventing a diagnosis to increase the marketability of existing drugs, rather than new diagnostic criteria that will help people who weren’t being helped before.

What do you think? If you could take a pill that might improve unpleasant negative emotions or thoughts you’re having, would you want that, even if meant classifying those feelings as a mental illness? Do you think this is a pharmaceutical conspiracy of sorts, or just coincidence when new conditions are written into the DSM that some doctors are already writing “off label” prescriptions in cases like grief? Do you think grief could qualify as worthy of a clinical depression diagnosis in some cases, but not others?

Photo Courtesy of QuantumJedi

About Marcus Williams

Marcus Williams writes what he knows, which is a lot about a little and not much about everything else.


  1. Kirsten (in MT) says:

    For anyone who doesn’t know, The DSM is the Diagnostic and Statistical Manual, sort of the bible of diagnosing mental illnesses.

    Also for anyone who doesn’t know, the so-called bible of diagnosing mental illness up until 1973 classified homosexuality as a form of insanity: It is a politically-motivated rather than scientifically-developed manual.

    A friend of mine died twelve days ago after a 3+ year battle with colo-rectal cancer. I stayed in his home with him and his wife (also a friend of mine) round the clock for the last few days of his life to help her care for him. I experienced the roller coaster of emotions over the years as I followed his progress- holding my breath on test days, ecstatic jubilation and hope for their future together when the came back clean, devastation when any anomaly cropped up, anger that such a horrible thing was happening to these wonderful people who in no way deserved it. I experienced the horror of witnessing the physically, mentally, and emotionally excruciating process of dying.

    I am grief-stricken. I have cried every single day, often more than once, over this loss. Last night was the first night since his death that I have not been woken up by nightmares. The simplest things will take me by surprise and knock me off balance. Seeing his shoes by his bed and suddenly remembering he won’t be putting them on again. He was a mountain climber in Alaska, and him not being able to stand at the end was particularly painful for him and for all of us. Seeing a bird I don’t know and suddenly realizing I won’t be having a conversation with Doug about what it is. He was very knowledgeable about all sorts of nature things, and particularly birds. Seeing a couple of empty Cougar Gold cheese cans on the shelf in the garage and knowing he will never again tell me the story of how one of our very favorite cheeses came to be. Really weird, random things just knock me down.

    This was the hardest thing I have ever been through in my entire life- far harder than my dysfunctional childhood, an abusive intimate relationship, and later a terrible marriage and divorce. All of those I either knew I would get past or go on to live better and never repeat again. This is permanent. This is engraved in history. It has left a huge hole in my heart.

    But if I had it all to do over again and couldn’t prevent this tragedy from happening in the first place, I wouldn’t miss a moment of this very traumatic experience. And I have no desire to medicate the pain away. It’s mine. It’s part of my humanity. It’s the natural consequence of having the capacity and willingness to love and care for others deeply. And it’s not a disorder.

  2. Brad Kelstrom says:

    One of the specificers for Major Depressive Disorder is that it is not better acounted for as bereavement. Bereavement is something called a V code so it is already something that can be diagnosed with the DSM-IV. Interesting that it’s definition might be expanding or changing in the DSM. The point you made that I appreciate is the stigma that attaching a label can do to someone. I think this can be harmful to a person’s personal identity and a lot of my client’s wear their diagnosis like a badge of honor. It is interesting when they whip out “oh, I’m borderline” or “I’m bipolar.” When ever I work with someone I try and reframe whatever mental health issue they have by saying they are someone with the symptoms of that diagnosis, rather then saying that is who they are.

    • As I replied to Eddie above (first comment in the thread), the controversy about this particular revision to the DSM-5 is about the elimination of the bereavement exclusion, so instead of being something to “better account for” depressive symptoms, it would qualify as major depression. If you’ve seen the proposed changes in question and have a different take on them as a professional, though, I’d be interested to hear it, because I’m just coming at it from the perspective of a layman, not a practitioner.

      Regarding the stigma/badge of honor, it’s a strange, strange thing trying to come to terms with mental illness diagnoses. I get what you’re saying about trying to frame issues as symptoms, but to the people having them, it’s who they are. How you think and feel is pretty much the essence of what your identity is, so when someone says they are symptoms to be treated, that’s really an assault on your identity, not something like treating a broken bone. If people diagnosed with mental illness accept it, they get dinged for wearing it like a “badge of honor” or “using their diagnosis as an excuse”, but if they don’t, they get dinged for resisting their diagnosis and/or recommended treatment. It’s a no win for the diagnosed person, which is part of the stigma.

      Basically, if you convince someone of their diagnosis for a mood or personality disorder, I would be more surprised by people who don’t turn that into part of their identity than people who do, because the symptoms of those diagnoses are inseparable from the subjective experience of who those people are.

  3. I think we need to deal with matters of the heart naturally and not numb it with drugs. The grieving period varies from person to person and depends on the situation. I would suggest: provide a good support system and check on the grieving person often.

    We keep on giving away function and control of our bodies and minds to drugs. I think we’re becoming infantile…. Chances are more people will die from overdoses than die from grief!

    • I agree about grieving varying from person to person, and a good support system is invaluable. I do think that it’s possible for grief to trigger a slide into actual major depression of the kind that drugs have been shown to help, especially for people who already have that kind of history or are at risk (family history, etc.), but slapping a diagnosis on ordinary bereavement after a few weeks sounds absurd to me.

      I wouldn’t call anti-depressants and mood stabilizers “mind control” in the sense of ceding all control to a drug (the idea is to restore control, not take it away), but I do worry about relaxing the diagnostic criteria to a point where every negative mental state is called a mental illness so some drug can be sold to “fix” it.

  4. It’s only classified as a mental illness if it’s pervasive, lasts longer than 6 months and various other signs of not letting go after a “normal” grieving period.

    If your father was prescribed an anti-depressant right away, there were either other mitigating factors or he shouldn’t have been prescribed the medication.

    • What I think you’re referring to is the “bereavement exclusion”, and that’s what the DSM-5 proposes to eliminate. From The Case for Retaining Bereavement Exclusion in DSM-5 (published 2/6/12):

      Dr. Wakefield[*] noted that eliminating the BE will have major consequences. It means, for example, that “just a few weeks after the loss of a loved one, if one feels the general distress symptoms that also occur during depression, one will be diagnosed as having major depression, even if the depression is transient and even if it contains none of the more severe symptoms [such as] suicidal ideation, slowed thought or movement, or preoccupation with one’s worthlessness.”

      * In case the name Dr. Wakefield raises any eyebrows, that’s not the same guy who caused the antivaccination panic.

      So unless I’ve misunderstood the proposed changes, that exclusion which you and I think is sensible is what’s on verge of being eliminated. If that happens, then according to the new diagnostic criteria, recent bereavement (within a few weeks) would in fact be enough to get diagnosed and treated for major depression.

      • Right now they’re “proposed” changes. And yes, I think they’re wrong if they do change them.

        I kind of doubt the BE will get eliminated; there’s a lot of pushback in the community.

      • Seems to be little more than a drive to turbo-boost the cash registers. Would certainly greatly increase the income of the practitioners if grief was considered a mental illness

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