|GRIEF SHOULD NOT BE PATHOLOGISED|
The role of public defender of DSM 5 has fallen on John Oldham MD, president of the American Psychiatric Association, and a good friend of mine for 45 years. John is a smart and good person placed by the unkind fates in the unenviable position of having to defend untenable DSM 5 decisions. He makes a soldierly attempt- but his arguments ring hollow and are tone deaf to the dangers of the DSM 5 proposal and all the obvious reasons it has met such universal scorn. I wish it were someone else on the other side of this question, but there is no alternative but to show the four ways in which Dr Oldham's arguments badly miss the point.
Dr. Oldham defense can be accessed here.
1) "When we say that we are recommending removing this exclusion of grief from the diagnosis of depression, people have misinterpreted this to mean that therefore everyone who is grieving after the loss of a spouse will be diagnosed as depressed. That is not at all the case. Even if you meet the criteria for depression, it doesn't mean that you're going to have treatment slapped on you. It just means that maybe you'd have a conversation about it with your doctor and perhaps agree to a watchful waiting period and be alert to how things go and maybe check in a little more frequently. Nothing is automatic; there are lots of options."
2) Dr Oldham notes that the DSM IV bereavement exclusion is "very limited; it only applies to a death of a spouse or a loved one. Why is that different from a very strong reaction after you have had your entire home and possessions wiped out by a tsunami, or earthquake, or tornado; or what if you are in financial trouble, or laid off from work out of the blue? In any of these situations, the exclusion doesn't apply. What we know is that any major stress can activate significant depression in people who are at risk for it. It doesn't make sense to differentiate the loss of a loved one as understandable grief from equally severe stress and sadness after other kinds of loss."
3) "We want people to get treatment who need it."
4) Dr Oldham says this was not a snap decision. "There was a lot of very thoughtful discussion about it. Nobody saw it as just clear as it could be. It was not an immediately agreed upon consensus. This is something that is sensitive and needs to be thought about carefully, and we recognize that"
This is clear writing on the wall that the DSM 5 decisions on many other equally reckless proposals are also written in stone. If DSM 5 won't back down in the face of this extraordinary pressure on grief, it is probably dug in on many of its other controversial and harmful proposals. My previous lingering hope that external opposition might lead to useful compromises was naively predicated on the overly optimistic assumption that the American Psychiatric Association would follow the rational path, cut its losses, and reject the worst DSM 5 suggestions. Instead, it is APA to the barricades.
So where do we stand? Most likely scenario: The press will increasingly pick DSM 5 apart and expose all of its considerable risks. APA will keep missing the point, continue to provide lame defenses, and follow its blind momentum forward to a premature publication date. A lamentably poor quality and terribly risky DSM 5 will be published. DSM 5 will be roundly rejected outside the United States and will have greatly diminished sales (and hopefully influence) within. But the drug companies will aggressively promote its suggestions to swell further the already swollen sales of antipsychotic, stimulant, antidepressant, and anti-anxiety drugs. The epidemic of childhood obesity will get worse; the illegal market in stimulants will flourish; polypharmacy will increase; and the severely ill will continue to get short shrift- and all sorts of other harmful unintended consequences will also flourish.