Psychologists are busy at work finalizing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — or, as it’s known in medical circles, DSM-5. This is the guidebook that mental health professionals use to, as Jerry Adler puts it, draw “lines between normality and pathology.” And, if those proposed changes do go through, the lines could be significantly redrawn, especially when it comes to grief and grieving:
Until now, psychiatry has acknowledged that, within limits, symptoms of depression after the death of a loved one are part of the human condition. Accordingly, in its definition of “major depressive disorder” the existing DSM incorporates a “bereavement exclusion.” In the proposed new version, this is replaced by an ambiguously worded footnote. “People who have depressive symptoms as part of their grief will now be diagnosable with a mental disorder,” says NYU professor Jerome Wakefield, a leading opponent of the change, “and potentially be the target of treatments that they don’t need.” The revision could affect as many as 4 or 5 million people each year.
A similar change has been made to the diagnosis of “adjustment disorder.” The draft creates a new category of “adjustment disorder—related to bereavement,” whose wording is so broad that it’s hard to imagine who might not be covered. Depression has strict diagnostic criteria, but this, Wakefield says, “is the first time that grief feelings—not depressive symptoms—have been pathologized. Practically everyone who is grieving will fall under this. They’re transforming our relationship to grief.”
The editorial board of The Lancet, a leading medical journal, has come out in opposition to these changes. Proponents of the change, however, contend that changing the definition could make it easier for the bereaved to seek treatment during difficult times as it would come with a specific diagnosis.