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 part of human development. To bypass grief via medicine is to bypass a core part of our humanity.
Last spring, writing for The New Yorker, Louis Menand expressed farther-ranging concerns about the D.S.M. and the psychiatric enterprise in general. In his article, he mentions over a dozen books that explore the problems with a culture, and an industry, that pathologizes normal human emotion. One author Menand mentions calls depression "a sane response to a crazy world," and rejects the notion that we should "paste a big smiley face over a world that we have good reason to feel sick about."
Despite reasons to use caution before prescribing medication to address depression, particularly in the wake of normal human grief, Menand and Frances both recognize that there is a thriving market for these types of medical solutions. We live in a culture that tries to avoid grief. We've discarded many of the cultural indicators of mourning: Widows don't wear black for a year; mothers who lose their children no longer cut their hair; we've given up on sackcloth and ashes. Americans spend thousands of dollars per person per year on medical care. Many of these costs, combined with the cosmetics industry, plastic surgery, and other commercial examples of our pursuit of perpetual youth, provide some measure of our desire to avoid aging, and with it, death. As Rob Moll notes in his excellent book The Art of Dying: Living Fully into the Life to Come, Christians have participated in this denial. Mortality and grief are rarely mentioned from the pulpit. Many churches have moved their graveyards from the center of town to the suburbs so we don't have to be reminded of death as we walk into the sanctuary on Sunday mornings.
For Frances, "Our lives consist of a series of attachments and inevitable losses, and evolution has given us the emotional tools to handle both." Menand echoes this sentiment when he writes, "Maybe we think that since we appear to have been naturally selected as creatures that mourn, we shouldn't short-circuit the process." For Christians, we can rely on more than evolution when facing grief. The Bible encourages God's people to experience grief, to recognize that the fabric of community is torn apart when a person dies. Genesis 50 hints at some of the ancient cultural practices surrounding grief, as Joseph mourns the death of his father for seventy days. Psalm 88, which ends with the words "the darkness is my closest friend," may be the starkest example of the biblical writers' sanction of mourning. Scripture includes countless other instances of expressing grief, through official times of mourning, psalms of lament, ritual practices, and even physical markers such as short hair and special clothing.