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maybe grief that lingers for a very long time and isn't dealt with at all, can turn into an illness or a crutch for some...some hold on to the person they miss that way but about it being an illness? not in the traditional sense, I don't think so anyway....some people who have existing mental problems may not be able to process grief or similar life stages..I think it's a grey area and every person is different in how they deal with what life throws them.
quote"The DSM is not set up to pathologize normal behavior or feelings. However, after they establish diagnostic codes, others--like the media, school personnel, child welfare agencies, parents, and even healthcare consumers themselves--take actions that RESULT in the pathologizing of normalcy. This can't be blamed on those who drafted, debated, researched, and published the diagnostic codes, but on those who USE them to pathologize normalcy to serve their own purposes."
I think people can be forgiven for being confused when they find these things in the Diagnostic and Statistical Manual of Mental Disorders.
For example, ODD is listed: "oppositional defiance disorder"- which is when your toddler doesn't obey you..... now if that's not normal for 2 year old- what is?
Why would anyone diagnose a toddler with something like that at all? Why not simply say it is normal and presume the visit is covered by insurance? No medication and no codes would be involved.
Now they want to call grief a "mental illness". (depression, doctor)
Personally, I would view the absence of grief as a mental illness.
EXACTLY!
What are you supposed to feel, thrilled?
In Judiasm they have (or used to have) a designated mourning/grieving period. I'm not Jewish, so if I have my facts wrong, feel free to correct me.
But they used to have a period of 30 days to grieve, for immediate family and close relatives. During that time, the bereaved was allowed to espress grief in just about any manner that wasn't dangerous. Nothing was expected of them, the rest of the group looked after his needs, food, etc. Contracts signed during this period were not enforceable, and any debts owed were not collectable during this grief period (they could be collected later). Most important, the bereaved was not to be alone. Someone had to be with him the entire 30 days, whether it be one or 100.
They realized that grief was a process. it was a way of bringing closure. They also realized a person in mourning wasn't quite "himself" and needed support and couldn't handle responsibilities. But, after 30 days, they were expected to come back to the "land of the living" All of this was done without pills, etc.
IMO, making grief a psychiatric diagnosis is just another way to make money!
Ok, my mistake, I now read the period of mourning is 7 days, not 30. Perhaps it was 30 days a long time ago. I don't know where I got that idea, of 30 days, sorry. My point is, Judiasm recognizes that mourning and grief are a process, it takes time, and goes in stages. It recognizes that grief happens, it takes time to recover, the assistance of others is needed, and a person will recover from grief, given time.
Last edited by MaryleeII; 05-30-2012 at 02:42 PM..
Reason: corrections
quote"The DSM is not set up to pathologize normal behavior or feelings. However, after they establish diagnostic codes, others--like the media, school personnel, child welfare agencies, parents, and even healthcare consumers themselves--take actions that RESULT in the pathologizing of normalcy. This can't be blamed on those who drafted, debated, researched, and published the diagnostic codes, but on those who USE them to pathologize normalcy to serve their own purposes."
Hey, I completely agree with you (this was to Hollytree, but I type too slowly). But in order for some parents and their kids to get some family counseling to address problematic oppositional behavior, they had to establish a diagnosis. (My opinion is that ODD is a problem with parents and not with the kid, but many would disagree).
But in my experience it would be very rare to diagnose a toddler with ODD. And the diagnostic criteria are a bit stricter than just acting oppositional or defiant or not obeying. It's an ongoing pattern of defiance, that has to be accompanied by problems with normal functioning.
Those who say diagnoses are "all about making money" have it wrong. Yes, diagnostic labels are about treatment getting paid for, but in most cases, that's about a person being able to gain access to services, and not about the professional getting rich. Very few mental health professionals would earn enough money to be considered "rich." And of those who fall into that category, I'd wager they are treating people who pay out of pocket, in which case a diagnosis is not needed for payment.
Most of us who provide services to people with Medicaid, Medicare, and SCHIP are getting very little reimbursement. But without that diagnostic code in place, we would not be eligible to get that small reimbursement, and the person would not be getting the treatment. Even very good insurance plans do not pay very generously for mental health treatment.
Physical (non psychiatric) diagnoses doen't see this kind of controversy, sicne there is usually concrete evidence of a diagnosis. To have a doagnosis of a fracture of the pelvis, you have an x-ray in front of you showing rhe fracture. To get a diagnosis of mitral valse prolapse, you have echocardiogram results showing the valve malfunctioning. For mental health diagnoses, we have to go with signs and symptoms, and because many of those signs & symptoms are subjective, we end up with "you must have 3 or more of the following."
Not arguing, just throwing this in as something to keep in mind when people distrust diagnosing as just a way of generating money. The whole point, again, is getting access to treatment for those who need it and want it, not to unfairly label people, drug people up, or pathologize the ups and downs of life. What people DO with the labels is on them.
Understand also, the medicalization of grief will allow us to be paid by our employers (sick leave) for a benefit outside of FMLA, where there is no pay. If we have an illness, we can take the time off and attend to our dis-ease. But most of the persons who will benefit from this type of leave will go out and make up for lost time instead of addressing mourning, sadness, and tears. They will not address the emotional wrap-up required OVER TIME that comes with the passing of another.
Ideas like this are great in the sense of what benefits may be garnered out of such declarations, but they will only encourage our slide into a drug-dulled anomie. Unfortunately, society will get what it asks for. Not to worry, bereavement will never be a ball-and-chain, like Bipolar Disorder or Psychosis; it won't keep you from getting a job or being dismissed from one. But it will allow us to parlay our experiences into something far less meaningful than the designers originally intended.
In this I find it kind of harks back to the Constitution, and in how that document is being misconstrued even today. Who said our jobs have to be meaningful if we can use the time we are given away from it to find other meanings? This is only America re-inventing itself and the import we place on our values.
This is just an example of news media people getting a story wrong, or manufacturing a story to get people interested in what's really a non-issue.
The current DSM (DSM-IV-TR) and the versions before it always had Bereavement as an issue that can be coded (V62.82) as an appropriate focus for clinical attention. This was not done to pathologize grief, but to allow people who CHOOSE to get counseling during their bereavement a way to have the counseling at least partially paid for. But many payers do not pay for services for V-codes, or they pay a greatly reduced rate, sicne they are "soft diagnoses" or problems that are really just in the range of normal. Some people who later end up in a severe depression triggered by complicated grief reactions could possibly have had that prevented if they had gotten some counseling back when their grief was still in the "normal" stage but only would have warranted the V-code.
The current DSM-IV-TR also includes in the definition of Major Depressive Episode, that in order to receive the more severe diagnosis, (Major Depressive Episode instead of just Bereavement), the person has to have "symptoms" of acute grief lasting longer than 2 months, OR the grief is accompanied by a marked impariment in everyday functioning, suicidal thoughts, or some other severe symptom. I put "symptoms" above in quotes, because you need to keep in mind that the whole point of the DSM is to give a medical definition to psychological and emotional problems so that treatment can be provided.
This does not mean that if your mother dies and 2 1/2 months later, you're still crying a lot, that you have a mental illness. It just means that if you now choose to go to individual or group therapy to get some help, that your payer would agree to pay for a "medically necessary" service. Insurance companies, and especially public payers like Medicare and Medicaid need a person to have a bona fide medical diagnosis in order to pay for a service; and if you're a taxpayer or a person paying for health insurance, you should be glad about that, or healthcare costs would go even more through the roof.
Any respectable treatment provider is going to follow his/her code of ethics and would not over-treat normal grief with more intensive (and expensive) services or medication. Yes, some unethical professionals will, but those are the ones who are doing unethical things already. If you find a professional providing and billing for unnecessary services, you can report them to their licensing board, and if they accept Medicare or Medicaid, report them to the OIG of the US Dept of Health & Human Services or your State's Attorney General's office or Medicaid Fraud division.
The DSM is not set up to pathologize normal behavior or feelings. However, after they establish diagnostic codes, others--like the media, school personnel, child welfare agencies, parents, and even healthcare consumers themselves--take actions that RESULT in the pathologizing of normalcy. This can't be blamed on those who drafted, debated, researched, and published the diagnostic codes, but on those who USE them to pathologize normalcy to serve their own purposes.
I'm a licensed mental health professional and even I agree that too many people are directed toward mental health services for normal bumps in the road of life, and normal unpleasantness that we all experience. But I don't think this is because of DSM diagnoses, but because people in our culture have been somehow convinced that they should never experience any unpleasantness, and if they do, it needs to be "treated." From my standpoint, I see these people getting services while people with more severe issues wait on waiting lists. This is why I've personally chosen to work with people with the most severe mental illnesses.
