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This article acknowledges the similarity between grief and depression, and
the difficulty in assessing which is which. This difficulty is rarely
mentioned in the media. See my comments after the
article. The links and hilights below
are mine. -
Peter Gerlach, MSW
+ + +
Yahoo Editorís Note: With the release of the
latest edition of the mental health manual, the Diagnostic and Statistical
Manual of Mental Disorders (the DSM), LiveScience takes a close look at some
of the disorders it defines. This series asks the fundamental question: What
is normal, and what is not?
The profound sadness that stems from grief can look a lot like the sadness
depression brings. The similarity can create a dilemma for mental health
professionals: When should someone
experiencing the loss of a loved one be diagnosed as depressed?
In its criteria for depression, the previous version of the mental health
manual, the fourth edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV), gave many people who are grieving a two-month
pass on being diagnosed with depression. (This exemption did not apply to
people experiencing extreme symptoms, such as psychosis.)
The architects of the new DSM-5, which will be released tomorrow (May 22),
found this two-month cutoff arbitrary and unnecessary and so have removed
it, making it much easier to diagnose a grieving person with depression.
[The 10 Most Controversial Psychiatric Disorders]
Bereavement doesn't necessarily last two months, and
someone could grieve and suffer from
major depression at the same time, argue the leaders of the DSM-5
task force in a summary published online in February in the Journal of the
American Medical Association (JAMA).
In both forms of sadness, someone can experience a loss of interest or
pleasure in activities they normally enjoy, as well as changes in sleeping
patterns, difficulty concentrating, fatigue and other symptoms. However,
there are distinctions.
Someone who is grieving typically focuses his or her thoughts on the person
who has passed away and experiences waves of pain rather than the constant
pain typical of depression. Research also indicates that in most cases the
depression-mimicking symptoms associated with grief tend to lessen over time
with the help of family and friends.
"When there wasn't effective medication available for depression, I think
people had a higher tolerance for grief," said Robin Rosenberg, a clinical
psychologist and co-author of "Abnormal Psychology" (Worth Publishers,
2009). "But because there is medication available, some people feel that
because we can do something that potentially alleviates the suffering
associated with grief, we should."
Those in favor of removing the two-month "pass," known as the bereavement
exclusion, argue that allowing the diagnosis of depression among those in
mourning could prevent or reduce suffering. Those on the other side worry
about an over-diagnosis of depression and unnecessary prescriptions, as well
as a reduced tolerance for grief as a natural process, Rosenberg said.
Being diagnosed with major depressive disorder has many repercussions and
can affect how those diagnosed view themselves and their risk of subsequent
depressive episodes, she added.
This brief article published professionally (JAMA) and in popular lay media
(Yahoo News) promotes the widespread public misconception that grief is only
associated with death. The author does not acknowledge that
broken bonds with precious rituals,
dreams, health, freedom, objects, settings, and relationships cause significant
implication of this is that lay people and mental health professionals may
mistakenly diagnose the symptoms of grief as "depression," so they may rely on
medication and perhaps therapy to alleviate their suffering. This is pointless,
expensive. and potentially harmful, for drugs cannot alleviate - and may hinder
- the natural psychological process of mourning.
article doesn't explore the possible roots of depression (early-childhood
abandonment, neglect, and abuse - "trauma"), or mention the
symptoms and toxic effects of incomplete
grief. Nor does it mention how family ignorance and dysfunction can promote
incomplete grief and depression.
experience as a therapist since 1981, typical adults and many mental-health
professionals are unaware of healthy grieving basics, and how common
incomplete grief is
in our culture. Lesson 3 in this non-profit Website focuses on bonding, loss, healthy grief, and how
unawareness can hinder the natural mourning progress.
- Peter K. Gerlach, MSW