Mourning in America

Grief shares many symptoms with depression, but should it be treated in the same way?

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Ellen Weinstein / www.ellenweinstein.com

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It’s a cardinal human experience: Someone we love dies, and we grieve the loss. This powerful emotion has inspired scores of poets, from Aeschylus to Jay-Z, and serves as the central metaphor of humanity for at least one of the world’s major religions.

In contemporary Western psychology, however, bereavement represents a conundrum. A depressed mood, diminished pleasure in normal activities, disrupted appetite and sleep patterns, thoughts of death—these are the hallmarks of bereavement. And they’re also the measures clinicians use to diagnose treatable depression. This confusion is reopening the debate over what constitutes mental health.  

At the heart of the debate, according to Scientific American (June 2011), are proposed changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), due in 2013. The DSM is a descriptive document that lists behaviors associated with various disorders. Doctors can compare these lists to the behavior of patients to make an informed—yet by definition, subjective—diagnosis of mental illness.  

Because bereavement and clinical depression share overlapping symptoms, the current version of the DSM prohibits prescribing psychiatric medications until two months after the death of a loved one. In the proposed DSM-5, this period is reduced to just two weeks. 

Allen Frances, the Duke University School of Medicine psychiatrist who served as lead author of the current rules, calls the change “a disaster.” Symptoms like sadness and loss of appetite are “completely typical of normal grieving, but DSM-5 would instead label you with a mental disorder,” Frances told the Montreal Gazette (April 18, 2011).  

Other critics contend that the revision has more to do with our attitudes toward bereavement than with medical evidence. “Many of the mental illnesses in the DSM are social constructions that are based on the cultural zeitgeist at the moment,” Leeat Granek, a psychologist and critic of the change, told McGill Daily (March 3, 2011). “We already live in a culture that is intolerant of grief and loss in general. The message is often, ‘You need to move on, you need to see someone.’ ” The real problem, she maintains, isn’t mental health, but the erosion of community structures—family, friends, churches—that can help us bear the pain of our losses.

168-cover-thumb.jpgHave something to say? Send a letter to editor@utne.com. This article first appeared in the November-December 2011 issue of Utne Reader.