Grief or Depression?

I read a most interesting report, Is Emotional Pain Necessary?, on NPR today. After recounting the story of a mother whose 14-month old daughter had died and how she struggled to cope, the article stated

But is what Theresa went through a normal part of grieving, or did the death of her child bring on a mental disorder — major depression — that could have been, perhaps should have been, aggressively treated?

Earlier this year, the American Psychiatric Association released a rough draft of its new Diagnostic and Statistical Manual of Mental Disorders, or DSM. It's a big book that lists all the mental disorders doctors can use to diagnose mental illness. One of the changes they're proposing is causing controversy.

Traditionally, the manual has warned doctors away from diagnosing major depression in people who have just lost a loved one in what's called "bereavement exclusion." The idea was that feelings of intense pain were normal, so they shouldn't be labeled as a mental disorder.

But the new DSM changes this. Buried in the pages is a small but potentially potent alteration that has implications not only for people like Theresa, but ultimately for the way that we think about and understand the emotion of pain.

The DSM committee removed the bereavement exclusion — a small, almost footnote at the bottom of the section that describes the symptoms of major depression — from the manual.

There is more than one way to analyze this recommended change. For starters, it may well be that members of the psychiatric community have noticed that a rather definitive line exists between normal grief responses and depression. As part of the article, it was suggested that extreme grief that extends beyond two weeks may cross the line to a mental health disorder. Consequently, all this proposed change might indicate is that they desire for their manual to more closely mirror current reality.

Needless to say, not everyone agrees with this [arbitrary] two week cutoff.

But Holly Prigerson, a researcher at Harvard University who studies bereavement, says that while there's no good research on what percentage of people will meet the criteria for depression after a loss, it's clear that most experience depressive symptoms far beyond two weeks.

"What we found," Prigerson says, "is that when you follow people — for example, between zero and six months post-loss — their depression symptom levels actually increase over time and peak at about six months post-loss."

Because grief and depression look so much alike, Prigerson says, she worries that people who are suffering from normal grief will be told that they are sick when they are not, and encouraged to treat their symptoms when they don't need to.

That is potentially a problem, Prigerson says, because we don't know whether the pain of normal grief actually helps people to process their loss.

I know this will come off sounding cynical -- perhaps it IS -- but another explanation for the proposed change simply might be a way to drum up more business for those in the mental health field as well as the pharmaceutical industry. If the threshold is lowered, this will naturally mean that more people will qualify and this equates to more "patients," work and money.

At this point, I'm not sure what to make of this draft revision. I can see both sides. What do you think?