A NYT op-ed reports that the APA is close to either dropping the bereavement exclusion from the Major Depression diagnostic criteria or adding something like Bereavement Related Depression.
I too find this troubling and see no way to characterize this other than an attempt to pathologize a normal human process.
One of the advocates left a comment on a post a couple of years ago. One of the links he left was a counter argument against the concerns identical to those expressed in this NYT op-ed. Among his counter arguments was this:
There are no convincing data showing that the bereavement exclusion for the diagnosis of major depression protects against “pathologizing” normal grief,
Really? The title of his response is “DSM5 Criteria Won’t “Medicalize” Grief, if Clinicians Understand Grief“. Isn’t the DSM a manual of DISORDERS?
Does someone who is grieving have a disorder? Even if they have the same symptoms as someone with a disorder? Is context unimportant? Does someone who experiences intense anxiety in the days following a traumatic event have an anxiety disorder until proven otherwise? How about a patient detoxing from alcohol or benzodiazapines?
Symptoms do not equal diagnosis.
UPDATE: What does this mean? It does not mean we ignore those symptoms. We can respond to the person’s suffering without treating them as though they are ill in some way. We can also recognize that the vast majority of grieving people will get their needs met from their family and community and that these natural supports should be the first line response. We can recognize them as at risk for depression and intervene if they are not experiencing gradual relief of their depressive symptoms.