No one wants to be sad. This can generally be agreed on. However, as it becomes more and more common for anti-depressants and anti-anxiety medications to be prescribed, the question becomes what is a socially acceptable level of sadness for a well-functioning member of society to experience? There remains a blurry, but important line between what is considered ‘normal’ grieving and what is classified as a mental disorder or depression. NPR’s Alix Spiegal recently explored a shift in this line due to changes in the criteria used by the American Psychiatric Association to diagnose depression.
Traditionally, the manual has steered doctors away from diagnosing major depression in people who have just lost a loved one in what’s called “bereavement exclusion.” The idea was that feelings of intense pain were normal, so they shouldn’t be labeled as a mental disorder.
But the new DSM changes this. Buried in the pages is a small but potentially potent alteration that has implications not only for people like Theresa, but ultimately for the way that we think about and understand the emotion of pain.
The DSM committee removed the bereavement exclusion — a small, almost footnote at the bottom of the section that describes the symptoms of major depression — from the manual.
Dr. Kenneth Kendler, a member of the committee behind the change, explains that grief and depression share the same symptoms – lack of sleep, loss of appetite, loss of energy. The key distinction between grief and depression is the amount of time the person experiences the symptoms.
In fact, in the new manual, if symptoms like these persist for more than two weeks, the bereaved person will be considered to have a mental disorder: major depression. And treatment, either therapy or medication, is recommended.
While Kendler believes that this change will only affect a small number, and for the better, Holly Prigerson a research at Harvard University believes otherwise.
“What we found,” Prigerson says, “is that when you follow people — for example, between zero and six months post-loss — their depression symptom levels actually increase over time and peak at about six months post-loss.”
Because grief and depression look so much alike, Prigerson says, she worries that people who are suffering from normal grief will be told that they are sick when they are not, and encouraged to treat their symptoms when they don’t need to.
That is potentially a problem, Prigerson says, because we don’t know whether the pain of normal grief actually helps people to process their loss.
Other experts expand Prigerson’s argument by voicing concern that society is continuing down a path to having an over-diagnosed and over-medicated population where to be sad is to be sick.
Dr. Allen Frances, the famous psychiatrist and a former editor of the DSM, says that more and more, psychiatry is medicalizing our experiences. That is, it is turning emotions that are perfectly normal into something pathological.
“Over the course of time, we’ve become looser in applying the term ‘mental disorder’ to the expectable aches and pains and sufferings of everyday life,” Frances says. “And always, we think about a medication treatment for each and every problem.”
From Frances’ perspective, if you can’t feel intense emotional pain in the wake of the death of your child without it being categorized as a mental disorder, then when in the course of human experience are you allowed to feel intense emotional pain for more than two weeks?