The thin (disappearing?) line

I'm sure you're all anxiously awaiting the new edition of the Diagnostic and Statistical Manual of Mental Disorders V (also known as DSM V, replacing DSM IV). You should be. In now-outdated edition IV there apparently was a footnote of sorts that made grief an exclusion to depression. In the draft edition of V however, the footnote is removed, and grief is essentially enveloped into the definition of depression. Which means, you, me, anyone who experiences a loss that s/he mourns (well, mourns deeply for more than say two weeks), will be thusly classified as suffering from depression. (To reiterate, right now V is in draft stage. The following discussion is on a possible -- but significant -- change in psychiatric diagnosis.)

If you've ever been hit up in a doctor's office by the quicky depression Q&A, you know it asks such things as, Do you have trouble sleeping? Do you have trouble focussing and making decisions? Has your appetite changed recently? And if you check yes to a certain number of these, you go on the doc's radar as being depressed. But if you're grieving the death of your child(ren), many of us probably answer yes to these questions, too. Have you lost joy? Does it take a great effort to do small things? Do you ever think about killing yourself?

So how to tell the difference between grief and depression? Is there a difference or is this a matter of semantics? Does it help or hurt our case when we say things like, "You never really get over it, you get through it and learn to live with it"?

There's an NPR news article on this shift in classification here.  According to this article, there is in fact a difference between bereavement and depression, but according to the doctor quoted therein it seems to be one of time: weeks. Not months, but weeks. If you're not rethinking some of those questions above in the space of 14-21 days, you will now be hit with a diagnosis of depression.


Allen Frances has emerged as one of the lead critics against this particular change. Frances was the chairman of the group who devised DSM IV, and wrote an op-ed in the New York Times highlighting his concerns. (Op-ed can be found here; sign in may be required.) Among Frances' problems with the proposed change from IV to V are that healthy people who happen to be hit upside the head with a loss will now be labeled as depressed. Which is a problem if you're applying for health care or a job. Frances also worries that drugs will now be willy-nilly doled out to people in mourning, who either won't need them, or will unnecessarily remain on them. Frances writes,

Turning bereavement into major depression would substitute a shallow, Johnny-come-lately medical ritual for the sacred mourning rites that have survived for millenniums. To slap on a diagnosis and prescribe a pill would be to reduce the dignity of the life lost and the broken heart left behind. Psychiatry should instead tread lightly and only when it is on solid footing.


I used anti-depressants, but they were not foisted on me by a doctor in the hospital. They also came later than two-three weeks. On the contrary, I went about a month or six weeks until it hit me one day that I was no longer functioning in a capacity that I needed to for the safety and well-being of my two-and-a-half year old. (I wrote about my decision to use anti-depressants here on Glow; the post can be found here.) I was also in the care of a psychoanalyst, and the decision to go on medication was entirely mine -- as was the decision to go off them in six months. They did not take away my pain or mitigate my grief. They did not put me in a fog, or even make me feel better. They helped me function. I still felt the awful full force, but could now drive and lift myself out of bed and otherwise make sure my toddler didn't play with knives while I hid under the covers.

Perhaps I'm different in that I actually sought help, and I'm wondering if there are babyloss parents out there who should but are caught in that whole "Can't make decisions" and "Small things are difficult" mode and don't pick up the phone to make that appointment. Or maybe I'm the rarity of which Frances speaks who actually needed treatment.

I'm a bit confused about the change from IV to V because it seems that there are already clear markers in place in order to make this distinction, markers that medical professionals are quite comfortable with. When I interviewed a grief counsellor for this site (interview found here) I asked her point blank what the difference was between grief and depression, and she gave a long and nuanced answer involving "normal" and "complicated" mourning, and the ability to "bracket" one's feelings later in the process and keep them somewhat separate from other parts of their lives. She also pointed out that it takes much longer than a few weeks to process loss and go through some of the more severe feelings. It seems to me this makes an enormous amount of sense. Are the people writing version V worried that psychoanalysts won't be able to do their jobs properly and discern these gradations? (Hey wait, aren't psychoanalysts doing the re-writing? Are they saying this is too difficult a job, or they can't be bothered, or what?)

Although I agreed almost entirely with Frances' arguments, I bristled a bit at " the sacred mourning rites that have survived for millenniums." Because I think babyloss is it's own little dark corner of bereavement, and I think we show here and on our blogs on a weekly basis that contemporary society has a ways to go before it wholesale accepts our particular grief as a healthy if not painful and uncomfortable process that people experience. Babyloss parents frequently speak of having no one to turn to or talk to, and in fact, document people turning and running in the other direction when given their news. God bless the internet, because places like this -- here, online -- have become a life-line for many who need to grieve and make sure they're in some bounds of normalcy. As we all showed a month or so ago when I asked for input on funeral services, there aren't as much "rites" as there is "getting through the moment to the best of our abilities." So where does this put us on the analytic scale? Are we difficult to place? So difficult that we might as well just lump us in the larger definition of depressed? I'm not saying because we as a group lack a cohesive and common social experience ergo we need Zoloft; perhaps this is a clarion call to examine babyloss more closely and for society to agree to abide and sympathize with us and give us the support that we so desperately need.


I want to open this to discussion to the people whom it actually affects. You. And find out what you think.


I don't mind anyone here getting defensive about being labeled depressed right out of the gate. Hell, I'm a bit pissed about it all, too. But I think we need to be a bit careful that our arguments against Draft DSM V's line of thinking don't play into any preconceived negative notions of depression, therapy, and anti-depressants. Society may not know how to deal with babyloss parents, but let's face it -- we're also battling a stigma of depression that paints its sufferers as weak. Weak and perhaps suicidal, delusional, or even alcoholic depending on what Lifetime movie you've seen recently. And there are people here, who read here, who have sought out therapy and used anti-depressants to their advantage, who have crossed that line between mourning and depression. Let's not take them down, too.

And what I'd really regret is slamming the new proposed change and taking down anti-depressants with it and then leaving a newly bereaved parent saying, "Well hell, I'm just grieving goddammit." And not wanting to eat his or her words two months later when they get knocked to the ground and are scraping the barrel because sometimes it's hard to make a decision, and sometimes its really hard to make a decision where you have to admit you were wrong about something, publicly. It shouldn't be that tough to ask for help, and to get it.

If I've learned nothing else writing and reading around here over the past few years, it's that everyone grieves differently. So I ask that in the comments, we're mindful of this.

So let's hear it. How do you feel about the proposed change that will essentially make grief a mental disorder? Semantics? Do you see a problem that could impact your life directly? Do you feel funny being labeled as such, or relieved that someone is even paying attention? Do you think you ever crossed that line between grief and depression, or think that you could? If you could address the people drafting DSM V, what would you tell them that you think might be helpful in making their decision? I realize many of you have already addressed this issue on your blogs -- please post a link to any posts in the comments.