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In my very first blog I brought up the problem we are facing in our society when we talk of grief as a condition or an illness often describing a mourner’s reactions as symptoms. As I understand a blog, it is a place where I can express my opinion and that is what I am doing. I hope my thoughts also stimulate readers to respond. The question was opened up for me quite vividly (and to my surprise) in a column written by Alex Beam in the Boston Globe on Friday July 17 in which he asked, “Who’s Crazy Now?” He was writing about the new Diagnostic and Statistical Manual of Mental Disorders, known as DSM-5, which is due to be published in 2012. He was alerted to the issues in reading a blog from a professor at Tufts Medical School; all of this pointing to a way readers widely interested in issues of our times are alerted to personally relevant issues with a speed that, for me, is often difficult to take in.
My concern is with how DSM-5 will list grief and bereavement. There has been a good deal of discussion that it should be included and I do not know what the outcome of this discussion has been. Beam quotes Dr. Allen Frances the editor of DSM-4 who called DSM-5 “a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medical treatment -- a bonanza for the pharmaceutical industry but at a huge cost to the new false positive ‘patients’ caught in the excessively wide DSM-V net.” One colleague was elated because if it is included, this approach will allow him to bill patients for “grief counseling.”
My concern, which has grown from what I have learned studying and working with the bereaved, is reflected by the concerns of Dr. Frances and Mr. Beam. I wish the article had been more prominently placed in the paper, although putting it on the last page in the entertainment section behind the comics may have resulted in more readers for it. I am reminded of a new widow I spoke with many years ago, who had to fight with her family and her physician to not take a tranquilizer they believed would help her through her husband’s funeral. She was determined that she would be alert and present at the funeral. She saw the tranquilizer as an intervention that would leave her numb and in a fog. She was very clear that if she cried, then she would cry, and they would have to live with it. I asked who should have been prescribed medication? Perhaps her family would have been better served than she? But she was not medicated, and they did learn to live with her grief and their own grief as well.
Peter Conrad, a sociologist at Brandeis U. titled his book on the subject The Medicalization of Society: On the transformation of human conditions into treatable disorders. Other colleagues of mine who are concerned with these issues are also raising questions related to how we talk about grief. A recent issue of the journal Death Studies (2008) vol 32:1, was devoted to the concept of recovery, asking whether recovery is a realistic way to describe the way grief ends. Recovery for me means an illness one gets over with the proper treatment. I am not sure ‘recovery’ is the best language to use in talking about what a mourner lives through.
I found two quotes I have used in the new edition of Widow to Widow (2004) about the consequences of medicalizing grief, for the larger world we live in.
“Through the propogation of belief in authoritative expertise, professionals cut through the social fabric of community and sow clienthood where citizenship once grew.” John McKnight, John Deer and the Bereavement Counsellor, N.Y.:Basic Books (1995).
“A pathology arises when outsiders may no longer evaluate the work by rules of logic and the knowledge available to all educated men, and when the only legitimate spokesman on an issue relevant to all men must be someone who is officially certified.” Eliot Friedson, "Dominant professions, bureaucracy and client services," W.Rosengren and M. Lefton (eds) Organizations and Clients. Columbus Ohio: Merrill. (1970)
Madelyn Kelly and I wrote A Parent’s Guide to Raising Grieving Children about a subject we would rather not face but that will touch our lives at one point or another, and my hope is that the book will help all of us become experts and thereby enrich the communities we live in.
