Sunday, 31 March 2013

Is grief a treatable illness?

All of us are affected by bereavement at some point in our lives. Whether we lose a parent, grandparent, child, sibling, other family member or friend, it is hard, especially if unexpected. Grief is a natural response, one which affects different people in different ways, hits harder or lasts longer with some of us, but is in the end a perfectly understandable process given what we have lost. Everyone deals with it differently too, perhaps coping after time, with support from loved ones or bereavement counselling, or any number of other ways. When my Dad died, over 10 years ago now, I threw myself into my gardening and that helped me work my way through the grief.

Now, though, it seems that some psychiatric organisations are considering that bereavement and the associated grief could be regarded as a mental illness which might potentially need medical treatment. In a BBC Radio 4 programme called Medicalising Grief earlier today (you can listen here for the next 7 days), Matthew Hill investigates the issues. In May 2013 the American Psychiatric Association will publish the 5th edition of The Diagnostic and Statistical Manual of Mental Disorders - or DSM – in which new mental disorders will be listed. What this actually means is that with each new edition of the manual, yet more people are potentially labelled as “mentally ill”. And with this edition, this could include those grieving for the loss of a loved one.

The DSM, which is apparently regarded as something of a “bible” by some psychiatrists, contains checklists of symptoms for each disorder. The checklist for grief, according to the programme, includes, at one end of the scale - sadness, insomnia, guilt, loss of pleasure and appetite, with suicidal tendencies rounding off the other end. Five or more of these symptoms, experienced for two weeks or more, would indicate that the person had a serious mental disorder, regardless of the underlying reason.

Some experts say that if people experience grief which leads to serious depression then they should be treated (the implication being – bring on the anti-depressants – more of which in the programme...). Others say that to be normally sad, for however long, does not mean that a person has a medical illness. There is an interesting article in The Lancet called Living with grief which explores the latter view in more detail.

When my father died unexpectedly and I had to cope with the consequences I didn’t consider that I might be ill. I was stressed and anxious, particularly in the first few weeks afterwards. I found it hard to concentrate on reading, I needed time to myself and with my close family, to absorb the finality of what had happened. It hurt, a lot, and for a very long time, but I never expected anything different.

How do you feel about redefining grief as an illness? Should people be prescribed anti-depressants if they feel depressed after losing a loved one? What is the difference between sadness and depression? And who should be responsible for deciding what is, and what is not, a mental illness?

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