The Politics of DS

Of all the misconceived DSM 5 suggestions, the one touching the rawest public nerve is the proposed medicalization of normal grief into a mental disorder. Fierce opposition has provoked two editorials in Lancet, a front page New York Times story, and incredulous articles in more than 100 journals around the world.

And now, during just the past four days, there has been the kind of online miracle that is possible only on the internet. Joanne Cacciatore wrote a moving blog that rapidly made its viral way across the world and into the hearts of the bereaved. An astounding 65,000 people have already viewed her piece and then passed it on to friends and families. You can join them at: http://drjoanne.blogspot.com

Dr Cacciatore is a researcher at Arizona State University and the founder of the MISS Foundation- a nonprofit organization providing services to grieving families whose children have died or are dying. The MISS Foundation has 77 chapters around the world and website that gets more than one million hits per month.

Dr Cacciatore writes:

“Across all cultures, the death of children is a particularly traumatic blow. Most people quaver at the thought of losing a child- for millions around the world this feared tragedy is reality.”

” I have long opposed the DSM 5 suggestion to remove the bereavement exclusion, but chose to remain silent because I simply could not believe it had any chance of making it into the final version of the manual. It made no sense that DSM 5 would allow providers to diagnose a serious mental disease- Major Depressive Disorder- when people are having nothing more than the perfectly normal symptoms of grief.”

“I decided to speak now because it appears almost certain that DSM 5 will actually go forward with this poorly conceived proposal to pathologize the authentic human experience of sorrow. After just two weeks, a grieving person may be categorized as ‘mentally ill’ at the casual discretion of a psychiatrist, social worker, or psychologist. The arbitrary, rapid-fire absurdity of this ’14-days post-loss-becomes-depression’ travesty has ignited a fire against the DSM machine in the pit of my being,”

“We cannot expect that a family should be functioning as if nothing has happened two weeks after the death of a child. I wonder how many people on that DSM 5 committee have buried or cremated their own child? Shouldn’t the relevant community- those affected by these insulting changes- have some input?”

“I cannot stand silently by and allow this diagnostic charade to find a place in DSM 5. To do so would be unethical and would violate what I know to be real and true and human. Big love means big suffering. And few, if any, relationships are as meaningful and filled with love as that between a parent and child. It badly misses the point and minimizes the experience to treat the death of a child as if the prescription of a pill can cure the normal heartache. As Lancet pointed out, the doctor having a compassionate and open heart is much more helpful than jumping to a premature diagnosis,”

The 65,000 person (and counting) endorsement of Dr Cacciatore’s cri-du-coeur is simply staggering and sends the clearest possible message to the American Psychiatric Association. Previously, DSM 5 has brushed off the many thoughtful and spirited criticisms mounted by experts in the field disputing its interpretation of the scientific literature as it relates to the diagnostic issues involved in grief. DSM 5 has equally shrugged off the criticisms coming from the broader field of medicine- as expressed in the Lancet. And DSM 5 has responded testily and ineffectually to the unanimous ridicule it has received in the world press.

Long ago, the APA should have realized that this suggestion needs a quick and decisive rejection- instead it turned a blind eye to all previous warnings. Now APA faces a far more serious and undeniable opposition- a spontaneous revolt by the large community of the bereaved. They soundly reject the DSM 5 proposal and refuse to allow themselves to be misdiagnosed by it. It has now come down to DSM 5 against the world. How long can APA depart from common sense and continue in the folly of medicalizing normal grief? I hope that APA will finally hear Dr Cacciatore’s plea and act swiftly on it.

Allen Frances, MD is Professor Emeritus at Duke University and former Chair of its Department of Psychiatry. He was Chair of the DSM IV Task Force.