The Donkey Is Sleeping Today

Two Weeks!

In Health on August 5, 2010 at 10:45 am

I recently heard on NPR that the American Psychiatric Association released a rough draft of its new Diagnostic and Statistical Manual of Mental Disorders, or DSM. The big, exciting news in this story was that the bereavement clause in the Major Depressive Disorder diagnosis was being removed.  This is proving to be a bit controversial.  And it should be.

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.

Now, by removing the bereavement exclusion, if a person who has experienced the loss of a loved one is experiencing the symptoms of depression (difficulty sleeping, loss of appetite, loss of energy, difficulty concentrating) for more than two weeks, then the person can be treated for depression.

All I can say is “Two Weeks”??!!  Here is my personal experience with grief.  Listen and then we can discuss whether two weeks is an appropriate time length here.  I was 35 weeks pregnant and my son died in utero.  For those of you who don’t know the timing of pregnancy, a full term pregnancy is between 37-40 weeks.  So, I was almost there.  Then, to top it off, I had to deliver a baby who I knew was dead.  I’ll admit, my grief isn’t your typical kind, but there was some major grief and trauma.

I can honestly say I don’t remember anything for the 6 months following. (Yes, I had all the depressive symptoms.) Well, I do remember that we went to Las Vegas for Christmas, so that we could pretend Christmas hadn’t arrived and our son wasn’t with us.  Vegas is always great place to escape.  But I was in complete shock (some would say Elizabeth Kubler-Ross’s Stage 1 of grief: Denial).  I don’t think I cried for 12-18 months.

I remember being asked at the hospital if I wanted a prescription for Prozac.  I just stared at the doctor, not even able to get my head around what had happened.  And then she said to me, “Well, if you want to get pregnant again, you probably shouldn’t take it.”  Pregnant again?  Yes, I was then told by a recovery nurse that I should wait three months to get pregnant.  I will tell you that getting pregnant again was the last thing on my mind.

Why is everyone so quick to medicate?  Don’t people who are grieving need time to process what has happened?  Is pain present in our life for a reason?  I’m in good company on these thoughts…

But for some people, the real issue raised by the bereavement exclusion is philosophical — or maybe the better word is existential. Dr. Allen Frances, the famous psychiatrist and a former editor of the DSM, says that more and more, psychiatry is medicalizing our experiences. That is, it is turning emotions that are perfectly normal into something pathological.

“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,” Frances says. “And always, we think about a medication treatment for each and every problem.”

From Frances’ perspective, if you can’t feel intense emotional pain in the wake of the death of your child without it being categorized as a mental disorder, then when in the course of human experience are you allowed to feel intense emotional pain for more than two weeks?

The idea that life is a bowl of cherries is disillusioning.  Life is hard. Period.  However, the lessons I learned through my experience with loss and trauma have made me a more complete person.  Yes, I know I’m trying to rationalize and make sense of what happened, but hear me out.  I now understand what it feels like to be in horrible pain, which allows me to connect more with other people who are experiencing similar losses and pain.  I feel more human. I am connected to the greater consciousness of life and suffering.

Here is a quote from Holly Prigerson, who researches bereavement at Harvard University:

“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.”

So, if there is anyone out there who has experienced tremendous loss and can tell me they are not experiencing grief symptoms after two weeks, then please let us all know.  You are probably one in a million.

– Kiley Krekorian Hanish

  1. Well I think this sounds like something that would come down to wizened discretion on the part of the psychiatrist. Losing someone close to you will have different effects on different people based on things like upbringing, brain chemistry, parenting, background, heredity, and so on. Therefore, it’s up to the doctor to decide to what extreme the bereavement has affected the patient and diagnose accordingly.

  2. Tears of thanks for writing about what you felt and went through after you lost your baby boy. Grieving takes as long as it takes. The process is not a “one pill a day” kind of fix, that’s for sure.
    Like you said: “Life is hard” – but it seems less so when we have others who feel similar pain and are willing to share their emotional vulnerability. Thanks be to you for doing so today.

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