The Medicalization Of Normal Emotion
Dr. Martin Seligman, at the Evolution of Psychotherapy Conference I attended in Anaheim a few years back, noted that after World War II, people's feelings needed to be pathologized, turned into disorders, in order for treatment to be paid for (in order, for example, for me to get a prescription for Ritalin for ADHD, which I don't consider to be a disorder; merely a reflection of an atypical brain -- better at some tasks than typical brains; worse at others).
@JeffreyGuterman, a Barry University professor of counseling I follow on Twitter, tweeted a New York Times piece by Allen Frances:
@JeffreyGuterman Good Grief: Proposed change to DSM would confuse normal bereavement with major depression by Allen Frances
Excerpt from Frances' piece here:
Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, can't sleep well and don't feel like going to work. In the proposal for the D.S.M. 5, your condition would be diagnosed as a major depressive disorder.This would be a wholesale medicalization of normal emotion, and it would result in the overdiagnosis and overtreatment of people who would do just fine if left alone to grieve with family and friends, as people always have. It is also a safe bet that the drug companies would quickly and greedily pounce on the opportunity to mount a marketing blitz targeted to the bereaved and a campaign to "teach" physicians how to treat mourning with a magic pill.
It is not that psychiatrists are in bed with the drug companies, as is often alleged. The proposed change actually grows out of the best of intentions. Researchers point out that, during bereavement, some people develop an enduring case of major depression, and clinicians hope that by identifying such cases early they could reduce the burdens of illness with treatment.
This approach could help those grievers who have severe and potentially dangerous symptoms -- for example, delusional guilt over things done to or not done for the deceased, suicidal desires to join the lost loved one, morbid preoccupation with worthlessness, restless agitation, drastic weight loss or a complete inability to function. When things get this bad, the need for a quick diagnosis and immediate treatment is obvious. But people with such symptoms are rare, and their condition can be diagnosed using the criteria for major depression provided in the current manual, the D.S.M. IV.
What is proposed for the D.S.M. 5 is a radical expansion of the boundary for mental illness that would cause psychiatry to intrude in the realm of normal grief. Why is this such a bad idea? First, it would give mentally healthy people the ominous-sounding diagnosis of a major depressive disorder, which in turn could make it harder for them to get a job or health insurance.
Then there would be the expense and the potentially harmful side effects of unnecessary medical treatment. Because almost everyone recovers from grief, given time and support, this treatment would undoubtedly have the highest placebo response rate in medical history. After recovering while taking a useless pill, people would assume it was the drug that made them better and would be reluctant to stop taking it. Consequently, many normal grievers would stay on a useless medication for the long haul, even though it would likely cause them more harm than good.
The bereaved would also lose the benefits that accrue from letting grief take its natural course. What might these be? No one can say exactly. But grieving is an unavoidable part of life -- the necessary price we all pay for having the ability to love other people. Our lives consist of a series of attachments and inevitable losses, and evolution has given us the emotional tools to handle both.
Check out Seligman's books here on Amazon. He's one of the psychologists I respect. Two of his books that I really like: What You Can Change and What You Can't and Learned Optimism: How to Change Your Mind and Your Life.
Another point is that people may avoid interaction w/ psychiatric and counseling professionals for fear that a diagnosis will be rendered that entails legal restrictions or may pose liabilities. For instance, certain diagnosis make it illegal for an individual to own a firearm, or to obtain certain licenses for handling hazardous materials.
And frankly I'd bet that almost everyone has experienced episodes of feelings and behavior that if they were diagnosed in the moment would classify them as mentally ill.
Adler at August 15, 2010 9:11 AM
It would have been really helpful if the writer of this piece had posted the suggested wording to be added to the DSM rather than just expect us to take his word about it. The larger point, though, is certainly correct, that there is an increasingly large tendency to pathologize what is within the range of normal human behavior.
Christopher at August 15, 2010 9:59 AM
Another piece of this is modern America's total lack of respect/support for those who are grieving.
A rabidly secular Israeli coworker paid an extended visit to friends in the US - and was appalled at the way a death was handled. There was no shiva (traditional 7-day mourning period in which survivors are comforted by friends and family) and the grieving survivors were basically expected to "snap out of it" or "get on with it" with no days off or anything.
Contrast that with Israel, where the 7-day shiva is state-mandated leave, paid in most cases, and social custom is for coworkers and professional acquaintances to pay a condolence call - which at least alerts them to the mourner's likely emotional state in the coming months.
Ben David at August 15, 2010 11:10 AM
Louis Farrakhan is a delusional, anti-Semitic bastard who needs to board his mythical Mother Ship and leave our planet. However, I watched part of a speech of his, and I agree with one of his criticisms of modern society: "When you want to go to sleep, take a pill; when you want to wake up, take a pill; etc., etc."
This potential expansion of a psychiatric diagnosis fits in perfectly with that beef.
mpetrie98 at August 15, 2010 1:20 PM
Take a look at the monographs for Paxil and Clonazepam, and you might not want what they prescribe for you. Psychotropics don't hit different people the same way.
