Shrinks Redefine Grief

Grief is the normal, natural response to the death of someone you care about.

 

Grief happens because you connect with another human being through love.

 

But if it's up to the American Psychiatric Association (APA), people who experience the fundemental yet normal process of grief could be routinely diagnosed right away as in a major depression and then prescribed anti-depressants before they have even had a chance to try and work through their feelings of loss on their own.

 

That's because the APA is changing the definition of certain behaviors such as grief, hoarding and binge eating, among others, in the handbook that contains the guidelines psychiatrists use for diagnosing people. 

 

When I was in the throes of new grief, I may have made people feel uncomfortable in my reactions to daily life and I know I felt lost, but I also know my reactions were normal.  Yes, I cried and I felt pain and sadness but anyone would have felt the same way in the same situation.  I was trying to deal with the sudden death of my husband, becoming a single parent and all the emotional baggage that comes with that kind of a traumatic event.

 

It takes time to deal with pain.  No one wants to feel pain it but it is your body's way of telling you that you have been hurt.

Normal grieving is not a mental disorder.

 

According to Wikipedia, a psychiatrist specializes in the diagnosis and treatment of mental disorders.  I did feel at times as though I was "losing it" while I was grieving but I also sensed that it was a feeling that would feel less raw as time went on.  Grieving that continues for years and progressively gets worse to the point that the person is immobilized and stuck and unable to move forward with their life is called complicated grief and it can require psychiatric help but not all the time. 

 

Psychiatrists are trained to try help us and improve our mental wellness, not take the easy way out and automatically write a prescription.  Medication prescribed to me in the beginning of my grief process might have made me feel better, but I don't it would have been helpful.  I think it would have been an artificial way of feeling better and that feeling eventually would have disappeared as soon as I stopped taking the medication.  Sooner or later, I would have had to work my way through the pain of grieving.

 

But maybe that's the APA's point: people sometimes don't want to do the hard or painful work and when that happens the APA is sending the message that it is ready with its prescription pad.

Please read the Associated Press story below and see what you think.

Shrinks, Critics Face Off Over Psychiatric Manual

by The Associated Press

May 15, 2013 2:37 PM

CHICAGO (AP) — In the new psychiatric manual of mental disorders, grief soon after a loved one's death can be considered major depression. Extreme childhood temper tantrums get a fancy name. And certain "senior moments" are called "mild neurocognitive disorder."

 

Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common human problems into mental illnesses in a trend they say will just make the "pop-a-pill" culture worse.

 

Says a former leader of the group: "Normal needs to be saved from powerful forces trying to convince us that we are all sick."

 

At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.

 

 

 

The psychiatric association formally introduces the nearly 1,000-page revised version this weekend in San Francisco. It's the manual's first major update in nearly 20 years, and a backlash has taken shape in recent weeks:

 

— Two new books by mental health experts, "Saving Normal" and "The Book of Woe," say the world's most widely used psychiatric guide has lost credibility.

— A British psychologists' group is criticizing the DSM-5, calling for a "paradigm shift" away from viewing mental problems as a disease. An organization of German therapists also attacked the new guide.

— Even the head of the U.S. National Institute of Mental Health complained that the book lacks scientific validity.

 

This week, the NIMH director, Dr. Thomas Insel, tried to patch things up as he and the psychiatrists group issued a joint statement saying they have similar goals for improving the diagnosis and treatment of mental illness.

 

The manual's release comes at a time of increased scrutiny of health care costs and concern about drug company influence over doctors. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.

 

"Way too much treatment is given to the normal 'worried well' who are harmed by it; far too little help is available for those who are really ill and desperately need it," Dr. Allen Frances writes in "Saving Normal." He is a retired Duke University professor who headed the psychiatry group's task force that worked on the previous handbook.

 

He says the new version adds new diagnoses "that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders."

 

Previous revisions were also loudly criticized, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual — including autism, attention deficit disorder and bipolar disorder — and billions of dollars spent each year on psychiatric drugs.

 

The group's 34,000 members are psychiatrists — medical doctors who specialize in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have stoked the tensions.

 

The most contentious changes include:

— Diagnosing as major depression the extreme sadness, weight loss, fatigue and trouble sleeping some people experience after a loved one's death. Major depression is typically treated with antidepressants.

— Calling frequent, extreme temper tantrums "disruptive mood dysregulation disorder," a new diagnosis. The psychiatric association says the label is meant to apply to youngsters who in the past might have been misdiagnosed as having bipolar disorder. Critics say it turns normal tantrums into mental illness.

— Diagnosing mental decline that goes a bit beyond normal aging as "mild neurocognitive disorder." Affected people may find it takes more effort to pay bills or manage their medications. Critics of the term say it will stigmatize "senior moments."

— Calling excessive thoughts or feelings about pain or other discomfort "somatic symptom disorder," something that could affect the healthy as well as cancer patients. Critics say the term turns normal reactions to a disease into mental illness.

— Adding binge eating as a new category for overeating that occurs at least once a week for at least three months. It could apply to people who sometimes gulp down a pint of ice cream when they're alone and then feel guilty about it.

— Removing Asperger's syndrome as a separate diagnosis and putting it under the umbrella term "autism spectrum disorder."

 

Dr. David Kupfer, chairman of the task force that oversaw the DSM-5, said the changes are based on solid research and will help make sure people get accurate diagnoses and treatment.

 

Dr. Jeffrey Lieberman, the psychiatry association's incoming president, said challenging the handbook's credibility "is completely unwarranted." The book establishes diagnoses "so patients can receive the best care," he said, adding that it takes into account the most up-to-date scientific knowledge.

 

But Insel, the government mental health agency chief, wrote in a recent blog posting that the guidebook is no better than a dictionary-like list of labels and definitions.

 

He told The Associated Press he favors a very different approach to diagnosis that is based more on biological information, similar to how doctors diagnose heart disease or problems with other organs.

 

Yet there's scant hard evidence pinpointing what goes wrong in the brain when someone develops mental illness. Insel's agency two years ago began a research project to create a new way to diagnose mental illness, using brain imaging, genetics and other evolving scientific evidence. That project will take years.

 

The revisions in the new guide were suggested by work groups the psychiatric association assigned to evaluate different mental illnesses and recent research advances. The association's board of trustees decided in December which recommendations to include.

 

Advocacy groups have threatened Occupy-style protests and boycotts at this week's meeting.

 

"The psychiatric industry, allied with Big Pharma, have massively misled the public," the Occupy Psychiatry group contends. Organizers include Alaska lawyer Jim Gottstein, who has long fought against overuse of psychiatric drugs.

 

The new manual "will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication," says the website for the Committee to Boycott the DSM-5, organized by New York social worker Jack Carney.

 

Committee member Courtney Fitzpatrick, whose 9-year-old son died seven years ago while hospitalized for a blood vessel disease, said she has joined support groups for grieving parents "and by no means are we mentally ill because we are sad about our kids that have died."

 

Gary Greenberg, a Connecticut psychotherapist and author of "The Book of Woe," says pharmaceutical industry influence in psychiatry has contributed to turning normal conditions into diseases so that drugs can be prescribed to treat them.

 

Many of the 31 task force members involved in developing the revised guidebook have had financial ties to makers of psychiatric drugs, including consulting fees, research grants or stock.

 

Group leaders dismiss that criticism and emphasize they agreed not to collect more than $10,000 in industry money in the calendar year preceding publication of the manual.

___

Online:
American Psychiatric Association: http://www.psych.org
Occupy Psychiatry: http://occupypsychiatry.net
Committee to Boycott the DSM-5 : http://boycott5committee.com

___
AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

The Big 300

 

 

Today marks my 300th post.

It's a personal milestone and truly a huge deal for me.  Big thanks go out to all of my family (especially my son, Ryan, who is my biggest blog cheerleader), friends and readers out there in the internet world who read Cry, Laugh, Heal.   You give me more than you know and I read and respond to all of the great feedback I receive!  And I hope to receive lots more feedback as I continue to write about the incredibly silly, sometimes sad and mostly spontaneous events that happen to me on my new journey as a widow and single mother.

I thought it would be appropriate to go back to the beginning, to the very first post I wrote launching Cry, Laugh Heal in December 2010.  This post is special to me because I had no idea what I was doing -- not that I really know now what I am doing -- but back then I really had no idea where Cry, Laugh Heal was going and what the reaction to it would be.  I just decided to jump in and try it and see what would happen.

