Yesterday I attended the Florida Adlerian Society’s annual conference; it runs for three days but I was only able to commit to one. It was a great day: wonderful speakers, challenging information, and, of course, the warm and friendly Adlerians in attendance.
Adler is one of the great founders of psychotherapy, but often is relegated to a corner with a few remarks about birth order and maybe credit for starting the child guidance movement. He’s much more than that, and if you’re curious, visit www.alfredadler.org.
An interesting point made during yesterday’s talks was the evolution of bereavement in psychiatry over the past few decades. The Diagnostic and Statistical Manual of Mental Disorders is the American Psychiatric Association’s published list of descriptions of various patterns of symptoms. The intention, back in the early 1980s and DSM-III, was to provide a structure for shared dialogue and research for the identified hypothesized mental disorders. No one was pretending these were all clearly identifiable and diagnosable, discrete brain diseases. In the DSM-III days, bereavement, as a category, covered up to a two year long period. If a grieving person was still sad more often than not, still struggling with aspects of grief and getting back to a (new) normal life, mental health professionals figured, depending on the relationship, two years was a reasonable time frame. Of course, some losses never heal – but people somehow figure out how to go on, just the same. The point is, no sensible person thought it was pathological to still have some regular bouts of tearfulness a year or more after your most beloved person died.
In 1994, the next edition of the DSM came along, DSM-IV. It gave people two months – not two years – to get over it and move on. If not – if the person was still crying, or numb, or having appetite and/or sleep disturbances, or otherwise met the minimum criteria for depression…well, that meant that bereavement was over and the person was now diagnosable with a major mental disorder – depression – which was now sometimes described as a permanent brain disease.
In 2013, the DSM-5 was published (note that the change from Roman numerals to integers was done by the APA – it’s not a typo on my part). The DSM-5 got rid of the bereavement issue entirely: now you get two weeks of being sad more days than not, plus the other possible symptoms, and you’re mentally ill with depression (according to the APA). There is no exception for bereavement, although it ought to be noted on the chart. One rationale provided, about which I’ve written in the past, is that this way people can get their health insurer to cover their grief counseling. Whether this makes it worthwhile to pathologize normal grief, I leave each reader to consider.
Are you mentally ill if you have trouble eating or sleeping, or burst into tears almost daily, two weeks after someone you dearly love passes away? I don’t know anyone who thinks so, but the manual that has become the healthcare provider’s and insurer’s standard frames it so.
Dr. Lori Puterbaugh
Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.