In a tremendous win for Big PhARMA, the American Psychiatric Association has added “Prolonged Grief Disorder” to its Diagnostic and Statistical Manual of Mental Disorder —a list of conditions for which insurance companies reimburse doctors. To break the news March 19, the NY Times made room on a front-page entirely devoted to the war in Ukraine.
“The decision marks an end to a long debate within the field of mental health, steering researchers and clinicians to view intense grief as a target for medical treatment, at a moment when many Americans are overwhelmed by loss,” wrote Ellen Barry. “Since the 1990s, a number of researchers have argued that intense forms of grief should be classified as a mental illness, saying that society tends to accept the suffering of bereaved people as natural and that it fails to steer them toward treatment that could help. A diagnosis, they hope, will allow clinicians to aid a part of the population that has, throughout history, withdrawn into isolation after terrible losses...”
Dr. Paul S. Applebaum, chair of the steering committee overseeing revisions to the DSM, offered the Times this example of people who need treatment for Prolonged Grief Disorder: “The parents who never got over it, and that was how we talked about them. Colloquially, we would say they never got over the loss of that child.”
Barry also quotes a shrink named Kenneth Kendler saying that the inclusion of Prolonged Grief Disorder in the DSM, “is kind of like the bar mitzvah of diagnoses. It’s sort of an official blessing in the world.” Kendler is a professor of psychiatry at Virginia Commonwealth University who, according to Barry, “has played an important role in the last three editions of the diagnostic manual.”
I flashed on Richard Nixon’s brilliant comment to HR Haldemann, “What the Christ is the matter with the Jews, Bob, what is the matter with them? I suppose it’s because most of them are psychiatrists, you know, there’s so many, all the greatest psychiatrists are Jewish.”
Barry’s story drew a barrage of eloquent letters from Times readers. Some excerpts follow:
• “It is more than six years since my wife died… With the passage of time, I was able to regain my normal functioning. I was able to work, to socialize with others and to laugh. But beneath the surface I retain feelings of loneliness, sadness and a certain emptiness. I return to an empty house, sleep alone in an empty bed and prepare meals to dine alone at an empty table. These are existential facts, and that I should feel the pain of her absence is not a mental disorder but a reality that will remain with me for the rest of my life. The cliché that everyone grieves in his or her way is assuredly true. That the psychiatric establishment has now pathologized prolonged grief is not only stigmatizing, but also imperious. When they develop a pill that will bring my wife back, I will reconsider my position.” —Joseph Chuman, Hackensack, N.J.
• “Unfortunately, each new DSM diagnosis opens up the floodgates for a new group of suffering people to treatment with psychiatric medications. As an internist/psychiatrist with 30 years of experience treating end-of-life patients and their families, I have witnessed psychiatry reduced to viewing all human suffering as a set of pathologic disorders or diagnoses that must be treated with drugs, fallaciously touted as curing everything. Make no mistake, ‘Medical treatment’ means only one thing — drug treatment... Bereaved beware.” —Charles E. Schwartz, New York
• “Thanks to Ellen Barry, whose fine piece on this latest addition to the American Psychiatric Association manual’s list of ‘disorders’ makes explicit its beneficiaries: psychiatrists and pill makers. I have had grief (longer than a year), have interviewed scores of people in grief, and have written about grief, and what strikes me as abnormal is not grief prolonged beyond the A.P.A.’s one-year prescription, but the degree of chutzpah required, professional training notwithstanding, to presume to set timelines for the normal grief of others, which in fact is as various as the grievers themselves.” —Martha Weinman Lear, New York