Grief not a mental illness, doctor warns colleagues

Dr. Grief blogs:

A recent headline and story from the Montreal Gazette – “Grief not a mental illness, doctor warns colleagues” – has triggered a storm of protest by angry readers.

Here are my thoughts. The Gazette story reports on a proposal by psychiatric experts to shorten the delay period – from two months to two weeks – for doctors to diagnose clinical depression in a patient grieving the loss of a loved one. The change could be implemented in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a classification system for diagnoses used by psychiatrists and other practitioners.

Critics of the proposed change have expressed concern that normal grief is being medicalized, and that there will be a surge in unnecessary prescriptions for antidepressants.

As a psychiatrist who specializes in treating the complications of bereavement, I would react similarly if the proposal were to change how normal grief – a universal human experience – is viewed. However, I believe the intention of the experts is to make it easier for clinicians to disentangle clinical depression from normal grief. While depression in the context of grief is understandable, as is a fever arising in response to infection, it is often something that benefits from treatment.

Depression in the aftermath of loss is common. Untreated depressive symptoms are associated with more severe depressions, poor medical health, and even death. In my experience, depression is all too often under-diagnosed. The DSM is not meant to be used mechanically without thought, nor can it ever replace balanced, non-judgmental clinical decision-making.

The ultimate goal for users of this manual is to work together with bereaved individuals to find the best way to ease their distress and alleviate suffering.