I see removing the "2 month rule" not as a way of calling normal grievers mentally ill, but a way of accessing needed services earlier for those who really do need them. Here's a hypothetical example:
My client has a severe mental illness, Schizoaffective Disorder, which includes a combination of all the symptoms of Schizophrenia and Biploar Disorder. We know from his history that in the past, when he has experienced losses, he deteriorated so severely that he ended up getting involuntarily committed to a hospital, having become a danger to himself or others, and these hospitalizations lasted an extended period of time, as it took him a while to come of of such a severe episode. He's in outpatient treatment at my clinic, and his Medicaid HMO covers a med visit every two months, and a counseling visit 10 times a year. This level of treatment has been enough to keep him stable, so additional services won't be approved. Let's say it's August, and he has already used up 8 of those counseling visits for the year. Today his mother dies. He is still in shock, and it doesn't seem like the loss has "registered" for him yet, but we anticipate that this loss will have results like the losses in his past. His family members, in the middle of grieving themselves, are frantic that he'll go downhill again, and they beg us for help in preventing it. I can now add a new code to his diagnosis, and get a new psych evaluation, additional med visits, plus counseling visits 2X week covered by his HMO. This additional support, before he begins the downward spiral, could help prevent the kind of deterioration he experienced in the past.
That's the kind of thing the diagnostic code changes are meant for.
TracySam,
I appreciated your post. I, too, am a licensed mental health clinician. Honestly, "V" codes frustrate me. I can't think of one that is reimbursable.
Like you, when I'm completing the Five Axis Diagnosis, I focus on the symptoms a person is experiencing. I also agree the " two month timeframe" doesn't really fit. I do understand, as you described so well above, what to watch for in a MDD. One of the reasons I don't agree with the definition and timeframe for a grief reaction is not everyone responds the same to losing someone close is we're all different and how we cope with daily setbacks depends on us; plus, depending on how we lost the one ( or more) leave us with different feelings. In some situations, such as murder or an accidental drowning etc. may well have more PTSD or Anxiety symptoms than someone who losses a 95 year old parent whose health has been failing for 3-4 years.
I agree with known clients clinicians may often predict how that person will respond and intervene in ways to increase output. therapy and hopefully avoid hospitalization. If it takes a brief hospitalization to stabilize so be it.
I guess I focus more on the symptoms for diagnosis, treatment planning and yes reimbursement.
I understand how a person who hasn't had to submit claims to an insurance company can see this discussion as being about money. In someways it is: if the client's insurance won't pay for the claims the client is responsible for 100% of the costs. Like engineers, lawyers, pharmacists and others along who attended college, grad school or more and the hours of training with clients to take the national exams stating the candidate is trained and qualified to practice. Then there are state licensure costs and malpractice insurance.
Somehow, I have to submit claims that will pay me the costs of keeping my office open and hopefully earn a living. For those who think this is just about $, I'm open to your suggestions of how else to keep my office open to your suggestions.
My emphasis has always been on how to help those who have asked me to help guide them in the recovery from losing someone they loved ( or other mental health issues) I take that trust and responsibility very seriously. That doesn't mean I agree with everything written in the DSM or every article.
Especially now that I have recently lost someone I was so close to, who made great sacrifices to benefit me and have had a set of highly unusual circumstances that allow the closest, FULL biological relative to make all decisions since the person died, I'm struggling to understand how the "2 months" timeframe for what is "normal grieving." In my specific situation, the closest "full blood relative," has refused to even allow a death notice or obituary in any newspaper or mortuary website. Does that fact and others, which I find so appalling I can't even write them, resolve in two months? No! If anything all of the highly unusual decisions could lead to a more complicated grief and other issues when social norms for grieving are being forbidden.
There are many sides to understanding grief, why diagnoses are made that pay the provider so survivors don't pay all the costs and realizing even those who treat grief and mourning in others can have complicated losses too.
Please. You don't have to be so snarky. I know that emotions first begin in the brain as a thought or feeling. What I should have said is grief is an emotional response to that painful event. I feel that labeling grief as a mental illness takes away from true mental illness, which should never be diminished in its importance. Grief is something that a person can (and often does) get over, at least to an extent that it isn't as painful as it was in the beginning. The feelings are replaced with profound memories that no longer make that person cry.
I'm only speaking of my own feelings, after the loss of my parents and someone else who was once a very important part of my life. However, as someone else mentioned, it is most likely being called a mental illness for insurance coding. Of course, one would have to actually have insurance to see a physician for it.
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