Grief following bereavement can be an intense, painful, and incapacitating experience, with significant morbidity and even mortality. Nevertheless, the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (henceforth DSM), since its third edition in 1980, has been steadfast in claiming that (normal) grief is not a condition calling for psychiatric intervention but, instead, a natural process involving acceptance, adjustment and meaning making. The so-called “bereavement exclusion,” specified by DSM-III and DSM-IV from 1980 to 2013, explicitly ruled out the diagnosis of major depressive disorder (which shares significant symptoms with grief, e.g. sadness, sleep disturbances) for some time (two months to two years) following bereavement. The 2013 removal of the bereavement exclusion, in DSM-5, proved controversial, even though the intention was not (as some critics claimed) to “pathologize” grief but rather to distinguish it more carefully from psychiatric disorders (such as major depressive disorder) sometimes triggered by the stress of grief following bereavement. I will argue that a consequence of the DSM-5's removal of the bereavement exclusion is the introduction of a new diagnosis of “prolonged grief disorder” (PGD) in DSM-5-TR (2022). I have found that there are unacknowledged assumptions about the “normality”—indeed even the sanctity--of grief following bereavement as well as assumptions about the “abnormality” of psychiatric disorder that have shaped DSM deliberations. I am critical of these assumptions and argue that they resulted in a PGD category too narrowly defined to address the needs of many bereaved people, as well as the needs of those grieving losses other than bereavement. I make suggestions for approaching the issues with a stronger focus on two important goals of psychiatry, which are to address suffering and to avoid stigmatizing psychiatric disorders.
扫码关注我们
求助内容:
应助结果提醒方式:
