Navigation Links
Is Grief an Illness? The Debate Heats Up

By Alan Mozes
HealthDay Reporter

THURSDAY, Feb. 16 (HealthDay News) -- The loss of a loved one can trigger deep emotional turmoil, but is the grief that follows a normal part of being human or is it a form of mental illness in need of diagnosis and treatment?

That's the gist of a major debate now unfolding in the world of psychiatry, as the American Psychiatric Association (APA) prepares to issue the fifth edition of its seminal reference guide to mental disease, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The issue: For the first time, the manual -- a touchstone for mental health professionals across the United States -- may not exclude the concept of "bereavement" from the constellation of behaviors and experiences that it deems worthy of consideration when clinicians set out to diagnose a major depressive disorder.

What does this mean? That feelings or outbursts accompanying the passing of a family member or close friend -- such as crying, insomnia, fatigue, confusion and profound sadness -- may now be viewed as a treatable illness rather than as a normal reaction to life's most shattering moments.

Needless to say, not everyone agrees with this shift in thinking.

"To me, grief is a normal condition, not to be tagged with a diagnostic code and to be treated," stressed Dr. T. Byram Karasu, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine and psychiatrist-in-chief at Montefiore Medical Center in New York City. "Everyone loses someone in their lives at some point. So, this would be classifying everyone at some point. No one would be immune to this."

"And that does not make sense, because grief is a normal and very healthy behavior," said Karasu, who also chairs the APA's National Task Force on the treatment of depression. "One has to feel joy as well as pain and depression, otherwise life is not worth living. And one should not interrupt the grieving by medication or psychotherapy. You have to feel the loss, and only by feeling the loss and recovering from it will the person become a better person. Interrupted grief will remain unfinished business."

Karasu's stance is in line with those expressed by the editorial board of the British medical journal The Lancet, which lays out its opposition to the new clinical approach in its Feb. 18 issue.

"Grief is not an illness," the journal's editors argue, noting that a diagnostic change in the APA's forthcoming manual would empower clinicians to interpret any post-loss despair that endures beyond a two-week window as a troubling sign of sickness rather than a standard sign of coping.

The Lancet team suggests that, instead, an intense but normal bout of grief can last six months to a year, depending on the very individualized nature of the particular relationship that has been severed by death.

"Medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed," the authors noted.

They acknowledged, however, that sometimes grief can morph into something much more complicated, longer lasting and "pathological." In such instances, true clinical depression may ensue along the lines of a so-called "prolonged grief disorder," a potentially new designation now under consideration by the World Health Organization. And such patients, the board agreed, might stand to benefit from some form of mental health intervention.

The concern over exactly when normal grief becomes a condition that perhaps requires treatment is what's driving the notion of inclusion in the DSM, said University of California, San Diego, psychiatry professor Dr. Sidney Zisook.

"It is well recognized that the death of a loved one, just like any other serious stressor, [such as the] loss of a job, diagnosis of a fatal illness, divorce can trigger a clinical depression," he said. "The ensuing depressive syndromes are no less severe or debilitating when brought on by bereavement as they are after any other life event or, indeed, when the depression seems to occur out of the blue."

"Acknowledging that bereavement can be a severe stressor that may trigger a clinical depression in a vulnerable person does not medicalize or pathologize grief," he suggested. "Rather, it prevents clinical depression from being overlooked or ignored, and facilitates the possibility of appropriate treatment."

"This acknowledgment," Zisook cautioned, "does not mean that we think acute grief should end in days, weeks or even months. For some, it may last for years, whether or not there is also a clinical depression. But, acknowledging that clinical depression may also be present in some bereaved individuals may go a long way towards helping those individuals get on with their lives."

For University of Michigan Medical School psychiatry professor Dr. Randolph M. Nesse, the debate boils down to a tug-of-war between basic common sense on the one hand and science's search for diagnostic consistency on the other.

"Everyone knows that grief is something that happens to everybody," he noted. "And just because an emotion feels bad doesn't mean it's wrong or unhealthy. Most often it's a common-sense response to a real problem."

