Wednesday, February 20, 2013

Grief vs Depression and DSM-5 Criteria

Photo by aussiegall. 
Over the years, my ability to identify emotions has broadened.

Like the legendary example of Eskimos having multiple words for snow, I'm finding that the longer I examine the feelings of others and my own feelings, the more words I have for them.

Recently, I have bumped into articles and podcasts that seek to distinguish between grief and depression.  Many people would conflate them.

However, observation and research have shown that grief over a loss--such as the death of a spouse--is a  natural, normal response.

People usually adjust between 6 months and 18 months to such a loss.

The bereaved can also have moments during the grieving process where they can connect with others, laugh and enjoy life even if they sometimes also return to feeling the enormity of their loss. The bereaved will also return to a sense of loss now and then during birthdays, anniversaries, holidays and other memory-evoking situations.  But generally, they are over time able to function and enjoy life.

Major depressive episodes, however, persists for weeks, months even years.  Diagnostic criteria require that multiple symptoms be present for at least a period of two weeks.  People suffering from major depressive episodes benefit from treatment; otherwise, they often fail to recover.

The following clip features Alexander Glassman, MD, professor of clinical psychiatry at Columbia University, who gives a brief explanation of the difference between grief and depression:



I am bumping into discussions of grief vs depression for a reason. 

The catalyst for these discussions is the revised DSM* manual, anticipated in May of 2013. This reference tool is powerful since it determines how insurance companies and government programs dispense services and benefits. The new diagnostic criteria will remove the bereavement exclusion, making it easier for people suffering spousal loss or other losses as receiving a formal diagnosis of clinical depression. 

Many are concerned that this inclusion of bereavement as a part of depression will medicalizes a normal emotional response. 

Here is just a sample of those who resist seeing grief and depression conflated with the forthcoming publication of the DSM 5. 
I can see the concern that some people will suffer from depression needlessly while those around them fail to recognize the more serious and persistent depressive symptoms.  I can also see how older adults are too often not diagnosed or treated for depression because ageism insists that such suffering is just part of the aging process. However, I am worried that the pendulum will swing too far the other way and deny people the healthy, needful process of grief work. 

Even though the distinction might be difficult to make, I encourage those with signs of grief and/or depression to seek help from a professional who works with the bereaved or the clinically depressed on a regular basis. See a therapist, go to group therapy, or visit your general physician.  It's too easy to have distorted thinking in either of these states of mind.

Drawing on the expertise of others to negotiate a new landscape can help a person gain a greater awareness of these feelings: how to name them, how to identify them and how to manage them in order to eventually adapt and function again. 

*Shorthand for the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

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