Should grief be called a psychiatric illness?

Monday, August 19, 2013 by: Ellie Maclin
Tags: grief, psychiatric illness, depression

(NaturalNews) Grief, something every human being will go through in the course of their life, may be diagnosed as a psychological disorder in the near future. If that change happens, the dangers of receiving an unnecessary prescription for medication are likely to rise.

The DSM-5 and grief

The next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), currently being written by experts at the American Psychiatric Association, will make a major change in the way grief is viewed (and potentially treated) by physicians. The current DSM-4 excludes depressive symptoms that are obviously grief-related from consideration for a clinical diagnosis of depression. Current guidelines recognize grief, even acute grief, after the loss of a loved one as normal and expected.

On the other hand, the DSM-5 guidelines would "specifically characterize bereavement as a depressive disorder," wrote Richard A. Friedman, M.D. in the New England Journal of Medicine last May. The new draft removes the "bereavement exclusion," in effect encouraging clinicians to diagnose major depression in people experiencing normal, even mild, symptoms of grief after only two weeks.

Grieving? Or depressed?

Friedman writes that the change in the DSM-5 would "medicalize normal grief and erroneously label healthy people with a psychiatric diagnosis." According to Friedman, experts who support the change, emphasize the possibility that patients who are shifting from normal grief into major depression may go untreated under the current configuration.

Depression is still under-diagnosed in the population at large, so the concerns are valid. But Friedman cites a study using data from the National Epidemiologic Survey on Alcohol and Related Conditions that shows bereavement-related depressive syndromes were in no way indicative of major depressive syndromes at a three-year follow-up. In other words, bereavement symptoms are not an indication that a person is likely to suffer from depression.

Pharmaceutical interests

The new language, Friedman says, would also "no doubt be a boon to the pharmaceutical industry." Antidepressants and antipsychotics are increasingly used as a first line of action in cases of depression by primary care practitioners, so the new language potentially expands the market for producers of these pharmaceuticals. That may be good news for Big Pharma, but it's bad news for vulnerable patients struggling to deal with a personal loss.

Implications for improper diagnosis

In cases where medication is truly necessary, the benefits can outweigh the risks. Putting someone on an antidepressant or antipsychotic unnecessarily; however, can mean subjecting that person to a range of medical problems and socioeconomic stigmas.

Psychotropic medications have a range of documented side effects that can cause severe negative health consequences, including weight gain, birth defects, increased tendency toward violence and aggression, suicidal attempts, homicidal tendencies, hallucinations, sexual dysfunction, miscarriage, withdrawal, diabetes, hyperactivity, interrupted sleep, seizures, blurred vision, heart attacks, speech problems, liver and kidney issues, nausea, and blood sugar problems (among others) according to the Citizens Commission on Human Rights International.

A diagnosis of clinical depression (or other mental health problems) can also influence a patient's future ability to secure health insurance. Life insurance premiums can also rise, according to Dr. Richard Weisberg. An irresponsible diagnosis during the normal grieving process may stay with a patient for a lifetime.

The implications of this new language in the DSM-5 are far-reaching and potentially dangerous. It will be imperative that primary care physicians, who are not trained mental health specialists, understand how to separate the normal symptoms of grief from valid depressive symptoms. These medical doctors must also be able to act as responsible gatekeepers, understanding the potential repercussions of their decision for long-term patient health.

Sources for this article include:

http://www.nejm.org/doi/full/10.1056/NEJMp1201794?query=TOC&
http://www.cmellc.com/landing/pdf/A11001051.pdf
http://www.cchrint.org/psychiatric-drugs/
http://www.nytimes.com
http://www.nimh.nih.gov
http://www.docrich.com/insurance_cautions.shtml

About the author:
Ellie Maclin is a writer and sustainable farmer with a love of all things handmade--food, tools, clothing, children... She has a B.A. with Honors from UNC-CH and a M.S. in Archaeological Resource Management from UGA.

Ellie writes for PlushBeds, Earth and
Economy, Natural Awakenings Memphis, and several online writers' co-ops. She also runs a small sustainable farming operation with her husband, providing vegetables on a subscription agriculture model and pork on a hog-share basis.

She lives and works with her husband and daughter on a historic family farm near Memphis, TN, in a farmhouse that was constructed starting in 1832. She is a "green living" specialist with experience in permaculture, organic farming, humane animal husbandry, ecology, anthropology, and the long view of human history on the agricultural landscape.