Here we go again. The so-called experts in psychiatry charged with updating the Diagnostic and Statistical Manual (DSM-5), the less than empirical “bible of psychiatry” that clinicians rely on for reimbursable diagnoses, have decided that six months, maybe a year if they’re generous, is sufficient time to recover from a life-shattering loss.
This pathologizing of “prolonged” grief is yet another example of the arbitrary labeling of human feelings that is present in every version of the DSM, and a reflection of the culture of pathology we have fallen prey to. Big Pharma couldn’t be more pleased as its chemists race to their labs in search of new psychotropic pills. I couldn’t be more concerned about the price women will pay.
Consider this comment by the psychiatrist who chaired the steering committee overseeing revisions to the DSM-5. While being interviewed for a story in the New York Times in March he said, “They were the widows who wore black for the rest of their lives. They were the parents who never got over it, and that was how we talked about them. Colloquially, we would say they never got over the loss of that child.”
The absence of context in that statement is stunning. The widows who wore black were likely not grieving forever; they were more likely observing a cultural norm. And can anyone who has not lost a child begin to understand the emotional agony of that experience? The insensitivity, judgmental language, assumptions, and lack of empathy and context among diagnosticians like that is nothing short of staggering. How can one practice psychiatry devoid of the emotional intelligence necessary to accompany someone on the long, sad journey of grief?
There are psychiatrists, psychologists and social workers who share this view. They are openly critical, arguing that pathologizing a fundamental aspect of the human experience is not only morally wrong, it’s dangerous, warning that being told you have a mental illness when you are emerging from a period of deep grief can add to despair and a debilitating sense of vulnerability.
The backlash against re-defining depression to include grief has been ongoing for at least a decade or more, along with longer term concerns about arbitrary labeling, lack of evidence-based diagnoses, overmedication of patients, and the lack of context in diagnosis, especially for women, who are all too often subjected to meaningless labels like “borderline personality disorder” and “premenstrual dysphoric disorder.”
Women are significantly more likely than men to be diagnosed with a range of psychiatric illnesses. They are also more likely than men to be prescribed psychotropic medication, given electroconvulsive therapy and hospitalized for psychiatric illness.
One of the leading critics of the DSM was the late Dr. Paula Caplan, a pioneering feminist psychologist who resigned from the DSM-4 committee because she recognized that over-diagnosing and overmedication were occurring on the basis of unscientific labeling and diagnosing, especially for women. In a piece she wrote in 2012 in the Washington Post she said, “Since the1980s, I have heard from hundreds of people who have been arbitrarily slapped with a psychiatric label and are struggling because of it.” She noted that “About half of all Americans get a psychiatric diagnosis in their lifetimes which can cost anyone their health insurance, job, custody of their children, or right to make their own medical and legal decisions.”
Others in relevant professions have similar, significant concerns about the DSM. Their concerns include oversimplification “of the vast continuum of human behavior,” misdiagnosis and over-diagnosis “simply because [the patient’s] behavior does not always not always line up with the current ideal,” labeling and stigmatization. The American Psychological Association, the American Counseling Association, and the society for Humanistic Psychology are among the professional organizations who have publicly shared their concerns about the DSM.
Psychiatric care and psychological counseling, of course, have their place in mental health. But practitioners, especially those charged with oversight of the troubling DSM, a reference book some professionals argue should be abandoned, as well as those who seek reimbursement for services, do clinical studies that require funding, and especially those who ignore context or lack sufficient empathy, must recognize their moral obligation to “do no harm.” That includes avoiding judgmental diagnoses, false assumptions, heavy reliance on medication, unhelpful labeling, and inherent sexism.
Paula Caplan had it right when she said “In our increasingly psychiatrized world, the first course is often to classify anything but routine happiness as a mental disorder, assume it is based on a broken brain or a chemical imbalance, and prescribe drugs or hospitalization…. These days you would think there is no such thing as normal.”
Perhaps the next DSM revision should include a new disorder: “Prolonged insensitivity to suffering.” It would be easily diagnosed by an absence of compassion and the overuse of meaningless labels upon meeting new people. Surely no one would argue with that.
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Elayne Clift is a health communications specialist and former Program Director for the National Women’s Health Network. She writes from Vermont.