I begin with a sample story of grief.
“Jane” is 40 years old, working part-time and parenting two young children, when her mother, who lives across the country, suddenly enters the hospital.
Jane can’t sleep. She can barely think straight. She flies out to visit but can only stay a week because of her kids.
She is told that her mother will recover, but shortly after Jane returns home, her mother is moved to intensive care and a week later she dies.
Jane is devastated. No close family member has died before. She walks around in shock; her heart aches; her eyes become waterfalls.
Although she behaves rationally on the surface, she has disturbing ideas, like wanting to snap photos of people at her mother’s memorial service. Angry feelings surface, not at her mother, but at friends who are unable to comfort her.
For an entire year, if her mother comes up in her mind, tears flow. She cries with her husband, with friends, in counseling, and even in encounters with strangers.
Eventually, she gets involved in a memorial project for her mom that eases her grief. Now, 25 years later, she handles death as well as anyone. In fact, she volunteers for Yolo Hospice.
I tell this story because it relates to the current fight over how to characterize bereavement in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, an important book you may not be familiar with.
The DSM plays a huge role in mental health, because where the DSM leads, medication and medical reimbursements follow. I worry that normal grief is about to become a disease.
A committee of the American Psychiatric Association is currently revising the DSM. Although their goal is to accurately characterize mental disorders, the inevitable side effect is that some mental states will be viewed as illness — with their treatment reimbursed by insurance companies — and others will not.
This next part gets technical, but I’ll cover it quickly.
The existing DSM-IV contains something called the “bereavement exclusion” which states that symptoms of major depressive disorder, like inability to sleep, lack of concentration and lack of energy, occurring within two months after the death of a loved one are not a mental illness.
Rather, they are symptoms of normal grief.
Writers of the revised manual propose eliminating the bereavement exclusion. They don’t think normal grief is a disorder, but they do believe in treating pain.
One committee member, Sid Zisook, said, “I’d rather make the mistake of calling someone depressed who may not be depressed, than missing the diagnosis of depression, not treating it, and having that person kill themselves.”
Eliminating the bereavement exclusion in the DSM-V would allow treatment of a much greater number of people, but it would also make grief less of a normal life event and more of a medical condition.
That’s the part that bothers me.
Jane’s story is mine.
When I first wrote about my grief, I heard from people who shared their stories. I remember one woman in particular who said she was completely unable to find any joy in life a full ten years after her mother’s death.
That’s depression. That kind of grief belongs in the DSM.
My situation was less clear. During my year of weeping, my counselor never suggested I take medication, but it wasn’t widely used back then. Today, she might have suggested that I consult a psychiatrist. If medication were free (i.e., paid by insurance) she might have felt a professional responsibility to make me aware I could have it.
Given my suspicion of psychoactive drugs, I probably would have said “no” but I would have been torn. I would have wondered if my refusal to take medicine was inflicting too much distress on my family. Maybe I would have accepted it, and then the next time accepted it again.
In the end, I healed myself by initiating my mother’s memorial project and sticking with it even when the logistics became difficult. The dolphin playground near Slide Hill pool still comforts me and my special seat on the concrete rim (created by my butt during construction) is now a source of humor as well as healing.
I can’t speak to what happens in exceptional cases of loss. People with certain personality types or terrible circumstances, such as bereavement due to crime or accident, may suffer “complicated grief,” including major depression.
Such people might need medication immediately after the death, and for many, the only way treatment becomes affordable is if their diagnosis is in the DSM.
I read one article, however, that suggested that once grief gets a stronger footing in the DSM-V, drug companies will start creating and marketing drugs directly for grief, as they have for depression and panic attacks. We can expect an explosion in the number of people taking that medication. I picture as many grief advertisements on the evening news as there are for asthma and erectile dysfunction.
That troubles me.
Every death is different. Every experience of grief is different. Mine was helped by counseling, getting involved in things, and, most of all, time. Someone else’s might be helped by a pill, although I still think that the best outcome is one that helps you believe in your own power to heal.
I worry that drugs are becoming the solution for everything.
— Marion Franck lives in Davis with her family. Reach her at firstname.lastname@example.org