A change in the 5th edition of psychiatric Tears.  Entombment of Christ, photo by Vassil, Wikimedia CommonsBible - the "Diagnostic and Statistical Manual of Mental Disorders” (DSM) - affects the grief stricken. Before, grief after losing a loved one was not included in the guidelines for diagnosing a “major depressive disorder.” Symptoms like sadness, trouble sleeping, loss of motivation were considered normal responses to the death of a loved one, and thus were not classified and treated in the same way as "major depression." Now the “bereavement exception” has been lifted.

A lot of people have their panties in a wad over whether this change implies some kind of value judgement - i.e., it's normal and appropriate to be depressed when someone you love dies, so you don't need help. But if you are seriously depressed for other reasons, you are messed up and need to be "fixed." People are also legitimately concerned that typical grieving is not really an "illness."

I am not a doctor, nor do I play one on TV or in this blog. But personally, I don't really understand what all the fuss is about. Yes, of course it is a normal and appropriate response to be sad when someone you love dies. To me, the more important issue is whether the bereaved should be able to get treatment if they need it, and whether that treatment can be covered by insurance.

When my husband died suddenly, I was, literally, "at a loss." I found seeing a grief counselor to be extremely helpful. During counseling, I gained insights, learned different coping skills, "allowed" myself to experience the loss, and was also able to be more realistic about it. In addition, it helped me deal with my internal struggles over a new relationship. I believe counseling speeded up my healing. And last but not least, it took some of the load off my family and friends.

I have my own opinions about the use of drugs to cope with loss. In one regard, I think anti-depressants dull the senses, and can prevent a mourner from genuinely feeling the depth of their loss, which may be a necessary precursor to moving through the grieving process. They may simply need time - or to talk with others - and not medication. On the other hand, anti-depressants might help people function or keep them from committing suicide, People who have a predisposition towards depression may have an extra hard time dealing with death. I think the decision about short-term use of anti-depressants should be left to the mourning individual and their doctor.

The only real concern I have is over judgements on timing. Everyone grieves in their own way, at their own pace. Most people would agree that someone who is still paralyzed by grief, or crying uncontrollably on a daily basis three years or more after a loss probably needs help. But the DSM seems to imply that if you are still very sad, fatigued, having trouble sleeping, are distracted etc., after two weeks, you need help. Two weeks? Ridiculous!

Someone who has lost their beloved life partner, or a very close member of their family - especially if that loss was sudden, unexpected or traumatic, is unlikely to be "over it" in two weeks. Right after a death, they may not be able to bear the thought of such despair and pain lasting even another day, but in reality, it is not unusual for real healing to take one or two years. In the interim, if the mourner needs help, I think they should be able to get it.





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