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I saw an article alleging that the APA is looking at reclassifying "grief reactions" as a mental illness in the DSM-V.
Quote:
Grief following the death of a loved one isn't a mental illness that requires psychiatrists and antidepressants, according to editors of The Lancet, who oppose "medicalizing" an often-healing response to overwhelming loss.
Routinely legitimizing the treatment of grief with antidepressants "is not only dangerously simplistic, but also flawed," says the unsigned lead editorial appearing in Friday's edition of the influential international medical journal. "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."
In rare cases, a bereaved person will develop prolonged grief or major depression that may merit medical treatment "or sometimes more effective psychological interventions such as guided mourning may be needed," they wrote. However, they suggested that for the majority of the bereaved, "doctors would do better to offer time, compassion, remembrance and empathy, than pills."
The editorial opposes the American Psychiatric Association's controversial proposal to re-categorize grief reactions as a mental illness in the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), due out in 2013. That book, often referred to as the Bible of psychiatry, defines mental health disorders and assigns them diagnostic codes which, among other things, drive health insurance reimbursements for treatment. Among other pending changes in the DSM-5 are the addition of premenstrual dysphoric disorder, and a revised definition of autism that some critics and parents fear could limit the number of youngsters receiving medical, social and school-based services for autism spectrum disorders.
We have become isolated as persons and families. Death used to be a part of life, and our 'funeral homes' used to be our converted living rooms. Persons who died were laid out in the house and the community would appropriately grieve the loss of a loved one. There would be support for days and weeks after, and a bereaved family was looked upon.
We now have hospitals, urgent care facilities, nursing homes and ways of isolating as well as sanitizing ourselves from becoming decrepit with illness and death. We've also become a society of quick technologies with 'do-overs' left, right and center. There is similarly a great influence from the popular media of what our bereavement reactions should be; entertainment TV and even much of educational TV is an oxymoron. The US has little understanding of recognizing death. We have ritualized life into our ceremonies because the topic of death is repugnant.
The 'medicalization' of grief and bereavement may very well be what is reflected in society, as a way of further sanitizing the experience. We take pills for many other ills, using it as chemical discipline when we don't otherwise use our full repertoires in addressing needs. Conversely, if one medical provider cannot take away my sadness and another says I have to 'bear' it for another few months, I can always shop for another opinion, with another 'expert' who can take it away in pill form within weeks.
The less we tune in to others as a society, the greater likelihood we will end up banishing something like the holistic experience of death. A true appreciation of the same allows a greater experience of every other minute. Death is a real disruption: it affects marriages, graduations, vacations, picnics, and all sorts of other fun things. And it can't be scheduled you know. Of course, if every other minute must be as finely tuned as a movie set, well, give me a pill to get over it.
IMO, its all about insurance, thats what diagnostic codings for.
Virgode has nailed it; unless something has a diagnostic code, insurance will not pay for treatment/medication, etc.
I have read about the proposed changes in the definition of autism before; many people fear this will be like ADD, where everyone jumps on the bandwagon of diagnosis and those with "true" autism will receive less treatment and care. But, again, if a physician cannot codify their diagnosis, the patient's insurance will not pay for treatment.
People who go thru the stages of grief, or who have a hard time passing through one or two of them, cannot simply be diagnosed with "depression", and may not get or be permitted access to the proper treatment/meds if the doctors cannot quantify their diagnosis.
I remember when a doctor was paid because s/he and his (or her) diagnosis was considered sacrosanct; there were no bureaucrats deciding if the doc got paid based on an arbitrary set of rules and whether or not s/he followed pre-ordained procedures. Of course, medical care was much simpler and cheaper then.
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.
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