Click here to see how this applies to child welfare:

How Medicalizing Grief Turns Into Dollars

The proposed revisions for the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the handbook for all disorders mind and brain – have been under serious fire in recent months, and the issues don’t appear to be quieting. The newest change to inspire protest from the mental health community is the idea that grief, once excluded from the definition of depression, is now included within it. This means that people grieving over the death of a loved one could theoretically go to their psychiatrist and be prescribed pills to treat the “condition.”

To treat people with antidepressants who are not depressed but simply grieving has no scientific backing to it at all. Critics, writing in the journal The Lancet, beautifully outline why the medicalization of grief is misguided for so many reasons. Antidepressants don’t do anything to the moods of non-depressed people, they point out, so there’s little likelihood that they would work to reduce grief. Arthur Kleinman, a medical anthropologist, says that since the APA wants to allow for treatment of the normal grieving process, it had to first yank it from Normalcy and plunk it down in the realm of Abnormal, or worse, “make it over into a disease—ie, depression.”

One has to wonder if money isn’t part of the issue. Some have wondered whether the newly restricted definition of autism isn’t partly about finance, since fewer kids will fall into the definition and be eligible for the services for which they were previously eligible. Medicalizing grief will no doubt result in many more prescriptions for antidepressants. “Its ubiquity,” says Kleinman, “makes grief a potential profit centre for the business of psychiatry.”

Also disturbing is the fact that the DSM continues to shorten the normal grieving processes. The DSM-III considered grief for up to one year acceptable, the DSM-IV only two months. No other culture, Kleinman says, considers two months a normal amount of time to grieve. They must be shaking their heads at us silly Americans and our strange attitude towards grief. Cultures across the globe vary hugely in what’s considered a normal timeframe to grieve, some devoting the remainder of the lifespan to mourning the loss of a loved one.
Why do we need to grieve? Does it allow the brain to process the events and recover from them? Perhaps. Robbing it of its ability to do so seems shortchanging, and possibly unhealthy. This is a fundamental difference between grief and clinical depression: grief, in many ways, makes sense, as there is direct cause for the feelings of sadness, loss, sleeplessness, and lack of concentration. With depression, there is often a less direct link between circumstances in one’s life and the symptoms of depression, and their severity.

And taking it a step further is the issue that our generation may just not want to deal with any kind of painful feelings, however necessary. We seem to be less and less willing to sit with our emotions, especially ones that are hard to figure out. “So that the now young adult generation,” writes Kleinman, “…may no longer want or need the suffering of grief to affirm its humanity, redeem its deepest values, and frame its collective and personal experience of loss. I had always imagined that if something like that happened, there would be a loss of the human.” It may be that our changing attitude towards psychology is making us less willing to experience our own feelings – or perhaps we are simply less capable of it than previous generations, since it’s increasingly suggested to us that pills can take the place of other methods of coping.

Critics call for the APA to reconsider its proposal. “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. Putting a timeframe on grief is inappropriate—DSM-5…please take note.”

Would you want to take a medication if it would help lighten the pain of grief? Or is it better to experience it, work through it, and wait for it to lift in its own time? There is undoubtedly a place where grief becomes depression when it does not lighten for a long time. But considering it a symptom of depression from day one seems like a damaging way to define it.