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?
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