Radwaste at August 15, 2010 1:23 PM
Another piece of this is modern America's total lack of respect/support for those who are grieving.
Although I'm sorry to hear the description of how friend's family was treated, I don't think that's typical. After recently losing our twin sons to complications of twin-to-twin transfusion syndrome, my wife and I received an amazing outpouring of support from family and friends, despite us being about a secularized as can be. Although Shiva in not part of our traditions, we were granted great latitude to experience our grief, and get our feet under us before getting back to our normal schedules. Our workplaces both said the same thing, "Take as much time off as you need;" and hers paid bereavement time beyond that covered under their official policies. Our freezer is still stocked with gifts of food, and thousands of dollars were donated in our sons' honor to churches, hospitals and other foundations that help take care of children (we requested no flowers, but asked that people make a gesture that would help children instead). Nothing can change what happened, but I'm deeply grateful for how those around us handled things. I hope the experience of support that we had is more typical than that of your friend.
Christopher at August 15, 2010 2:23 PM
Adler is right, any one of us could have been put away under the old rules of commitment using current definitions of "mental illness."
Another interesting book on this topic is Manufacturing Depression by Gary Greenberg, who says that the DSM has already expanded the definition of depression way beyond what anyone would recognize as serious and severe depression. According to him, much of the "help" people get from antidepressants is really just placebo effect, according to studies that big pharma has gone to great lengths to suppress.
With so much woo and quackery actually being taken seriously by the Medical Field (and govt insurers) now, placebo is the new cure.
carol at August 15, 2010 3:25 PM
First of all, Christopher, I'm sorry for your loss.
Secondly, I lost my husband in '98 to suicide. I was 32. Like Christopher, I got a lot of support from family, friends, and coworkers. The outpouring of support was amazing and really let me know how important both I and my husband were to those around us. I've had a chance over the years to return that favor to others going through the loss of a relative, and THAT'S what the grieving process is. We all look out for each other. Giving someone a pill is not going to fix them.
Unfortunately, you've got to deal with it, or you'll pay for it later.
Ann at August 15, 2010 3:43 PM
Christopher, I'm so sorry for the loss of your sons.
From what I can tell, there doesn't tend to be a "typical" response to someone else's loss. I've heard everything from Christopher's and Ann's experiences to situations in which people were expected to get over enormous losses within a week. You occasionally see letters to advice columnists in which writers try to pathologize a friend or family member who has lost a spouse, a child, etc. a few weeks past and is "still" experiencing serious grief.
marion at August 15, 2010 5:37 PM
Marion, you're so right. For myself, I HAD to go back to work. I went back a week after my husband died, and my general manager comes up and says, "I'm impressed you returned to work so soon." Um, were you going to pay my bills while I was out? And, have you ever sat around a house all day with WAY TOO MUCH to think about? Didn't think so.
Everyone has to deal with grief in his or her own time. When it doesn't ever seem to get better, or the person doesn't seem to be making any progress, THAT'S when you have to pull that person aside and say, "Do you need some help?" Because, chances are they do, but they don't know how to ask. When the dust settles after the funeral and people start to go back to their lives, THAT'S when it gets hard. No one realizes, because the person grieving often doesn't know how to ask for help. Most of us don't have any experience with this until it happens to us. I will say, online support groups are awesome and one in particular saved my sanity. It's awesome when you're up at 3am and can't sleep to find a kindred spirit who will talk to you. And, as you get better, you return the favor. Helping others who are new to your path goes a long way towards your own recovery, IMHO.
Ann at August 15, 2010 9:07 PM
I appreciate the kind words, Ann and Marion. My approach to dealing with the loss was similar to Ann's - I needed to get back to work quickly to give myself something to do. Fortunately, I had the space to work from home, so that I could be here at times when my wife needed me. I haven't done the support group thing at all, but my wife has found it helpful.
Christopher at August 16, 2010 9:29 AM
I had a similar situation, although it was divorce rather than death. At my annual OB-GYN visit, the doctor was doing the follow-up talk and found out that I'd recently split up with my husband. (It came up when I informed him that I had no need of birth-control pills.) When I admitted that, yes, I was depressed, he volunteered to write me a prescription for some anti-depressants.
I politely refused, but it threw me for a loop. First off, that my gynecologist was offering me anti-depressants. Second, that being depressed after the break-up of my marriage was considered unhealthy. (NOT grieving sounds pretty unnatural.) Grieving is a natural reaction to a painful situation like that. Masking the feelings with chemicals sounds like a much more unhealthy reaction to me.
Please understand, this was normal depression. I wasn't suicidal, I wasn't neglecting my one-year old daughter, and I wasn't exhibiting anti-social behavior. I was just sad. And with time, effort and a lot of self-reflection, I got over it. It's been eight years since then, but I'm still taken aback by the memory of how casually he offered the pills, as if it wasn't any big deal.
Kelly at August 20, 2010 8:59 PM
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