Wednesday, January 25, 2012

More Insanity From the APA

Grief Could Now be Classified as Mental Illness:

When does a broken heart become a diagnosis?

In a bitter skirmish over the definition of depression, a new report contends that a proposed change to the diagnosis would characterize grieving as a disorder and greatly increase the number of people treated for it.
Or to put it another way, no one would ever be able to grieve properly again. By taking the grieving process and assigning it deviant status (with the requisite psychotropic meds), people will never be able to process the loss of a loved one, however awful the event may be.

The new report, by psychiatric researchers from Columbia and New York Universities, argues that the current definition of depression — which excludes bereavement, the usual grieving after the loss of a loved one — is far more accurate. If the “bereavement exclusion” is eliminated, they say, “there is the potential for considerable false-positive diagnosis and unnecessary treatment of grief-stricken persons.” Drugs for depression can have side effects, including low sex drive and sleeping problems.

But experts who support the new definition say sometimes grieving people need help. “Depression can and does occur in the wake of bereavement, it can be severe and debilitating, and calling it by any other name is doing a disservice to people who may require more careful attention,” said Dr. Sidney Zisook, a psychiatrist at the University of California, San Diego.

So you may not have sex or ever sleep again, but somehow that will make you less depressed. Or something.

In blogs, letters, and editorials, experts and advocates have been busy dissecting the implications of this and scores of other proposed revisions, now available online, including new diagnoses that include “binge eating disorder,” “premenstrual dysphoric disorder” and “attenuated psychosis syndrome.” The clashes typically revolve around subtle distinctions that are often not readily apparent to those unfamiliar with the revision process. If a person does not meet precise criteria, then the diagnosis does not apply and treatment is not covered, so the stakes are high.
Those "stakes" being money. You can read the rest of the article, but I love the inadvertent nod to Labeling theory towards the end.

For now, these revisions are still in play; the completed manuscript is due to the printer in December. In the longer term, the politicking is likely to have a corrosive effect on the process, some experts said. Recent findings in genetics show that nature does not respect psychiatric categories — many different disorders seem linked to some of the same genetic glitches.
In other words, you continue to look in the wrong place. Psychiatric disturbances are not nature-based, but nurture-based. Society determines which behaviors are pathologies, and central to this process are issues of deviance, conformity, social power and social control.

But I repeat myself.


Reauthored said...

This is actually incorrect information. The APA is not proposing including grief in the depression category. Bereavement falls under "adjustment disorders" (not "mood disorders") which is a category that is used to diagnose people who are significantly distressed in reaction to an identifiable stressor and it is significantly impairing their life. Bereavement related adjustment disorders cannot be diagnosed until a minimum of 12 months after the death of the loved one AND be inconsistent with cultural norms. See this page from the DSM-5 website for more information:

Reauthored said...

Furthermore, insurance companies REQUIRE a diagnosis to pay for services - including mental health counseling. The APA is not suggesting that we just give medication to grieving people, but they need to include bereavement somewhere because of the third party payer system. As much as I HATE calling emotional responses to things a "disorder" I also know that in order to see clients who are covered by insurance I MUST diagnose them with something. I am more concerned as a clinician about the lowering of diagnostic thresholds for other disorders such as ADHD.

Todd Krohn said...

According to the Wakefield First report, the APA's proposal in the DSM-V is to "eliminate the bereavement exclusion" which "recognizes that depressive symptoms are sometimes normal in bereaved individuals." Its retention is called "vital" to "prevent false positive diagnoses" of depression, when no such condition exists.

Also, as they note, "a considerable number of individuals reach the 5-symptoms-for-2-weeks level that satisfies diagnostic criteria for major depressive disorder" following the death of a loved one. For this exemption to be removed would mean millions more grieving individuals could be labeled "depressed" within days of burying their loved one. Two weeks seems a long way from the proposed "minimum of 12 months" you say exists on the DSM-V website.

As to the role of insurance: insurance makes more money off the dispensation of pharmacology than they do grief counseling or talk therapy. Insurance's role should be irrelevant in determining the science of diagnostic criteria (if it is indeed "science" we are talking about).

Completely agree with you on ADHD.