More than 65,000 Grievers Must be Heard and Should Be Heeded
Psychiatric Times
By Allen Frances
March 5, 2007
Of all the misconceived DSM-5 suggestions, the one touching the rawest public nerve is the proposed medicalization of normal grief into a mental disorder. Fierce opposition has provoked two editorials in Lancet, a front page New York Times story, and incredulous articles in more than 100 journals around the world. And now, during just the past few days, there has been the kind of online miracle that is possible only on the internet. Joanne Cacciatore wrote a moving blog that rapidly made its viral way across the world and into the hearts of the bereaved. An astounding 65,000 people have already viewed her piece and then passed it on to friends and families. You can join them at: http://drjoanne.blogspot.com.Dr Cacciatore is a researcher at Arizona State University and the founder of the MISS Foundation – a nonprofit organization providing services to grieving families whose children have died or are dying. The MISS Foundation has 77 chapters around the world and website that gets more than one million hits per month. Dr Cacciatore writes:
"Across all cultures, the death of children is a particularly traumatic blow. Most people quaver at the thought of losing a child — for millions around the world this feared tragedy is reality. I have long opposed the DSM-5 suggestion to remove the bereavement exclusion, but chose to remain silent because I simply could not believe it had any chance of making it into the final version of the manual. It made no sense that DSM-5 would allow providers to diagnose a serious mental disease– major depressive disorder – when people are having nothing more than the perfectly normal symptoms of grief.""I decided to speak now because it appears almost certain that DSM-5 will actually go forward with this poorly conceived proposal to pathologize the authentic human experience of sorrow. After just two weeks, a grieving person may be categorized as ‘mentally ill’ at the casual discretion of a psychiatrist, social worker, or psychologist. The arbitrary, rapid-fire absurdity of this ’14-days post-loss-becomes-depression’ travesty has ignited a fire against the DSM machine in the pit of my being. We cannot expect that a family should be functioning as if nothing has happened two weeks after the death of a child. I wonder how many people on that DSM-5 committee have buried or cremated their own child? Shouldn’t the relevant community– those affected by these insulting changes – have some input?"
"I cannot stand silently by and allow this diagnostic charade to find a place in DSM-5. To do so would be unethical and would violate what I know to be real and true and human. Big love means big suffering. And few, if any, relationships are as meaningful and filled with love as that between a parent and child. It badly misses the point and minimizes the experience to treat the death of a child as if the prescription of a pill will cure can cure the normal heartache. As Lancet pointed out, the doctor having a compassionate and open heart is much more helpful than jumping to a premature diagnosis."
The 65,000 person [and counting] endorsement of Dr Cacciatore’s cri-du-coeur [all within 4 days] is simply staggering and sends the clearest possible message to the American Psychiatric Association. Previously, DSM-5 has brushed off the thoughtful and spirited criticisms, mounted by experts in the field, disputing its interpretation of the literature as it relates to the diagnostic issues involved in grief. DSM-5 has equally shrugged off the criticisms coming from the broader field of medicine– as expressed in the Lancet. And DSM-5 has responded testily and ineffectually to the unanimous ridicule it has received in the world press. Long ago, the APA should have realized that this suggestion needs a quick and decisive rejection – instead it turned a blind eye to all previous warnings. Now APA faces a far more serious and undeniable opposition – a spontaneous revolt by the large community of the bereaved. They soundly reject the DSM-5 proposal and refuse to allow themselves to be misdiagnosed by it. It has now come down to DSM-5 against the world. How long can APA depart from common sense and continue in the folly of medicalizing normal grief? I hope that APA will finally hear Dr Cacciatore’s plea and act swiftly on it. Grief deserves dignity not diagnosis.
But I’m afraid that the DSM-5 Task Force has a bigger problem, and this is only a symptom. They see emotions as symptoms in need of treatment. When they argue that Grief needs to be part of Major Depressive Disorder so we will know to treat it appropriately, I’m afraid that they are really revealing a more fundamental and dangerous trend in their thinking – emotions themselves are an object of treatment, not signals from the interior, not part of our psychobiology, not part of a miraculous system that has evolved from some primordial brine more eons ago than we can conceive. Rather than seeing diseases as conditions where the system has become dysfunctional, they seem to see feeling bad as the target itself – anxiety rather than fear, depression rather than sadness. And they respond to all criticism by explaining that we just don’t understand what they’re trying to do [they’ve got that backwards too].
I really appreciate Dr. Cacciatore joining the dialog and I hope they listen, but I doubt that they will. They’ve taken such a wide turn and they think the rest of us just don’t understand what’s right around the corner. They see us as a bunch of deluded tree huggers lost in deluded antiquity unable to see the beauty of receptor chemistry and altered brain pathways. Everyone who is depressed feels bad and needs relief from those emotions that have plagued mankind since the dawn of the hippocampus. So their position with the grief exclusion is just the tip of the iceberg of misunderstanding about the way human beings actually work, have evolved to work, and what ‘diagnosis’ and ‘treatment’ really mean.
