The American Psychiatric Association is in the midst of a controversy around the updating of its Diagnostic and Statistical Manual of Mental Disorders or D.S.M., psychiatry’s official tool for deciding between mental disorders and “normality.”
Apparently, the DSM-5 is preparing to classify grief from the death of a loved one as clinical depression, as early as two weeks after the loss. The change eliminates the so-called “bereavement exclusion,” which exempts grieving people from diagnoses of depression for two months unless their symptoms are self-destructively extreme.
The change was first proposed over a year ago, and there has been a hue and cry in psychiatric circles about this change in classification. The controversy has yet to die down, and the D.S.M. 5 will not be published until May.
Opponents of the classification change worry that it is an easy way to simply medicate people to ease their pain, when in fact, the need for processing, perhaps coupled with talk therapy and simply time is usually the best way to move through profound loss.
I haven’t been in therapy in many years, but my understanding is that there is a movement towards medicating for even what could be classified as mild depression, rather than spending months on the couch working out your problems through talk and analysis. My hunch is that this has to do with the movement in our quite-broken health care and insurance system, the same one that moves women who have had babies onto the conveyor belt out of the hospital the same day they give birth, or, when generous, the next.
In other words, a quick fix for something that probably could benefit from a little more time.
While I am not a therapist, I have spent a lot of time in their waiting rooms. And while I am not a professional expert on grief, I have spent a lot of time wandering in its fields. And I am quite sure that declaring someone clinically depressed two weeks after a terrible loss is a mistake.
I have experienced two profound losses in my life, and, as anyone who reads my blog regularly can attest, they have affected me in ways that will resonate forever.
The first loss was my infant son, who died 15 years ago this week, in my arms, five days after his traumatic birth. The second loss was my mother, eight years ago, who died three weeks after being given a diagnosis of fourth stage lung cancer. She was 68.
The grief I felt with the loss of my son was unlike anything I could imagine. Certainly, we didn’t know him as a person. His loss did not leave a hole in my life the size of the globe, which is what would happen if, god forbid, I lost an older child.
The devastation wrecked upon us by his death was instead the loss of hope, of promise, of all that we had invested in trying to bring him through a challenging pregnancy and delivery. We couldn’t imagine that at the end of it all, we would not bring our son home.
But when he was born, and his little lungs didn’t work, and he was whisked off to Children’s Hospital to live on the ECMO machine to help him breathe, and then developed a bleed on his brain which would mean, if he even lived, a life with no cognitive value, we had to let him go. We had to live with our decision to take him off the machine and let his soul and body leave us with a gaping loss that permeates my every move to this day.
That is not to say that I live in a miasma of unending grief – far from it. But I am who I am because of my son, and because I lived through and continue to live through the experience of that grief. I am not, and was not, depressed. Nor do I think that medication would have helped me. I had to wade through the shoals of that sadness alone, and feel every crag as I walked, in order to come through on the other side.
While I went through that process, I had people – well-meaning, good-intentioned people, friends and others, who thought they could help me by offering such advice as “why are you still wearing that necklace?” (the one on which I had his name around my neck.) And “thank goodness you already have a child.”
But for all the pain around all the gaffes, the fact is that I had to live through it in order to understand the strength of the grief, and the power it gave me to live.
When my mother died, fairly suddenly, painfully and in the midst of the repairs to our challenged relationship, I had to wade through a different kind of grief. This was grief that led me to keening in my bed at night, crying waterfalls six months after her death at 5:00 in the afternoon when I was supposed to be cooking dinner for my children, sleeping alone in our guest bed many times because nighttime was the only time in which I could be completely alone with my thoughts and I needed that complete alone time to process.
Again, in my case, medication was not was needed. I needed time and space to mourn my loss, to accept that I was never going to hear her voice again, never see her hug my children again, and I would never again be able to share with her my own mothering journey, different though it was from hers. It was something that wove us together in her last years, that healed our relationship and allowed me to love her in a new and more appreciative way.
My grief paved the way for me to understand this.
I am not going to get up on a soapbox and protest the D.S.M 5. I believe fully in the power of medication for depression, and believe in its power to really ease people's pain. I do question, however, the validity of diagnosing depression so quickly into a mourning process. I am not going to spend much time worried about the proposed changes, except here, to say that I think they are misguided and developed in an academic (and perhaps insurance-driven) vacuum.
I am not currently mourning a loss, or steeped deeply in grief. But I know the time will come again. And when it does, whatever the loss, I will take the tools I have gathered from past experiences and hope they will guide me through my new experience.
Every loss is different. People grieve in different manners and at different speeds. Grief can take you by surprise decades after its first appearance. You never quite lose the mental picture of the person you loved and lost. And you have to be patient and kind with yourself as you wade into those untested waters.
photo by martinpro via Flickr