 

When I read that first post today, I see a different person, a person still yearning to go backwards to the time when my husband was alive and well.  I still feel that way sometimes but now the feeling comes less frequently and not as strong as it did then. 

I definitely still feel passionately about changing the way people think about grief and trying to help people as they try to rebuild their lives after the loss of a loved one.  That's the reason I started Cry, Laugh, Heal: to open up the subject of grief and it's resulting resilience.  Grief is a natural reaction to a loved one's death and eventually it will happen to you whether you like it or not.  It doesn't help anyone when we make grief a taboo topic.

Everyone's grief journey is unique and certainly full of ups and downs.  I have found that for most people, the passage of time tends to lessen the waves of pain and eventually, the loss becomes less raw and more manageable.  One day, after many years, I had what is called a light bulb moment and finally realized that my husband would never want me or our son to be miserable.  I can't tell you how or why it happened, but it finally clicked in my brain that he would have wanted us to heal and find happiness.

To my great surprise, I have discovered that an inner strength does slowly build with the taking of each day as it comes to me.

I hope you enjoy reading my first post:

Clothes To You

December 23, 2010 

With the today's launch of Cry, Laugh, Heal, I’ll start by sharing an unexpected moment that helped me cope with my husband’s death.

Grieving can take you down some unpredictable paths -- sometimes revealing humor where you least expect it.

I learned the importance of having a sense of humor early in life while growing up in a large Irish Catholic family. If you couldn’t laugh at yourself, then someone else would imitate you until you did. So laughing and making jokes about life’s bumps in the road was part of my DNA, an integral part of my spirit, and it served me well until my husband died.

Suddenly, I found myself in this new role of being a middle-aged widow and single mother and I felt as though I was outside of myself performing some sort of high-wire act. On the one hand I was trying to move forward and support my young son, while on the other hand I was completely numb. As much as my family and friends supported me, I felt as if no one really got my “spin cycle” of emotions and what I was trying to handle.

I decided I needed to find others who had also lost loved ones and talk to them about how they managed to put the pieces back together and go on with their lives. I started going to group support sessions at Sibley Hospital’s bereavement group called Widowed Persons Outreach (WPO) and it was there that I found the emotional resources and freedom to talk about ALL the issues surrounding my husband’s death -- even the things that sound really irreverent and crazy to other people.

Talking about the emptiness, the surreal feelings, the memories and the loss of future memories was exhausting but therapeutic. But the best thing that came out of these emotional dialogues was that I unexpectedly rediscovered my sense of humor.

We were talking about what happens when you have buried your loved one yet their belongings – their clothes, their food, their books, most of what they owned – is still all around you. I jumped into the discussion and began talking about what happened to me one day when I was in the house all by myself. That particular day, I really felt like I was falling apart and all I wanted was some kind of contact with my husband.

I opened my cell phone, walked around the room and stared at it, thinking there actually was the possibility that something might happen -- a ring, a text, a signal of some sort from my husband. I know it sounds strange but when you are in the throes of deep grief and your loss is so raw, you are just hurting and not being logical.

I closed my eyes and imagined that he was hugging me. Then I opened the hall closet and took one of his tweed jackets off the hanger. I put it on and of course I immediately felt better. I smelled him in that precious jacket and I imagined his arms around me. I was comforted and torn up at the same time.

As I talked about this experience to my group, I said to the husky man sitting across from me, “Trying on his clothes really made me feel a lot better. Haven’t you ever done the same thing?”

Without missing a beat, he said with a completely straight face, “I gotta tell you. I have never, ever once thought about wearing my wife’s clothes.”

I totally burst out laughing. Something about the serious expression on his face, his delivery and the mental picture of this big guy in a small pastel sweater made me laugh so hard I couldn’t get my breath. And everyone else started laughing too so I knew that we had hit on something close to people’s hearts.

It was then that I knew life was going to be a little softer. Nothing was going to be great or wonderful; just slightly more bearable. For a long time, I didn’t think it was okay to laugh. I wasn’t supposed to be enjoying myself and besides, nothing was funny to me anyway.

There is a very thin line between crying and laughing. Many times you find yourself doing one of them and all of a sudden you are doing the other. But a good cry or a good laugh can make you feel as if a huge weight has been lifted and that’s what this blog is here to do.