Certain revisions and proposed revisions for the fifth and latest version of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-V, which provides diagnostic criteria for “mental illnesses,” have been met with significant controversy due to proposals that seemed to label bereavement as a mental disorder. However, no complaints seemed to be made about the fact that normal reactions to trauma are labeled as mental illnesses in the DSM-V, as they previously have been.
Discussion among the psychiatrists writing the DSM-V included the possibility of considering “complicated grief,” or grieving that lasts an extremely long length of time, among other criteria, as a mental disorder, but this convoluted idea never materialized in the latest DSM. The only significant change that occurs for bereaved individuals is that the so-called “bereavement exclusion” for the diagnosis of Major Depressive Disorder has been eliminated. This exclusion previously barred mental health professionals from diagnosing those who were experiencing what would normally be labeled as depressive symptoms immediately following the death of a loved one with a depressive disorder, expressing understanding that grief is normal, healthy, and to be expected after such a tragedy. Depending on your perspective, this can be seen as either heading in a direction in which every facet of the human experience is labeled as an illness, or a positive step for those experiencing overwhelming despair after losing a loved one, who now, at least, stand a better chance at having their counseling needs covered by insurance. My question is, why is it that responses to grief are not considered mental illnesses, yet not only has there never been an exclusionary clause for, say, someone who was raped immediately before becoming depressed, but the DSM-V includes twelve diagnoses that apply exclusively to trauma survivors and largely include little more than natural reactions to trauma? The diagnosis of Post-Traumatic Stress Disorder or PTSD literally encompasses nothing more than some of the most common reactions to trauma, not to mention that the DSM-V includes six other trauma-specific disorders categorized as “Trauma- and Stressor-Related Disorders” and five categorized as “Dissociative Disorders.”
The DSM has consistently reflected societal views and norms, and that is, truly, where the problem lies. After all, this is the publication that once considered homosexuality to be a mental illness, but revised this once society began recognizing that gay people have every right to be gay without being labeled as crazy. If your husband dies, it is accepted and expected that it will likely take you quite a while to recover and get back to your prior level of emotional stability and functioning. However, if you are sexually assaulted or otherwise abused or terrorized, society basically tells you to “just get over it”- if you cannot do that, the overwhelming sentiment is that you must just be mentally ill. Although psychiatrists are medical doctors, psychiatry can be much more accurately categorized as social science, rather than medical science. If we want to change it, we may have to change public sentiment first.
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