After more than a decade of argument, the most powerful body in the United States added a new disorder to its diagnostic manual.
The decision marks the end of a long debate within the field of mental health, steering researchers and clinicians to view intense grief as a target for medical treatment at a time when many Americans are overwhelmed by loss.
It was designed to apply to a small group of people who are unable to return to previous activities after a loss.
It's inclusion in the Diagnostic and Statistical Manual of Mental Disorders makes it possible for clinicians to bill insurance companies for treating people with the condition.
A competition for approval of medicines will likely be set off by it, as naltrexone, a drug used to help treat addiction, is currently in clinical trials as a form of grief therapy.
A number of researchers argue that grief should be classified as a mental illness because society tends to accept the suffering of grieving people as natural and that it fails to steer them toward treatment that could help.
They hope that a diagnosis will allow clinicians to help a part of the population that has been withdrawn into isolation after terrible losses.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 their husbands or wives who they had lost.
He said that the parents never got over the loss of the child.
Critics of the idea have argued that the designation of grief as a mental disorder risks pathologizing a fundamental aspect of the human experience.
They warn that there will be false positives when grieving people are told by doctors that they have mental illnesses.
Drug companies will try to convince the public that they need medical treatment to emerge from mourning, and they fear grief will be seen as a growth market.
"I completely, utterly disagree that grief is a mental illness, and I operate the Selah Carefarm, which is a retreat for grief," said the associate professor of social work at Arizona State University who has published widely on grief.
When someone tells us we are not normal, we no longer trust ourselves and our emotions.
The new diagnosis can be traced back to the 1990s, when Holly G. Prigerson was studying a group of patients in late life, gathering data on the effectiveness of depression treatment.
She noticed that in many cases, patients were responding well to antidepressants, but their grief was still high, despite the fact that they were responding well. The psychiatrists on the team showed little interest when she pointed this out.
She recalls being told that grief is normal. How do you know that depression and anxiety are not a problem?
Dr. Prigerson wanted to gather data. Many symptoms of intense grief, like longing and pining and craving, were distinct from depression, she concluded.
She found that the symptoms of grief peaked six months after the death. She said that a group of outliers remained stuck and miserable, and would continue to struggle with mood, functioning and sleep over the long term.
She said that you aren't getting another soul mate and you are kind of eking out your days.
When the American Psychiatric Association proposed expanding the definition of depression to include grieving people, it provoked a backlash, which led to a broader critique that mental health professionals were overdiagnosing and overmedicating patients.
The professor of social work at New York University said that clinicians want diagnoses so they can categorize people coming through the door.
Researchers kept working on grief, seeing it as distinct from depression and related to stress disorders. A professor at Columbia University developed a 16-week program of psychotherapy that draws heavily on exposure techniques used for victims of trauma.
Data from clinical trials showed that Dr. Shear's therapy was better for patients suffering from intense grief than other therapies. The new diagnosis should be included in the manual, according to Dr. Appelbaum, who is chair of the committee in charge of revisions to the manual.
Dr. Shear and Dr. Prigerson were part of a group that agreed on criteria to distinguish normal grief from the disorder.
The most sensitive question was how long is it?
The A.P.A. begged and pleaded to define the syndrome more conservatively because they felt they could identify it six months after a death.
She said that they were politically smart about it. She said that the public was going to be angry because they still feel grief, even if it's their grandmother at six months.
She said that the criteria should apply to 4% of the people who have died.
The new diagnosis in the revised edition of the manual is a breakthrough for those who have argued for years that intensely grieving people need tailored treatment.
Kendler is a professor of Psychiatry at Virginia Commonwealth University and has played an important role in the last three editions of the diagnostic manual.
He said that it is an official blessing in the world.
The diagnosis is likely to popularize Dr. Shear's treatment and give rise to a range of new ones, including drug treatments and online interventions.
Dr. Shear said it was difficult to predict what treatments would emerge.
I don't know when the last time there was a brand-new diagnosis, she said.
She said that she was in favor of anything that helped people.
Amy Cuzzola-Kern said her treatment helped her break out of a terrible loop.
Her brother died three years ago of a heart attack. Ms. Cuzzola-Kern wondered if she should have noticed he was unwell or if she should have told him to go to the emergency room.
She had trouble sleeping because she had withdrawn from social life. She had begun a course of antidepressants and seen two therapists, but nothing seemed to work.
She said that she felt like she was living in a suspended reality.
She entered a 16-session program. She would tell the therapist about the day she learned her brother had died, but it was a painful experience. She said she had accepted the fact of his death by the end.
She said that the diagnosis was a gateway to the proper treatment.
Am I embarrassed or ashamed? Do I feel like a pathological person? She said that she needed professional help.
Others said they were wary of any expectation that grief should be lifted in a specific time period.
The victim services department of Mothers Against Drunk Driving doesn't put a time frame on when someone should or shouldn't be moving forward. The organization encourages people who have died to seek mental health care, but does not have a role in diagnosis.
Filipp Brunshteyn, whose 3-year-old daughter died after an automobile accident in 2016, said that grieving people could be set back by the message that their response was not good.
He said that anything that says that is not normal could cause more harm than good.
Ann Hood said that setting a year as a point for diagnosis is cruel. She said that her experience was full of peaks and valleys.
The first time Ms. Hood walked into her daughter's room after her death, she saw a pair of ballet tights lying on the floor. She screamed but it was not the kind of scream that comes from fright.
She slammed the door and then turned off the heat in that part of the house. At the one-year mark, a friend told her it was time to clear out the room, but she ignored him.
Three years after Grace's death, Ms. Hood woke up and went back to the room. She emptied the bureau and closet and lined up her little shoes at the top of the stairs after she sorted her daughter's clothes and toys into plastic bins.
She doesn't know how she got from one point to the other.
All Rights Reserved © 2024
