Dear Dr. Pies,
Whilst I appreciate your courteous reply to my article “I’m Not Sick, I’m Grieving — The Day Grief Was Medicalized” published August 22nd, 2019, I do take issue with a number of the points you make.
I also note, without meaning to sound churlish, that you failed to apologize for your “very jarring and inappropriate” (your words) use of the phrase “bouncing back” when referring to my grief.
A ‘sorry’ would have sufficed.
Be that as it may, there are a number of important issues that warrant clarification. At the risk of adding to the already large number of articles online that deal with this contentious issue, I take your public reply to mean that you invite comment in the same way that you so eloquently gave it.
I should like to start with the question of the removal of the bereavement exclusion, which was at the heart of my article. I argued that the changes in the DSM-5 had the effect of pathologizing grief because “If you present with symptoms such as deep sorrow, loss of appetite, crying, insomnia, wanting to be with your dead child or loved one… AFTER TWO WEEKS POST-LOSS, you can be diagnosed with a mental disorder.”
Your reply to my article stated that “there is nothing pathological about the grief that follows bereavement.” Indeed, you’re quite right, there isn’t.
Grief is a natural, adaptive response to loss, and to suggest otherwise is to turn one’s back on what it means to love deeply and to be a sentient being.
Yet you failed to address my disquiet regarding the not insubstantial question of profit for pills, an odd omission because, as we both know, the subject of big pharma in psychiatry is a theme worthy of discussion.
I refer to Dr. Allen Frances of Duke University, Durham, North Carolina, who the NY Times once called “the most powerful psychiatrist in America”. He’s also the author of ‘Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life‘.
Dr. Frances, who was on the panel of the DSM-IV, is now one of a large number of critics of the DSM-5. He argued vehemently against the removal of the bereavement exclusion because he felt it “would subject many people to unnecessary and potentially harmful medication treatment.”
In fact, Dr. Frances was so critical of the process of how the DSM-5 was compiled that he stated: “I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to the premature publication of an incompletely tested and poorly edited product…”
He’s not the only one who’s concerned. Author and psychotherapist, Dr. Gary Greenberg, who is Professor Emeritus of Psychology at Wichita State University and wrote ‘The Book of Woe: The DSM and the Unmaking of Psychiatry‘ and ‘Manufacturing Depression: The Secret History of a Modern Disease‘ believes that the DSM panelists form part of “an institutionally paranoid organization..and they have a lot to protect here”.
He told the BBC that “The American Psychiatric Association owns the DSM. They aren’t only responsible for it: they own it, sell it, and license it. The DSM is created by a group of committees. It’s a bureaucratic process. In place of scientific findings, the DSM uses expert consensus to determine what mental disorders exist and how you can recognize them. Disorders come into the book the same way a law becomes part of the book of statutes. People suggest it, discuss it, and vote on it…In the case of the DSM-5, committee members were forbidden to talk about it, so we’ll never really know what the deliberations were. They all signed non-disclosure agreements.”
Another critic of the DSM-5 is Lisa Cosgrove, professor at the Center for Ethics at Harvard University. A major part of her research agenda focuses on the ethical and medico-legal issues that arise in psychiatry because of financial conflicts of interest.
She explains that on the DSM-5 panel “three-fourths of the workgroups… have a majority of members with ties to drug firms, 21% up from the DSM-IV. In fact,” she adds, “5 out of the 12 members of the mood disorders panel, including its Chair, have a link to pharma company Eli Lilly whose drug Cymbalta has been tested in clinical trials for bereavement related depression.”
No one is implying research fraud – yet it’s easy to see how pro-industry habits of thought in the medical profession could lead to bias in decision making.
The bereaved have a right to know that ‘evidence-based medicine has been compromised by industry influence.’
Perhaps you can now understand my disquiet regarding the DSM-5 when I come across opinions such as these. It’s as if suffering and grief have been turned into commodities.
Add to that, the research shows that a disproportionately high number of bereaved parents are misdiagnosed with clinical depression and in the US as many as 40% of bereaved parents ARE prescribed psych medication. Of these, 32% are given medication within 48 hours of the death of a baby and 44% within one week.
The bereaved, and especially loss parents who have more severe and enduring symptoms, deserve to be made aware of this.
Is not an open, frank conversation between patient and doctor ultimately the best way to find a compassionate way to living with grief?
I now turn to your assertion that “Psychiatrists and other mental health professionals are capable of telling the difference between grief and clinical depression.”
Should I take this as fact? Are you attempting to allay my fears?
Because the reality is that “drug companies have marketed heavily to primary-care doctors, who now prescribe 80% of psychiatric medication. Most psychiatric diagnosis is being done in seven-minute sessions with doctors who are not very interested or well trained in psychiatry.”
Whatsmore, in your own article ‘Psychiatrists, Physicians, and the Prescriptive Bond’, dated 2010, you express unease at the state of psychiatry:
“Some psychiatrists have become too enamored of the biomedical model and the ubiquitous ‘pills for ills’ that often promise more than they deliver. Some of us—ignoring our better angels—have allowed market forces to pull us far from our heritage of listening, understanding, and healing. At the same time—somewhat paradoxically—some psychiatrists have lost touch with their medical roots and allowed their skills as physicians to deteriorate… Unfortunately, many prescriptions for psychotropics are written in haste—often after the infamous 15-minute med check—and without any real understanding of the patient’s inner life or psychopathology.”
“The perverse notion—once voiced by a well-known psychologist, but echoed recently by some psychiatrists—that ‘prescribing is no big deal’ reflects ignorance not only of psychopharmacology but also of the moral dimensions of the prescribing act.”
How right you are.
I’m disturbed at how the bereaved are (
Grief is not a disorder to be fixed nor an illness to be medicated with psychotropic drugs.
“The real controversy is over the legitimacy of psychiatry. They know theirs is an embattled profession and this is their major battleground… if the public gets hold of that, it’s not going to be good for them.”
Respectfully yours, Katja Faber
Katja Faber is the mother of three amazing children. Following her 23-year-old son’s murder, she used her legal training to work closely with private lawyers and the State Prosecutor in her fight for justice for her dead son. She hopes to inspire others in seeking justice for their loved ones and through her writing break the taboo of homicide loss and child loss grief. She runs her own farm, a magical place where she hosts private retreats for those in need of support and healing. Katja recently completed the Certification for Compassionate Bereavement Care® through the Center for Loss and Trauma in partnership with the MISS Foundation and the Elisabeth Kubler-Ross Family Trust.
To read her blog and further articles by Katja do please follow the link to her dedicated webpage in honor of her son KatjaFaber.com. You can also connect with Katja on her FB writer’s page.
Her farming IG account where she reflects on daily life in the country and the healing process of grief is on Instagram.