In Diagnosis: Grief? and Diagnosis: Grief? (Part II) I wrote about the proposal to remove the bereavement exclusion from the diagnostic information for Major Depressive Disorder (MDD) in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV). All of the proposed changes have been reviewed and the final decisions have been made as to what will change in the new edition. The DSM-V will publish in March 2013 with some major revisions. The manual is a tool for physicians to use to diagnose mental disorders. The bereavement exclusion removal proposal has been debated for months between professionals and lay people. There are people who believe it should remain in the manual, to prevent grief from being diagnosed as depression. This would seem to be an appropriate exclusion to underscore because grief can so often share symptoms of MDD. This is not to say that someone shouldn’t be diagnosed with MDD during bereavement–if there’s a history of episodes of depression or symptoms of depression prior to the loved one’s death, then it may well be that the loss has triggered an episode of MDD or worsened already existing, undiagnosed depression. By the same token, it also could mean that after some targeted counseling, focused on the loved one’s death and helping the patient learn to cope with the death, a diagnosis of MDD would no longer make sense.
Rather than taking a firm position on the decision to remove the exclusion (since I am not a mental health professional), I am writing this post to inform readers of the decision that’s been made. Why? So that you can be prepared and educated if you seek out any sort of care or counseling. Oftentimes, patients, especially those whose hurts aren’t physical can be dismissed with the stroke of a pen on a prescription pad. I’m not against psychotropic medication as a rule, I just think that it shouldn’t necessarily be the first line of defense against psychological difficulties, unless, of course a person isn’t stable and needs medication to stabilize their condition before they can begin the work of addressing their psychological issues with a licensed therapist.
I am confident that, for the most part, physicians use the DSM as a guide, not a hard and fast rule, since “normal” varies so much from person to person. Make sure, however, that your doctor treats you as an individual, not as a number or a list of symptoms. Any good physician should look at you as a whole person, not just a disorder or a diagnosis, and if they don’t, it’s a sign that it’s time to find a new physician. As someone who fired a doctor because he preferred to pull out his prescription pad than actually talk to me, I know that it can be difficult. But please, do what’s best for you. Don’t worry about the doctor you leave behind–someone else will be there to fill that appointment slot tomorrow.
Learning how to ask for help, learning about the latest developments in the study of grief and depression, and understanding the possible ramifications of the changes in the DSM can help you to be fully prepared to speak with a physician or therapist about your grief. If you’re not sure if you’re depressed or just grieving, talk about that too. Although it can be hard, being proactive about your psychological care and your bereavement journey is the best thing you can do for yourself and your family.
One final thing. Until March 2013 nothing will change, and even then, there may be no major changes in the way bereavement is treated. But understand that even though the bereavement exclusion exists today, there are doctors who will jump to diagnose depression and want to write a prescription. Educate yourself on depression and grief so that you can have a reasoned discussion with any medical professional from whom you seek help and so that you can get exactly the assistance you need: no more, no less.
If anything has really been decided around this issue, it’s that much more research needs to be done with regard to grief and all of its variations. Or maybe no research needs to be done at all, since everyone grieves. And since everyone grieves and everyone is different, maybe there’s no way to define what grief should or shouldn’t look like.