Ellen Barry set off a firestorm of commentary in her New York Times article titled, “How long should it take to grieve? Psychiatry has come up with an answer.” That “answer” is for the American Psychiatry Association (APA) to include a new mental illness in their Diagnostic and Statistical Manual of Mental Disorders (DSM), often referred to as the “Bible” of Psychiatry: “Prolonged Grief Disorder” (PGD).
While those advocating for the inclusion of this “condition” claim they can predict it in bereaved people six months after a death, the APA apparently “begged and pleaded” to move the time frame to one year. Why? “To avoid a public backlash,” according to Holly Prigerson, a professor of sociology in medicine at Weill Cornell Medical College, and one of the most vocal proponents of the movement to pathologize grief.
That backlash has not been avoided.
Researchers claim that a small percentage of people grieving the death of a loved one continue to experience intense grief that is pathological, and that they would benefit from medical treatment. Medical treatment, it turns out, is a pill.
Barry notes that this new diagnosis will “most likely open a stream of funding for research into treatments…and set off a competition for approval of medicines by the Food and Drug Administration.” Most likely? It’s already happening, and not to “treat” normal, natural, and common responses to the death of someone, like depression or anxiety. Prigerson and colleagues already have other plans, with clinical trials in the works. A 13-question screening tool (PG-13) for PGD purports to diagnose the condition, including whether you’ve had trouble accepting the loss, and how often over the past month you’ve felt yourself yearning for the person you lost. (Note to Prigerson et al: We did not “lose” our person. They died.)
Their study hypothesis is that PGD is a disorder of addiction and state that “the primary gateway symptom for diagnosis is yearning: persistent longing, pining for, or preoccupation with the deceased.” Their description continues, “In this way, patients with PGD continue to ‘crave’ their loved ones after they have died, due to the positive reinforcement provided by their memories of the loved one.”
Due to the positive reinforcement provided by their memories of the loved one.
In order to, presumably, break the addiction caused by these memories of the loved one, they’re testing a drug used to treat addiction, naltrexone.
Like the idyllic drug commercials we see on American television, warnings about the side effects of naltrexone are briefly mentioned in the study in which Prigerson and colleagues are engaged, including nausea, vomiting, abdominal pain, headache, and fatigue. While they do note that naltrexone has a Black Box Warning, that don’t mention that a Black Box Warning is the strictest labeling requirement the Food and Drug Administration can give, to alert consumers that the drug may have serious or life-threatening side effects, in this case hepatotoxicity, a fancy name for impairment or injury to the liver.
As a side note, The U.S. and New Zealand are the only countries in the world allowing direct-to-consumer advertising for the pharmaceutical industry, for which they shelled out over $6.5 billion in 2019, and an additional $20 billion for advertising to physicians. Also of note is that Cosgrove et al. (2014) report that 69% of the DSM-5 task force members reported financial ties to the drug industry, a 21% increase over the prior edition, DSM-IV. You bet this new diagnosis will set off a competition for approval of medicines by the FDA. And you can likely visualize the commercials now: Pandemic Grief Got your Down? We are Here for You!
I predict this treatment will become another massive disappointment in a long line of pharmaceutical marketing deceptions, joining 1954’s Thorazine (“The Wonder Drug”), 1955’s Miltown (“The Happy Pill”), 1987’s Prozac (“A Breakthrough Drug for Depression”), and more recently, the whole class of opioids. A few people relieved to know their suffering has a “name” will be paraded out as examples of a drug’s success in treating their “condition.”
The drug-related treatment implications of “Prolonged Grief Disorder” are concerning for many reasons, including this ever-growing movement to turn human experiences and challenges into mental conditions. The DSM has a lengthy history of pretending to be scientific, while creating new mental illnesses by consensus among psychiatrists and other mental health professionals as to the existence of these “conditions.” Every “mental disorder” in the DSM is a social construct, as Thomas Insel, the Director of the National Institute of Mental Health from 2002-2015 encapsulated in this statement: “While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary…the weakness is its lack of validity.”
Others have not been as kind in their summaries of the DSM. In The Past, Present, and Future of the DSM, Harvard University psychiatrist S. Nassir Ghaemi describes the DSM as “so popular that it became a bible. We’ve created a bunch of terms – most of which were created out of the blue with no scientific rationale – but just because we would all agree on the definitions. And now we act as if they were handed down by God himself and can never be changed. And that’s essentially what’s happened in the last 40 years.” In the same article, Professor of Psychiatry at the University of Toronto Edward Shorter digs even deeper: “One of the strangely unscientific aspects of the DSM is that it’s largely the product of horse trading. People sit down around a big table and say, ‘I’ll give you your diagnosis if you give me mine.’”
And to add injury to insult, Barry quotes psychiatrist Dr. Paul Appelbaum, the chair of the steering committee overseeing revisions to the DSM’s Fifth Edition, whose words insult every parent who has ever had to bury their child as he described people with “Prolonged Grief Disorder”: “They were the parents who never got over it, and that was how we talked about them…Colloquially, we would say they never got over the loss of that child.”
