{"id":34479,"date":"2013-03-24T22:34:23","date_gmt":"2013-03-25T02:34:23","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=34479"},"modified":"2013-03-25T00:59:56","modified_gmt":"2013-03-25T04:59:56","slug":"in-the-range-of-a-mandate","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/03\/24\/in-the-range-of-a-mandate\/","title":{"rendered":"in the range of a mandate…"},"content":{"rendered":"
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Opening Pandora’s box: how DSM-5 is coming to grief<\/a>
by Gordon Parker<\/strong><\/sup>
Acta Psychiatrica Scandinavica<\/font><\/strong> 2013: 1–4. DOI: 10.1111\/acps.12110<\/div>\n

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In mourning, it is the world which has become poor and empty; in depression it is the ego itself.<\/em><\/strong><\/sup><\/div>\n
Freud<\/em><\/strong><\/sup><\/div>\n

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Until recently, DSM-5 architects had sought to reposition grief within the depressive disorders: a proposal generating multiple reviews and critiques, and evoking concerns about a risk of ‘pathologising’ bereavement. Friedman captured a second common ‘medicalization’ concern, whereby a diagnosis of ‘major depression’ could be made in those experiencing normal bereavement after only 2 weeks of mild depressive symptoms, and which could then lead to ‘unnecessary treatment with antidepressants and antipsychotics’. This discussion paper considers historical changes in categorizing grief within recent DSM manuals, focuses on broad parameters that differentiate grief and depression, and then considers implications to a DSM-5 website comment written by Professor Kendler, before I offer a revisionist position…<\/strong><\/sup><\/div>\n

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… And so Pandora’s box is further opened. Rather than drawing bereavement within the domain of the clinical depressive disorders (as DSM-5 appears still to favour), we might better lean the other way and consider whether many currently positioned clinical depressive disorders (especially the reactive depressive conditions) might fit more comfortably within a grief paradigm, and benefit more from management weighting such a model.<\/font><\/strong><\/sup><\/p>\n

Many have put a reductionist view that grief is completely normative and depression is always clinical, and that any merging will ensure a wide-scale move to manage bereaved people with psychotropic medication. To be fair, DSM-5 is likely to be addressing a reality – that some bereaved individuals will develop a clinical depressive episode – and that their treatment might then involve a differing management paradigm to that for normative grief. However, the recent DSM-5 annotation or website note appears underpinned by Kendler’s observation that the DSM-IV grief exclusion criterion is ‘not logically defensible’. This essay seeks to broaden the list of logical parameters that invite consideration. In particular, it invites weighting of phenomenological distinction between grief and depression, and consideration of an alternate paradigm that allows some reactive depressive disorders to be more logically modeled and managed as ‘grief’ states.<\/strong><\/sup><\/div>\n<\/blockquote>\n
Unfortunately, only the first page of this 2½ page article is available on the Internet, so I’ll try to summarize Parker’s points [which I’m sure will be my version of his points, since this is something I feel strongly about]. In Mourning and Melancholia<\/em><\/a> [1917], Freud commented on the difference between grief and depression:<\/div>\n