A thoughtful editorial published Thursday in the British medical journal The Lancet explores a question that most of us, sadly, have to grapple with at some time. Should grief be treated as a “mental illness” for which medical treatment is warranted?
The unsigned editorial explains that the forthcoming, revised 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders may differ from earlier editions in that it would not have practitioners consider whether bereavement may be the cause of a patient’s depression. Up till now, the paper explains, a psychiatrist following the DSM’s guidelines for diagnosing a “major depressive disorder” would ascertain whether the patient had recently lost a loved one and would likely attribute the patient’s feelings of “deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite” to that loss. Should the proposed change to the DSM take hold, the paper suggests, should those symptoms persist for more than two weeks after the death of a loved one, it “could be diagnosed as depression, rather than as a normal grief reaction.”
Why does that distinction matter? Because one of the main functions of the DSM is to spell out the appropriate treatments, including drugs, for various mental conditions. Under the proposed new guidelines, psychiatrists would be encouraged to view post-bereavement grief as a condition warranting treatment with antidepressants.
That would be a change for the worse, the author argues. For one thing, he or she writes, “The evidence base for treating recently bereaved people with standard antidepressant regimens is absent.”
Beyond that, the author argues that to treat grief with antidepressants is to deprive the bereaved person of a process that most of us need to go through if we’re to emerge whole and healthy at the other end. The author acknowledges that in some instances, prolonged grief may become severe or morph into depression, but adds that those situations can be addressed with treatments other than drugs, such as “guided mourning.”
But for most of us, “grief may be a necessary response to bereavement that should not be suppressed or eliminated.”
The author concludes, “Grief is not an illness; it is more usefully thought of as part of being human and a normal response to death of a loved one. . .For those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy, than pills.”
What do you think of this issue?