'Grief is not a mental illness that should be treated with pills': Doctors hit back at creeping medicalisation of life events
Treatment of grief with antidepressants is 'dangerously simplistic', experts say
Backlash follows the American
Psychiatric Association's reclassification of grief as a mental illness

By
Lauren Paxman

Last updated at 3:54 PM on 17th February 2012

Grief is not a mental illness that should be treated with anti-depressants, experts say.

In an unsigned editorial in the influential medical journal The Lancet, experts argue that grief does not require psychiatrists
and that 'legitimising' the treatment of grief with antidepressants 'is
not only dangerously simplistic, but also flawed.'

The debate follows a decision by the American Psychiatric Association to classify grief as a mental illness in a bid to allow to doctors to be more flexible about how early patients can be treated for depression after the death of a loved one.

Bereaved not ill: A controversial decision to reclassify grief as a mental illness has been criticised by medical experts in The Lancet (file photo)

Bereaved not ill: A controversial decision to reclassify grief as a mental illness has been criticised by medical experts in The Lancet (file photo)

The lead editorial states: 'Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one.'

The Lancet's comments follow the APA's decision to add grief reactions to their list of
mental illnesses in their fifth edition of the psychiatry 'bible',
Diagnostic
and Statistical Manual of Mental Disorders, (DSM-5), which is due out in
2013.

But The Lancet, along with many psychiatrists and psychologists have called for the changes to be halted – saying they would lead to a 'tick
box’ system that did not consider the wider needs of patients but
labelled them as 'mentally ill’.

They agree that in rare cases, bereavement will develop into prolonged grief or major depression that may merit medical treatment. However, they suggested that for the majority of the bereaved, 'doctors would do better to offer time, compassion, remembrance and empathy, than pills.'

The DSM-5 proposal – which has been opposed by The Lancet's editorial writers – would eliminate the so-called 'grief exclusion.'

This 'exclusion' means that anyone who has experienced bereavement cannot be diagnosed as depressed for a certain period of time.

In a previous edition, DSM-III, that period of time was set at one year.

The DSM-IV reduced that period to two months and DSM-5 plans to reduce the period to just two weeks.

The unsigned lead editorial reads: 'Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one' (file photo)

The unsigned lead editorial reads: 'Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one' (file photo)

Although the proposed changes to the fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) would not directly
affect clinical practice here, where doctors tend to use different
international guidelines, experts say it would eventually influence
research and thinking in the field.

Defending the change in timeframe, Dr. Kenneth S. Kendler, a member of the DSM-5 Mood Disorder Working Group, said it would allow for an earlier diagnosis but would by no means force it.

Simon Wessely, of the Institute of
Psychiatry, King’s College, London, said 'We need to be very careful
before further broadening the boundaries of illness and disorder.'

'Back in 1840 the Census of the United States included just one category for mental disorder.

'By 1917 the American Psychiatric
Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347
in the last revision. Do we really need all these labels Probably not.
And there is a real danger that shyness will become social phobia,
bookish kids labelled as Asperger’s and so on.’

'Grief is not an illness; it is more
usefully thought of as part of being human and a normal response to the
death of a loved one'

Whereas people who are bereaved are
currently given help where necessary, in future they might find
themselves labelled as having a depressive disorder if their symptoms
lasted longer than a certain period of time, he added.

Peter Kinderman, Professor of Clinical Psychology and Head of Institute
of Psychology, University of Liverpool, said 'It will exacerbate the
problems that result from trying to fit a medical, diagnostic, system to
problems that just don’t fit nicely into those boxes.

'Perhaps most seriously, it will pathologise a wide range of problems
which should never be thought of as mental illnesses. Many people who
are shy, bereaved, eccentric, or have unconventional romantic lives will
suddenly find themselves labelled as 'mentally ill’.

Dr. Arthur Kleinman, a Harvard psychiatrist, social anthropologist and global health expert, says that the main problem is the lack of 'conclusive scientific evidence to show what a normal length of bereavement is.'

According to the Lancet writers, 'it is often not until 6 months, or the first anniversary of the death, that grieving can move into a less intense phase.'

They added that grieving is individual, shaped by age, gender, religious beliefs and the strength of the relationship with the lost loved one.