Monday, August 2, 2010

Is Grief Ever a Mental Disorder?

Listen to Kenneth Kendler and others weigh in on NPR's morning edition: 

Is Emotional Pain Necessary?

I see several false assumptions in this debate: 
1) Meeting the criteria for Major Depressive Disorder means you have the illness: Wrong. The criteria are necessary, not sufficient. Just means you may have an illness. 
2) If you have the illness, you must have treatment: Wrong. The patient gets to choose whether to be treated and how.
3) Treatment means medication: Wrong. There is also psychotherapy. And what about grief counseling. A Grief counselor is not likely to kick you out of "treatment" based on the 2 week rule. Neither is a psychotherapist. But the criteria may impact whether insurance pays for them. 
4) Treatment will remove the pain of grief. Wrong. Neither medication nor psychotherapy will prevent the aggrieved from feeling bad about a loss. One could argue that improvement after treatment suggests there is or was an illness. We don't have happy pills yet.
Bereavement and grief by definition involve reaction to an adverse life event. Depressive illness in contrast often occurs in the absence of any connected adverse event, and usually seems to insulate and distance the individual from external circumstances. Treatment of depression may lead to increased sensitivity to loss.

No comments:

Post a Comment