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After my mother-in-law died, I remember thinking that I finally understood the word depressed. It felt as though I had been pushed underneath a heavy boulder, one that wasn't crushing me but instead confining me and keeping out the light. Although I cried on occasion, I didn't feel unbearably sad. Rather, I felt emotionally anesthetized, as though joy and sorrow had been pressed out of my life. It didn't last forever, and as I look back, I can even say that I'm grateful for the experience. My former grief seems like an appropriate response to the reality that my husband's mother, my friend, died prematurely.

So when I read the New York Times op-ed by psychiatrist and professor emeritus Allen Frances about a recent proposed change to the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), I shared his concerns. Frances—chairman of the task force that created the previous version of the D.S.M.—is no skeptic when it comes to using therapy and medication to treat mental disorders. But he describes this scenario: "Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, can't sleep well and don't feel like going to work. In the proposal for the D.S.M. 5, your condition would be diagnosed as a major depressive disorder."

This, he warns, "would be a wholesale medicalization of normal emotion, and it would result in the overdiagnosis and overtreatment of people who would do just fine if left alone to grieve with family and friends, as people always have." Although the rationale behind the proposed change—helping people before they form self-destructive patterns—is good, Frances argues that grief is a necessary ...

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Boundaries in Grief
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August 2010

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