When and how did we get to a place where we believe the end goal of grieving the death of a child is to get over it?!
Clearly there is still a lot of work to do for people to become grief-informed and to #UnderstandGrief. As a professional who has worked with children, teens, young adults, parents, and caregivers who are bereaved for over 30 years at Dougy Center: The National Grief Center for Children and Families, who has listened to parents whose children were murdered in school shootings, through wrongful acts of others, in car crashes, and natural disasters, I am disheartened and deeply disturbed by this new diagnosis, and determined to speak on behalf of those who want to be remembered, yearned and pined for after they die. And for those of us who resent being told we have a mental disorder for doing so.
heroin
Joshua
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Most people expect to experience grief as an unavoidable part of life.
The grief pill might be a bit like valium, very good at the start and then – a rapacious creditor.
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Persons with a faster metabolism might reach the 6-month grief pathology threshold in only 4 or 5 months, probably…. I are a psych-i-atrister….I are smart. I sell pills. Business is very, very good for me!…. I help people with their mental health condition illnesses…. Obviously, if you typically get more than 7 hours per night of sleep, you can expect to reach the grief threshold in as much as 6.3 – 6.6 months, instead of the usual 6. So there’s hope, sleepyhead!
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Maybe I’m being overly optimistic (not typical of me), but this latest DMS ploy has generated a lot of anger. Could the psychiatric profession have gone too far?
Hopefully this will result in more skepticism about psychiatry and make it just a little easier to effect change.
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The hubris of this new diagnosis is almost impossible to fathom. And I knew a new drug–or use for a drug–would follow right behind the diagnosis. I say stay away from psychiatrists, find a kind and compassionate counselor, and surround yourself with loving friends and family. How dare they think they can determine how long anyone should grieve?
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Thanks so much for this, Donna– and you have won the word for best psychology one-liner this week: “We did not lose our person.”
Okay, I get it, the addiction model does have some usefulness outside of chemical addiction, if used SPARINGLY, and with a keen awareness of its limitations. But this is the most twisted construct I’ve ever encountered in the discipline, even within the forever-burning dumpster fire known as “Behavioral Psychology.”
As a psychotherapist who frequently uses existential interventions, yeah, I got a few problems with this. First of all, memories of our loved ones are ASSETS, and some of our most critical ones, not pathologies. Do we really have to explain this? These are the memories we need when you’ve dropped into a six foot closeout over the rocks, or are staring down the barrel of a gun, or are facing a life-threatening medical crisis: “So glad I had 30 years– or 20 minutes– with the person I love.” These memories can be the only thing that rescues us from abject meaningless and despair.
Trying to inhibit our access to those memories with chemicals… it seems like getting rid of fire extinguishers because we’re afraid people will start huffing them even though we have no evidence anyone has ever done that. Hell, why not cut straight to the chase– just discourage people from having meaningful relationships so they won’t have those nasty memories to begin with?!
The whole idea that a memory– an internal event– could provide positive reinforcement in a way that could become addictive just seems totally shady. If that were true, I could become addicted to thinking about cute dogs, and someone could develop a medication for THAT.
There’s some kind of categorical error here I can’t put my finger on. It’s probably a really simple one that someone else could explain better than me, but just knowing that someone even entertained this idea as a joke, let alone seriously proposes this as a theory, just has me so depressed I can’t even think straight.
I mean, sure, we can say it’s probably not a good idea to build a habit of screaming into a pillow when you’re mad because you trigger an internal event– a release of adrenaline– that can become addictive, the way a hit of nicotine could. That makes some kind of sense because you’re starting with a behavior — screaming — that produces the internal state — adrenaline — that could serve as positive reinforcement. So yeah, I tell clients it’s not a great idea to scream into pillows on a regular basis– once might be cathartic, but doing it every day could cause new problems. It’s a dull idea, in the way that all behavioral interventions are kind of boring, but useful in a tactical way.
But saying that an internal event, a thought tied to an emotion– such as a memory– can become problematic because it has some kind of innate propensity to become habit forming, to produce other thoughts that are linked to other emotions…
It just seems like a theory built only on assumptions, that’s almost designed to be unprovable. Like one of those trick math problems where the answer is always the same no matter what number you start with if you include the phrase, ‘subtract the number you first thought of.’
Sorry, I know I’m chasing my own tail here… going in circles, I can’t find the right metaphor. How can you use behavioral constructs where there’s no behavior?! It’s like, “You can’t think about this because it will make you think about that.” Arggh!
The naltrexone angle– don’t even get me started. In 12 step, sure, I’ve heard some people say it helped them kick opiates, but I’ve also heard of alcoholics who have used it for months without having any change whatsoever in their drinking pattern.
So… this is a drug we’d use for grief? For intrusive memories, we would target…
Opiate receptors?! Sure! Why stop there, go ahead, shut off the oxytocin, too!
No. Just… no.
