"Acknowledging that bereavement can be a severe stressor that may trigger a clinical depression in a vulnerable person does not medicalize or pathologize grief," he suggested. "Rather, it prevents clinical depression from being overlooked or ignored, and facilitates the possibility of appropriate treatment."
"This acknowledgment," Zisook cautioned, "does not mean that we think acute grief should end in days, weeks or even months. For some, it may last for years, whether or not there is also a clinical depression. But, acknowledging that clinical depression may also be present in some bereaved individuals may go a long way towards helping those individuals get on with their lives."
For University of Michigan Medical School psychiatry professor Dr. Randolph M. Nesse, the debate boils down to a tug-of-war between basic common sense on the one hand and science's search for diagnostic consistency on the other.
"Everyone knows that grief is something that happens to everybody," he noted. "And just because an emotion feels bad doesn't mean it's wrong or unhealthy. Most often it's a common-sense response to a real problem."
"So, my take is that it would be senseless to eliminate the grief exclusion [from the DSM]," said Nesse, who is also a professor of psychology at UM's College of Literature, Science and the Arts. "But, because it can be so damn hard to figure out when an emotion is normal or not normal without really knowing what is going on in a person's life, there are undeniable advantages to having a neat, clean, simple check-box kind of classification system for diagnosing depression. It makes it easier. So, you include grief as a box to tick, whether or not there is a real problem to be diagnosed."
"But that is what is so troubling," he added. "Because when someone gets a diagnosis of depression it then encourages giving that person treatment. And the getting of that treatment then pushes the person being treated into believing they do indeed have a problem that needs treatment to begin with. And that can be very unhelpful in many, many cases in which grief is really a normal and healthy response to a life event."
For more on bereavement, visit Mental Health America.
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