Hi All - I've been following the discussion of pathological grief with some interest, and TIPSTERS have raised some useful points. I am by no means an apologist for DSM-IV or V (in fact, have criticized both) and don't have a good enough handle on the recent research literature to evaluate many of the claims re: the proposal for pathological grief disorder (PGS). Nevertheless, when discussing these claims, it's crucial to understand that the draft criteria are much more stringent (e.g., they don't imply that a diagnosis can be made in 2 weeks) than implied in some recent TIPS messages.
Below are the draft criteria for DSM-V (or now DSM-5, as it seems to be abbreviated increasingly). Note in particular Criterion D (Timing) below. Again, many interesting and troubling questions can be raised about these draft criteria; but they certainly don't imply that anyone grieving over the loss of a loved one (and yes, I've been there too), even for a couple of months, will receive diagnoses of a mental disorder in DSM-5. Perhaps other draft criteria for PGS are floating around too, but if so, I'm not aware of them. ..Scott ______________________________________________________________________ Table 3. Criteria for PGD proposed for DSM-V and ICD-11. Category Definition A. Event: Bereavement (loss of a significant other) B. Separation distress: The bereaved person experiences yearning (e.g., craving, pining, or longing for the deceased; physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) daily or to a disabling degree. C. Cognitive, emotional, and behavioral symptoms: The bereaved person must have five (or more) of the following symptoms experienced daily or to a disabling degree: 1. Confusion about one's role in life or diminished sense of self (i.e., feeling that a part of oneself has died) 2. Difficulty accepting the loss 3. Avoidance of reminders of the reality of the loss 4. Inability to trust others since the loss 5. Bitterness or anger related to the loss 6. Difficulty moving on with life (e.g., making new friends, pursuing interests) 7. Numbness (absence of emotion) since the loss 8. Feeling that life is unfulfilling, empty, or meaningless since the loss 9. Feeling stunned, dazed or shocked by the loss D. Timing: Diagnosis should not be made until at least six months have elapsed since the death. E. Impairment: The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning (e.g., domestic responsibilities). F. Relation to other mental disorders: The disturbance is not better accounted for by major depressive disorder, generalized anxiety disorder, or posttraumatic stress disorder. -----Original Message----- From: Michael Smith [mailto:[email protected]] Sent: Wednesday, August 04, 2010 11:33 AM To: Teaching in the Psychological Sciences (TIPS) Subject: Re: [tips] DSM and grieving I think the main point of the article is that the bereavement exclusion was dropped and an additional point is that this is the result of one person's decision...gives one such faith in the scientific process. To the effect that, if you grieve longer than 2 weeks, regardless of the cause, then you should be treated as you now have a mental illness. Most ordinary people will rightly consider this a ridiculous statement. --Mike On Tue, Aug 3, 2010 at 4:34 PM, Mike Palij <[email protected]> wrote: > My reaction to the article is somewhat different from that of Nancy's. > I can understand her reaction but as someone who's had his own > share of bereavement, I would say that some people are able to > get through the grieving process in a "reasonable" amount of time > and others have great difficulty in doing so and may require assistance > in getting through the process. The loss of a spouse, in contrast > to the loss of a child, is a far more common event but it is recognized > as a potentially risky situation for the surviving spouse because of > the increased risk of that spouse's death, something referred to at > the "widowhood effect". One review of the widowhood effect provides > three general explanations for thie effect: (a) the death of a spouse > directly causes the death of the surviving spouse through some > process/mechanism, (b) "Homogamy", that is, husbands and wives > are similar in many respects and one should expect a correlation > between the time of death of one spouse and another, and (c) members > of a couple are exposed to many of the same environmental variables > which may cause the non-simulatneous death of both). More info > can be obtained from a review by Elwert & Cristakis in their 2008 > review article in the journal Demography which is available here: > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789302/ > > I admit to being surprised at people who are able to "snap back" after > the death of a spouse and re-marry within a year a two -- I simply > do not understand it. Similarly, the loss of a child, the loss of a parent, > the loss of a close friend, the loss of a loved one, the loss of someone > who had substantial meaning to one, all of these will be handled differently > by different people. Some will get over the loss though it may take years, > while some may never be able to get over the loss though, perhaps, the pain > of the loss might be mitigated with passage of time. For this latter group, > I think some form of psychotherapy may be appropriate in helping to > process the loss, appreciate the significance of the loss, and to develop > the rationale why one needs to move on. > > Just a couple of points more: > > (1) The widowhood effect varies by race. I'll leave it up to the reader to > speculate what is the form of this interaction. Then go and read this: > http://asr.sagepub.com/content/71/1/16.abstract > > (2) Severe bereavement effects have been seen with animals. The > example that stands out in my memory is from the National Geographic's > PBS special on Jane Goodall in which the male Flint, who had problems > been weaned from his mother Flo, died shortly after her death, apparently > from depression and grief; see: > http://en.wikipedia.org/wiki/Kasakela_chimpanzee_community#Flint > I recommend watching the original documentary "Among the Wild > Chimpanzees" to fully appreciate what happened. > > My own opinion is that pharamacotherapy is probably not very useful > in this situation though for some it may provide some temporary relief. > Losing a loved one under traumatic situations (e.g., watching them die > in front of you) can also lead to PTSD which would have be dealt with > seperate from the effects of grieving. > > -Mike Palij > New York University > [email protected] > > > > > > On Tue, 03 Aug 2010 12:14:09 -0700, Dr. Nancy Melucci wrote: >>I just read the story. It is even more outrageous when they suggest >>that the grieving for the loss of a child - the worst possible lost, made >>even harder in modern times when so few of us experience it (so >>more isolating than ever in an already death denying culture) - is >>more like a treatable illness than a normal reaction. >> >>Two modern cultural themes emerge of course - fear of being sued >>("I'd rather call it depression...") and of course the gigantic gold mine >>that labeling more and more of the colorful, unsettling and some times >>deeply painful emotional states that comprise a full life has become to >>psychiatry and the pharmaceutical industry. >> >>I have become more and more comfortable in my lectures criticizing >>the unscientific and shoddy construction of the DSM. And teaching >>the views of Szasz as serious insights and not the rantings of a fringe >>dweller. >> >>When we are happy all the time, no one will be happy anymore. >> >>Nancy Melucci >>Long Beach City Colleg >>Long Beach CA > > -----Original Message----- > From: Dennis Goff <[email protected]> > To: Teaching in the Psychological Sciences (TIPS) <[email protected]> > Sent: Tue, Aug 3, 2010 6:52 am > Subject: [tips] DSM and grieving > > I heard this story on NPR yesterday morning and thought that it could be used > as a nice introduction to some of the controversies surrounding the new > edition > of the DSM or even a class discussion about the definition of a psychological > disorders. The story discusses diagnosing "grief reactions" as a depression. > > "The DSM committee removed the bereavement exclusion - a small, almost > footnote > at the bottom of the section that describes the symptoms of major depression - > from the manual." > > The title of the piece - "Is Emotional Pain Necessary?" > > http://www.npr.org/templates/story/story.php?storyId=128874986&ps=cprs > tiny http://tinyurl.com/2g7yc22 > > --- > You are currently subscribed to tips as: [email protected]. > To unsubscribe click here: > http://fsulist.frostburg.edu/u?id=13541.42a7e8017ab9578358f118300f4720fb&n=T&l=tips&o=3964 > or send a blank email to > leave-3964-13541.42a7e8017ab9578358f118300f472...@fsulist.frostburg.edu > --- You are currently subscribed to tips as: [email protected]. 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