Monday, August 02, 2010

Shrinky Stuff on NPR's Morning Edition

In case you missed Morning Edition today, it was about how grief fits into the diagnostic criteria for major depression, and the debate that went into this for DSM-V.

Want to listen? Click HERE.

Want to read? Click HERE.


What underlies a lot of this discussion is: Is it harmful to interrupt a normal grief process by medicating?

Over the course of time, we've become looser in applying the term 'mental disorder' to the expectable aches and pains and sufferings of everyday life.


Maggie said...

While I agree that people should be able to get help in dealing with grief, I'm not so sure about the idea of that help being medication. Is there any evidence that medication even works to relieve depression-like symptoms of grief? We know that antidepressants don't do much for mild depression. Is there reason to believe that they would help with a normal sadness? Are we talking about grief, or the "Complicated Grief" diagnosis proposed for inclusion in the DSM-V? Certainly, a grieving person who doesn't have a sufficient support network needs therapy, and a grieving person predisposed to depression may need antidepressants. But if we're talking about a normal person experiencing normal grief, the whole question of whether or not it can be harmful to interrupt the normal grieving process with medication is moot without first proving that antidepressants will relieve their emotional pain. And I mean "relieve" and not "numb."
I'm the first one to admit that some diagnoses exist as a way to provide therapy for a normal experience that still needs help, and I don't have a problem with that concept. I do, however, have a problem with the concept of treating those situations as though they were the same as a mental illness with similar symptoms. If someone has a sore throat from screaming at a sports event, you wouldn't treat it with antibiotics, not because their throat isn't sore, but because antibiotics wouldn't help. It's not just about providing any care, it's about providing the right care.
I'm sorry to state the obvious, since you shrink-rappers seem to understand this, but from my experience, the psychiatric community in general does not. I must say that I have trouble in a lot of my responses to posts and questions on your blog, because you frequently address your own concern over negative perceptions of psychiatry. I feel silly making such obvious statements, but I've learned the hard way that not everybody takes the obvious for granted.

moviedoc said...

Maggie makes great points, esp. the distinction between "relieve" and "numb." If the drug relieves, the condition probably was pathological. It's not just about providing the right care, it's about doctor and patient having the right to choose what care to try without worrying about what someone else thinks.

S said...

From the transcript:

And just because pain after loss is normal, Zisook says, doesn't mean you shouldn't treat it.

"I mean, [pain] is a normal consequence of breaking a bone. But that doesn't mean that we don't treat the pain. We treat the pain vigorously," Zisook says.

This comment really stood out for me. To continue with Zisook's analogy, you also do not automatically treat the person with a broken bone as though they have a chronic pain condition. You have to treat pain appropriately. I see Maggie addressed this issue much more cogently than i could.

EastCoaster said...

It didn't seem to me that the woman who bashed her head against her child's gravestone was grieving in a healthy way.

I wouldn't say that she was depressed, but I don't know that it's "normal" grief. What happened to the concept of complicated bereavement?

Where does the work of someone like John Bonanno fit in. I sort of love him just for taking down the stages of grief and Kubler-Ross outside of dealing with death. Of course, plently of people are still taught that stuff.

Have people read his book The Other Side of Sadness?

Anonymous said...

Thanks to Pacific Psych's comments on the NPR blog, I found this link that points out that Dr. Zisook has some relevant financial relationships that readers of Shrink Rap need to know about:

Just so people know I am not picking on psychiatry, one time, I sent a scathing email to the owner of an alternative health site when I felt relevant financial disclosures had not been mentioned.

Anyway, as one who experienced the most "normal" grief situation in losing an elderly parent a few years ago, putting a two week limit on grief is absurd.

Depending on the person and the situation, it may take weeks before the numbness abates so you can even process what has happened which may resemble symptoms of depression but isn't.

Also, the process of grieving involves going through all the significant dates for the first time without your loved one.

I will stop here for now.