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I could say “totally insane!” Actually, it shows that psychiatry lacks empathy and intelligence. It also shows a lot of characters in tv, movies, literature, etc. would have this very sick diagnosis. Actually, in my case, they already tried to force me out of grieving after my sister passed away twenty years ago this month with their drugs and therapizing. It didn’t work. eventually, the drugs almost killed me. However, I lived despite it all and there is not a day that goes by that I do not think of her, nor my dad who passed away in 2013, or my grandparents or even a great aunt who passed away when I was twelve. Grief is a part of life. It is both a pleasant and unpleasant part of life. I firmly believe that living through grief is part of the learning curve of life and it is something we must do. If we cannot grieve (and each person, does it to their own unique timetable) then we basically have no compassion for each other and ourselves. It is necessary to the survival of the “species.” One more point is that it is partially our memories of who were, are, or want to be which define each one, both individually and as in the many groups to which we belong. Grieving is part of that and does encompass more than the loss of someone we love. But essentially psychiatry is just too stupid and too uncaring to see this. This is why if we do not survive as a species on this planet, it will only be due to psychiatry, not anything else you may hear otherwise. Thank you.
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Hello Donna, I am a retired trauma therapist who dealt multiple times with parents who had grief over losing a child. These were the most heart wrenching sessions. It is hard to realize the depth of grief when just using your imagination. When it really happens, the pain for most people is hard to describe. Yet at the same time, it has something in common with the experience of all people who have Trauma. There is a great deal of difference in the ability of people’s brains to process trauma. Some process and let go of trauma more easily than others. I have come to believe that the brain needs help to process grief or trauma. What helps the most is processing grief while the brain is receiving Bi-lateral stimulation. This is so easy and natural, and it has shockingly effective results. I have advanced EMDR training and put it into a self-help program in a not for profit download. Please write to me so I can arrange to give it to you for free. You are also welcome to give it away for free to as many others as you think would benefit. Read about it at: Se-REM.com. Please write to me at: [email protected]. Take care, David Busch, LCSW (retired trauma therapist).
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This enrages me..lose a child and then let them tell us how long to grieve..I guess to them I will always be an addict because I will grieve my son till I take my last breath..thank u for sharing this
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Grief is a highly individual thing. It varies with each individual. It varies with each death the person experiences in a lifetime. Grief also encompasses more than just the loss of loved one. It can also include the loss of a “pet”, the loss of a job, divorce, even a move or other transition of life such as graduation, the birth of a child, marriage, etc. Grief is an important part of life. It is in its tragedy, a seemingly bittersweet experience. It actually unites us, although expressed uniquely by each person, in that it is a “leveling plane.” One cannot get through life and grow without grieving. There is not a pill on the face of the earth that can take away the responsibility of grieving. Each person must go through it—usually many times over. We cannot bypass it, jump over it, fly over it, etc. We must live through it. And for some kinds of grief, like the loss of a loved one; such as a child, spouse, parent, or sibling; it can take a lifetime and is only resolved when reunited after death in a place such as heaven. To steal grief from us is just bullying in the very worst sense. It is a form of terrorism on a grand scale. It means taking away the very thing which makes us human and connects us to our divine nature. “Non-human animals” grieve too. Are we to drug them also? One can not stop the process of grieving. I wish it were so, but if it were, it would stop us from living. We would not only be grieving those we had lost; but we would technically be dead ourselves. Oh yes, we would be talking, walking, breathing, etc. on the outside. But on the inside, we would be dead. All of us shells of we were, are or could be. If we take pills for grieving, as the article suggests, then you might as well kiss the planet goodbye and all those wonderful achievements of civilization and the beauties of nature, kiss them goodbye too. It is unthinkable. Grieving is nature’s way to remind us that we are still alive and still live; despite the pain we are enduring at the time. This may be the worst thing to happen to humanity, since … Thank you.
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I have been thinking about this “grief pill.” If they really want to make such dangerous garbage, then they can also take care of all the legal, financial things one must do after the passing of a loved one. And they can also clean out the closet and other things of the loved one who just passed and try to determine the best way to “dispose” of the items in accordance with the “wishes” of the loved one. They can come to the place where the funeral or memorial service is being held and hold the hands of the grieving. They can make sure the appropriate food for the family is available and the family in their grieving does not go hungry. They can make sure certain “death” practices as determined by the culture and religion of the family are upheld. It is quite obvious that those who have this so-called “grief pill” have no idea what the passing of a loved one entails; in fact, may have never truly experienced the death of a loved one or the death of anyone. It reminds me of my father, along with a group of Vietnam Veteran Army Chaplains were in a Sociology class taught by a young professor’s assistant. He tried to teach death from a textbook perspective. Of course, these Chaplains who had served in Vietnam, in the trenches weren’t having any of it. As the story goes, these Chaplains, one by one enlightened this young professor’s assistant with their experiences with not only the dying in Vietnam, but also delivering death notices to the surviving families stateside. His eyes were opened. I do not think our eyes are closed to the absolute ideocracy and lunacy of this idea. I am afraid those who thought of this have no idea of what they are doing. For, in their idea to create a “grieving pill” they not only devalue death and dying; they devalue life and living. It is just another way to make us into “robots.” Thank you.
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Some say that there will be also a punishement for happy idiots.
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I need the pill for the grief of having your entire life destroyed by psychiatry.
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