Latest Edition Of Psychiatry’s “Bible” Labels “Excessive Grief” A Mental Disorder

The latest edition of the DSM, psychiatry’s “bible” of mental disorders, features an entirely new one: excessive grieving for a deceased loved one.

The NYT reported over the weekend that the inclusion of the new “disorder” marks an end to a prolonged debate within the field of mental health, prompting researchers and clinicians to view intense grief as a target for medical “treatment”, aka the prescribing of psychiatric medication, which would likely lead to a financial windfall for pharmaceutical companies. The disorder’s inclusion in the DSM-5, the latest edition of the manual, means insurers can be billed for the medication.

The new diagnosis, prolonged grief disorder, was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.

Its inclusion in the Diagnostic and Statistical Manual of Mental Disorders means that clinicians can now bill insurance companies for treating people for the condition.

Psychiatrists have been pushing for recognition of this “grief disorder” since the 1990s. And some of the experimental treatments under consideration involve drugs that have previously mostly been used for the treatment of alcoholism and opioid use disorder.

It will most likely open a stream of funding for research into treatments — naltrexone, a drug used to help treat addiction, is currently in clinical trials as a form of grief therapy — and set off a competition for approval of medicines by the Food and Drug Administration.

Since the 1990s, a number of researchers have argued that intense forms of grief should be classified as a mental illness, saying that society tends to accept the suffering of bereaved people as natural and that it fails to steer them toward treatment that could help.

Some examples of individuals suffering from grief disorder include widows or widowers who never overcome the loss of a spouse, and parents who struggle to overcome the loss of a child.

A diagnosis, they hope, will allow clinicians to aid a part of the population that has, throughout history, withdrawn into isolation after terrible losses.

“They were the widows who wore black for the rest of their lives, who withdrew from social contacts and lived the rest of their lives in memory of the husband or wife who they had lost,” said Dr. Paul S. Appelbaum, who is chair of the steering committee overseeing revisions to the fifth edition of the D.S.M.

“They were the parents who never got over it, and that was how we talked about them,” he said. “Colloquially, we would say they never got over the loss of that child.”

Unsurprisingly, many psychiatrists oppose the inclusion of this “grief disorder” in the DSM-5, arguing that it will inevitably lead to many “false positives”, since distinguishing between normal and abnormal levels of grief will be difficult.

Throughout that time, critics of the idea have argued vigorously against categorizing grief as a mental disorder, saying that the designation risks pathologizing a fundamental aspect of the human experience.

They warn that there will be false positives – grieving people told by doctors that they have mental illnesses when they are actually emerging, slowly but naturally, from their losses.

So once again, the field of psychiatry is putting the interests of drug makers and insurance companies over those of patients, many of whom will now be prescribed drugs to treat “grief”, a  normal – and for all people, inevitable – facet of life.