For the Grieving, a New Definition?


Grief — the sadness felt after losing a loved one  — is  being considered for part of the diagnosis of depression under a set of proposed, new guidelines for doctors.

The proposed classification could allow millions more people to be diagnosed for depression. It is controversial, say public health experts, because that could drive up costs and affect how people are treated by private and public health plans.

If the definition of depression is broadened, said John Palmer, who was a public trustee for the public programs Medicare and Social Security, the public health programs “will have to find a way to cover them.”

The controversy surrounds the 2013 release of the fifth edition of a book called the Diagnostic and Statistical Manual of Mental Disorders, or DSM-V.  It outlines every accepted mental disorder, including depression.  The manual includes detailed descriptions of symptoms so doctors and nurses identify the patient’s problem.s

But some mental health experts say the manual’s proposed expansion on depression goes too far.  Now, someone experiencing mild depressive symptoms for up to two weeks after the death of a family member or friend is excluded from the diagnosis of depression.  Mild symptoms include sadness, appetite loss, sleeplessness, or lack of concentration.

The proposal for the new manual is to eliminate that exclusion.

The implications for public and private health insurance plans are broad, said SU’s Palmer, who has experience with crafting health care policy.  Insurance plans and policy makers may have to adjust coverage to cater to the larger demand, said Palmer.

“You’re more likely to see a shrinkage in coverage,” said Palmer, “Some plans may limit the number of therapy sessions a person could have in one year, for example.”

Meanwhile, the debate over the proposal to expand depression’s diagnosis continues to heat up.

Dr. Allen Frances chaired the task force for the edition used now. He called the plan “reckless” and said it could end up classifying normal behavior as a disorder.  “The boundary between normality and mental disorder is inherently fuzzy,” said Frances, “A very small change could affect millions of people”

Frances credits his colleagues with a genuine desire to make more help available to the grieving. But, he suggests, that the greatest beneficiaries of the new definition will be drug companies.  They do not influence the process, he said but, he added, “Drug companies are on the sidelines, salivating, waiting for these drug guidelines to be made official.”

In addition, doubters say the current definition gives doctors enough leeway to help the bereaved with severe symptoms of depression. For example, patients could be immediately treated if they experienced symptoms such as suicidal thoughts, any thoughts of hurting themselves, or an extreme slowness in thought that becomes physical.

The new edition’s task force disputes worries that it is turning grief into a mental illness.

The task force’s spokesperson says it is trying to eliminate an arbitrary restriction that has kept doctors from providing complete care.

Supporters of the new definition say it is the right thing to do.  Dr. Sidney Zisook, a research psychiatrist and advisor to the task force, says doctors don’t have to wait two weeks to treat patients’ who have lost their jobs or spouses in divorce.

“Why should bereavement be any different?” asks Zisook.

He says the change is not meant to make grief less normal or turn it into an illness.  He argues the new definition will allow doctors to help distressed people.

The debate is just the beginning of an approval process that has already produced more than 8,000 responses about all of the manual’s proposed changes.  The American Psychiatric Association, which manages the task force, is now sorting everything out. The history of the debate can be found at the task force’s website.

“Some of these proposals may not even make the final cut,” said Dr. Roger Peele, a member of the task force. “There’s a long way to go.”

(Matt Porter is a graduate student in broadcast and digital journalism.)


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