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4 Nov 2012

Please Read: Revolution on Standby: Bereavement and the DSM-5

::::::::::Becoming::::::::::: Revolution on Standby: Bereavement and the DSM-5

Dr. Joanne Cacciatore is a brave, strong woman, a bereaved mother. She is the founder of MISS Foundation that helped me so much in the first year and still does.

Please read her blog post, think about it. If you can, spread the word; if not, just make sure you keep it in mind when you come across people who think grief has a time limit. Please have the strength to tell them it doesn't.

Thank you.


  1. It is pathologizing. There is no doubt about it.

    Do you think there is a chance that with diagnosis it will be easier for grieving individuals to get more access to valuable and affordable resources? Foe example a soldier diagnosed with PTSD (post traumatic stress disorder) has access to free mental health service sand a good reason not to go back to the war zone compared to a soldier who does not have the diagnosis. This is true even though PTSD is a NORMAL response to ABNORMAL event. And if you want access to free treatment you need the diagnosis. Same with Postpartum Depression, OCD, General Anxiety Disorder. Even things like getting more than 3 days of work for grieving might be easier if you do have the diagnosis. It's not fair. It truly isn't. But this is how our society is. And although it is pathologizing and unfair it may make things easier in the bureaucratic world that we live in.

  2. I see your point. But why not diagnose grief as Grief and add it to the list of diagnoses you mentioned that can qualify people for time off and treatment.

    The problem with calling Grief something else, like Depression, PTSD, etc, is that we begin treating it incorrectly and make matters worse for people who are already very vulnerable. This is not helping, but hurting the bereaved. Treating Grief as Depression or PTSD is akin to treating Lung Cancer as Lung Infection. It is wrong and will do more damage than good. There is a reason they make a distinction between PTSD, Depression, OCD. Why not call it all Mental Disorder and treat it as such? It won't work, that's why.

    When Amelia was stillborn, I really needed help. I was sent to a Reproductive Mental Health department that kept trying to fit me under the Postpartum Depression diagnosis. But I was not depressed, so they kept telling me I was ok and sending me away. I was not ok, I had acute grief and needed help. About six months later someone finally took the time to listen and told me I had PTSD. But they had no resources to help me, I had to find my own help. By that time I did not trust anyone in the mental health profession and found help from the MISS Foundation, a non-profit organisation that is mostly run by the bereaved parents, not the people who call grief depression so that they can help me.

    I fell through the cracks of the system that is supposed to be there for me because there is no mentioning of Grief in it. If there was, they could have diagnosed me with Grief and been able to help.

  3. You are absolutely right! To paraphrase Voltaire, normal grief is not 'Major', is not 'Depressive,' and is not 'Disorder.' Grief is the normal and necessary human reaction to love and loss, not some phony disease.

    Two people diagnosed with depression/grief/PTSD, whatever it may be, should not be treated in the same way. Because they are two different people. Mental health professionals should understand that. Even the same type of cancer is treated differently in two individuals. It's never a one size fits all approach. Especially when you are talking about therapy. Supporting people in pain is not a science, it's art. And DSM is all about science. It is designed and discussed by a group that is 95% men and 100% medical professionals whose views are very different from many humanistic and holistic therapists & counsellors. I am very saddened to see that you had such a traumatic experience with the system on top of the trauma you already lived through.

    In my experience diagnosis is sometimes helpful in getting access to resources. But then it takes so much time and effort to help the person shake off the label that they received in order to get that treatment. The label can help you get resources but it can also hurt you even deeper before it points you in the right direction.

    It will be a great news if this DSM does not actually include these ridiculous changes. As you can see I am trying really hard to see at least something positive in it. And failing miserably. Sometimes what they call in DSM a "research based treatment" is more of an "insurance-covered-treatment" forcing therapists to work with one “scientific” approach that research shows works for (lets say) 75% of people. What about other 25?

    You are a brave soul! And I am drawn to reading your posts even though they sometimes evoke a lot of negative reactions. Sometimes I don’t agree with your feelings. HOW STUPID OF ME? – not to agree with someone’s feelings? That’s must be the stupidest thing to say EVER! They are your feelings, your experiences.
    Thank you for sharing them. It’s honest and raw. And because it is so raw it is sometimes hard to digest. It’s your truth and you seem to be not afraid of speaking it and you are even letting some anonymous strangers post comments. You are an inspiring mother.

  4. Fantastic post, great discussion, and so important. It is one of the arguments proponents use to promote the change in the DSM - that it will help people get resources. But it doesn't make any sense if you are not treating the right thing. First, do no harm, isn't that it?

    I agree that sometimes I read some of what you write and have a lot of negative reactions. But I realize that my reaction is actually about the fact that Amelia died. I wish you weren't writing these things because I wish she hadn't died. When my son was stillborn, I rejected a lot of my own feelings, and still do sometimes. But what I am really rejecting is his death. I wish it hadn't happened to either of us. Sending love out to you, Amelia's mom. Thanks for writing about this important subject. Working on my own blog post about it! xo

  5. @ Amelia's mom: Thank you for sharing this blog post and for your blog. Your honesty has provided readers with insight into the experiences of a bereaved parent. People/society have difficulty with topic of death, especially the death of a child. So, more often than not, there is discomfort and silence.

    @ Anonymous: Am not entirely sure about the *science* behind the DSM. Dr. McHugh (Psychiatrist) speaks to this as outlined in these two articles:
    1. New England Journal of Medicine (up there in so far as medical clout):
    2. Johns Hopkins Medicine:

    Here's a quote from the New England Journal of Medicine article:
    'For example, psychiatrists using the DSM diagnosis “major depression” tend to mingle bereaved patients with both those afflicted by classic melancholia and those demoralized by circumstances. The mixing of similar-appearing patients who have conditions that are distinct in nature probably explains why use of this diagnostic category expanded over time and suggests why the effectiveness of antidepressant medications given to people with a diagnosis of major depression has, of late, been questioned.2 This tendency to blur natural distinctions may explain why other DSM diagnoses — such as post-traumatic stress disorder (PTSD) and attention deficit disorder — have been overused, if not abused.

    @Toren's mom: Thank you for pointing out the obvious negative consequences of diagnosing grief as depression after two weeks of the loss: inadequate/inappropriate/harmful treatment (as Dr. McHugh alludes to in the New England Journal of Medicine).