Grief is Not A Disorder

 You may never have heard of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s diagnostic guidebook. The fifth edition is currently in draft form and scheduled for publication in May. It was first issued in 1952 and the fifth edition will be the first update since 2000. (When I was a mental health worker in the 1980s, DSM-III was being used.)

DSM-5 has been in the news recently because of the way it plans to reclassify grief.  Previous versions of the manual have excluded grief as a depressive condition. Meaning if you went to your doctor and reported feelings of deep sadness and loss, insomnia, inability to concentrate or loss of appetite that lasted longer than two weeks, your doctor would find out if you had lost someone close to you. 

Sure, your doctor might have prescribed something to help you sleep. My dad’s doctor did for him after my mom died. But by making grief an extenuating circumstance in diagnostic terms, the manual signified grief as a normal part of life. No more, if DSM-5 proceeds without further edits. You could very well be diagnosed as depressed for having a completely normal response to a loss, and prescribed antidepressants when the best healing agent is simply time.

If there’s one thing I’ve learned about grief, it’s that it’s not linear. It won’t be resolved in two or three or six months, much less two weeks. The respected medical journal The Lancet said it beautifully. “Building a life without the loved person who died cannot be expected to be quick, easy, or straightforward. Life cannot, nor should not, continue as normal. In a sense, a new life has to be created, and lived with.”

I trust doctors will continue to use their common sense, no matter what the final DSM-5 looks like. But as Allen Frances, M.D., wrote in Psychology Today, “If DSM-5  remains completely tone deaf and intransigent, it simply will not be used.”

Grief is a part of life, like love or joy or pain. It is not a disorder, and treating it as though it were is a big mistake.

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10 thoughts on “Grief is Not A Disorder

  1. Jackie – I agree completely. Grief is not a disorder. Thank you.

    And since I know of no other way to contact you, let me take this opportunity to thank you for “From Zero to Mastectomy”. I spent 3 weeks with my sister while she went through almost exactly what you did – with the same “zero” diagnosis, same size tumor, etc. Except she didn’t have lumpectomies….just had the left breast removed. As I was her caregiver after surgery, I cannot tell you how amazed I was that when I typed the word “mastectomy” into the search bar on my Kindle, your book popped up first thing. Your sharing prepared me for what was ahead. (especially concerning the drain tube maintenance, and the adhesive remover pads!)Thank you, and God Bless You today in His own special way.

    Marilyn Bardin
    Twisp, WA

  2. Hi Jackie, I just caught your blog on a search today and am responding only to this post, and not to all the content of your blog. I have seen these proposals for this update in the DSM-V on grief, and can’t begin to express my anger at this direction in medical care. Like you, I believe that grief is part of the normal rich experience in our lives. Classifying grief beyond two weeks as pathology, and providing drugs to manage the symptoms benefits the pharmaceutical manufacturers, and also lets physicians process their patients more quickly. A person who chooses not to engage in drug therapies could then be labelled as non-compliant. I am concerned that this will have repurcussions on leave-of-absence or disability claims for people who are employed.

    I have had a fascinating, unmedicated journey through grief over the past two years, and am grateful for every moment that I could be with and in this process.

    • Maura,
      Thank you so much for stopping by and sharing your thoughts. I also worry about repercussions with non-compliance/medical records/insurance/etc. but that could be a whole other post. I read something recently that really stuck with me about electronic medical records in the U.S. and why many doctors don’t like them–it talked in part about how if you don’t include something as a choice, then it doesn’t exist. Very, very scary.

      On a more personal note, I think it’s wonderful that you can find the beauty in the grief journey. That’s a gift.

  3. Jackie,
    Last September, nine months after James died, I saw my doctor because I couldn’t sleep or eat and I was depressed. My doctor prescribed antidepressants, but I didn’t take them–they scare me–choosing instead to listen to Guided Imagery audio casts. After listening to them several times, I felt like a new person. I still miss James, and my life is not the same, but I’m no longer paralyzed with grief. Whenever I tell people about Guided Imagery, I’m pretty sure they won’t look into it which is sad. They act like it’s hocus pocus witchcraft.

    XOXOXO,
    Brenda

    • Brenda,
      Thanks so much for sharing your experience and even more for sharing what helped you. I hope this will help people see it’s not hocus-pocus. If you haven’t written about guided imagery on your blog yet, perhaps you should! XOX

  4. I marked this post earlier in the week to read and am only now getting around to doing so. What an excellent post Jackie – you have done us all a great service by sharing your views with us on this. Recently I asked my bereavement counsellor to tell me what the difference is between grief and depression and while her answer helped clarify things for me, your post really helped me understand. Thank you too for that beautiful quote from The Lancet – I really found it comforting to read. And thank you also to Maura and Brenda for sharing their valuable experience – knowing that others have walked this same path and created new lives out of the ashes of the old is hugely encouraging to me right now.

    • Marie,
      Thank you so much for sharing your thoughts and for including my post in your roundup this week. I’m so glad my post was helpful and I hope the healing continues in your journey. I know it will.

  5. Pingback: Weekly Round-Up « Journeying Beyond Breast Cancer

  6. Just one of many issues coming to light surrounding the new DSM. Seems like it’s got a quirky selection of ‘disorders,’ and your point is more than well-taken: Grief is not a disorder. It’s an appropriate reaction to sad events in our lives. It should not be pathologized, or medicated away. I hope Allen Frances is correct–and believe he will be so. The DSM will not run our lives if it is tone-deaf–and we will be allowed our grief in the face of sad occurrences.So glad you brought this point to attention.

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