One can feel grief about more than just the loss of a loved one – for example, the loss of a dream. The boy who dreamed of gridiron greatness and didn’t make the team; the aspiring actor who didn’t get the part; the President who marched us off to eradicate the red menace of world communism or to conquer jihadism and then watches us slink home with the mission unaccomplished. We are defined by our lost dreams, all the better for having done the psychological work that follows and gained the humility that comes from the process. Many of the "stuck" people who report for psychotherapy are in need of help in finding out what’s interfering with that kind of grief – the kind that transforms and allows for what we call maturation.
I love it when you show your psychoanalytic roots… a brilliant post!
Beautiful, and I wholeheartedly agree! Thank you!
I’ve always said pharmapsychiatry’s grand mission is to stamp out sadness. It denies our humanity.
Wonderful Post Mickey!
…emotions that have plagued mankind since the dawn of the hippocampus.
The brain can be quite romantic.
I think there is more going on than an effort to describe deep human connectedness as a pathology— I think there is an effort to raise indifference, reductionism, and cold “analytical” (uncaring) thinking to a status that is most out of place as well as being unfounded; and in the process they are rationalizing the abuse inherent in the medical model of “mental illness”.
I can define you. And classify you. And file you. And, because I have defined you as broken, there is nothing you can say to defend yourself or to define yourself. And I can do that in twenty minutes. And if what I prescribe you causes more problems, that only means that you’re more broken than I thought you were. And I can do this because you came to me for help.
At this juncture, it seems the APA’s philosophy can be summed up as, “It sucks to be you.”
I
Go read Ronald Pies defend this bs agenda at http://psychcentral.com/blog/archives/2012/02/28/how-the-public-is-being-misinformed-about-grief/all/1/
warning, I am part of the ensuing thread.
In the example given, how would a 72 year old man who lost his wife to cancer three weeks ago feeling particularly bleak be evidence of a mood disorder, especially since he says he’s cooking and cleaning for himself? Do people suddenly get mood disorders in their seventies that they’ve somehow been able to mask for very nearly three-quarters of a century?
Perhaps he was also exhausted from caring for his dying wife. Perhaps he’s introverted and needs a bit of solitude to deal with his pain. Perhaps his wife made social situations more tolerable for him. Perhaps his physical health has declined significantly. Perhaps he has a lot of unresolved feelings about his relationship with his wife, and perhaps did or said things that a thoughtful person has every reason to feel guilty about. Perhaps, he’s suffering from burnout— a common condition for caregivers. Perhaps there is a huge hole in his days that he can’t fill arbitrarily. Perhaps most of his good friends are dead now, and he blames himself for a lack of connectedness with acquaintances who were pleasant to be around before; but now seem to have little relevance to his life. Perhaps struggling with his own mortality on top of all he’s been through recently is just too much.
To assume that the psychiatric industry won’t, on the whole, use any excuse to prescribe more drugs and shorten visits is Pollyanna. Any professional who thinks differently should try to get professional help that most working people would call “affordable” and see what we get.
Doesn’t it make more sense to look for social and personal reasons for an elderly person who just lost a spouse to be un-engaged in our culture and feeling overwhelmed with negative feelings three weeks after losing a spouse?
I started to comment on Dr. Pies monograph, but decided to save my limited typing skills for another day. The discussion hinged on reimbursement, medication, the magnitude of his symptoms, psychotherapy, how many criteria he met, whether he had “what psychiatrists call Major Depressive Disorder” or bereavement – all seeming to me to be peripheral to his care.
What did he need to help him find his life without his wife? What did he think about in the empty spaces of his day? Did he even really deeply know she was gone? Did he talk to her in his mind? Was he showing her his devotion by being frozen? Was he fasting as a way of trying to evoke her return? To punish her for leaving? To protest to what gods may be about the cruelty of his fate – a modern day Job? What was their relationship? Were they codependent about the activities of daily life? Were there children or family members available? If so what kept them away? Did they see his “state?” Did he have a life of his own before? friends? hobbies? What was his previous experience with loss?
A gajillion other possible personal meanings might help understand the depth and character of his response. If he’s come to see me, he obviously doesn’t know the answers himself and is asking for some help. Sounds like a patient to me. Maybe a patient for me, but more likely someone to refer into Dr. Cacciatore’s network or other bereavement support groups. He’s hardly the first 72 year old man to feel such things and this is the kind of presentation that is very amenable to help from support groups. Perhaps he’s a person whose only psychological confidante was his wife and needs to learn new ways of forming intimate bonds. And there’s a way outside possibility that he is having a pathological grief reaction – what used to be called a psychotic depressive reaction – and may at some point legitimately be a candidate for a more biological approach. I mention this latter possibility because such things happen at times and one always has to have an eye cocked for “Zebras.”
There’s more to ‘diagnosis’ and ‘treatment’ than taking symptoms at face value at a point in time and measuring them against a listing or gauging their severity. Bereavement is, indeed, “a place” – but a different place for each of us, subtly unlike any other. He doesn’t know how to be in his version yet…
If federal prosecutors rejected the settlement offer for Risperdal marketing by Janssen Pharmaceuticals, how does that relate to the settlement in Texas at the trial you attended?