"So, my take is that it would be senseless to eliminate the grief exclusion [from the DSM]," said Nesse, who is also a professor of psychology at UM's College of Literature, Science and the Arts. "But, because it can be so damn hard to figure out when an emotion is normal or not normal without really knowing what is going on in a person's life, there are undeniable advantages to having a neat, clean, simple check-box kind of classification system for diagnosing depression. It makes it easier. So, you include grief as a box to tick, whether or not there is a real problem to be diagnosed."

"But that is what is so troubling," he added. "Because when someone gets a diagnosis of depression it then encourages giving that person treatment. And the getting of that treatment then pushes the person being treated into believing they do indeed have a problem that needs treatment to begin with. And that can be very unhelpful in many, many cases in which grief is really a normal and healthy response to a life event."

More information

For more on bereavement, visit Mental Health America.

SOURCES: Sidney Zisook, M.D., professor, psychiatry, University of California, San Diego; T. Byram Karasu, M.D., chairman, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine and psychiatrist-in-chief at Montefiore Medical Center in New York City, New York City; Randolph M. Nesse, M.D., professor, psychiatry, University of Michigan Medical School, and professor, psychology, University of Michigan College of Literature, Science and the Arts, Ann Arbor; Feb. 18, 2012, The Lancet

Copyright©2010 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Father Channels His Grief into Advocacy, Promotes Simple Actions to Make Hospitals Safer for Children
2. New Website and Self-Help Book Validate Women Experiencing Grief After an Abortion
3. Mother Talks of the Anger, Confusion and Grief of a SIDS Death
4. When a Parent Dies Suddenly, Childs Grief May Persist
5. Grief Is a Real Heartbreaker, Study Finds
6. Universal Health Care Debate Coincides with Release of My eMHR, the Nation's First Free Electronic Personal Health Records System
7. Study Revives Debate on Prostate Drug
8. BU Study Contributes to Online Health Education Debate
9. The Reality of Sex Addiction Stirs Debate
10. Rhetoric, framing efforts have little influence in same-sex marriage debate
11. Critique 029: What should we advise about alcohol consumption? A debate amongst scientists
Post Your Comments:
Related Image:
Is Grief an Illness? The Debate Heats Up
(Date:11/25/2015)... ... November 25, 2015 , ... The ... perfect dish and pleasing the palates of attendees is of the utmost importance. ... to a seasonal get-together, give these recipes a try this holiday season. , ...
(Date:11/25/2015)... Nairobi (PRWEB) , ... November 26, 2015 , ... ... African Union Commission (AUC), European Union (EU), ANDI Pan African Centres of Excellence, ... Nations Office in Nairobi (UNON) for the opening of the 5th African Network ...
(Date:11/25/2015)... ... November 25, 2015 , ... Dental professionals who would like ... , are invited to attend Dr. Mark Iacobelli’s Advanced Implant Mentoring (AIM) CE course. ... OH. , As the co-founders of Advanced Implant Mentoring (AIM), Dr. Iacobelli and ...
(Date:11/25/2015)... (PRWEB) , ... November 25, 2015 , ... Smiles ... of TMJ Disorder, Bruxism, and moderate facial wrinkling. While many patients are aware of ... of the great success Botox® delivers to those suffering with discomfort, soreness, and pain ...
(Date:11/25/2015)... ... , ... “While riding the bus, I saw a passenger in a wheelchair ... to be a convenient and comfortable way to protect them from bad weather, so ... safely travel during cold or inclement weather. In doing so, it ensures that the ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... , Nov. 25, 2015  Linden Care, LLC, a ... treatment outcomes for patients suffering from chronic pain, said ... a Temporary Restraining Order (TRO) enjoining Express Scripts from ... companies. --> --> ... of its legal options. --> ...
(Date:11/25/2015)... AVIV, Israel , November 25, 2015 ... (NASDAQ: KTOV ) (TASE: KTOV), a biopharmaceutical company ... simultaneous treatment of various clinical conditions, today announced the ... 3,158,900 American Depository Shares ( ADSs ), each representing ... purchase up to 3,158,900 ADSs. The ADSs and warrants ...
(Date:11/25/2015)... , Nov. 25, 2015 Endo International plc (NASDAQ: ... De Silva , President and CEO, will discuss corporate updates ... in New York on Wednesday, December ... . Click on Investor Relations, and then the link to ... the presentation,s start time to visit the site and download ...
Breaking Medicine Technology: