Comments by Joanne Cacciatore, PhD

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  • “I am not one who easily loses his temper, but I confess to experiencing markedly increased limbic activity whenever I hear someone proclaim, “Psychiatrists think all mental disorders are due to a chemical imbalance!” In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it. On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves.2 And, yes—the “chemical imbalance” image has been vigorously promoted by some pharmaceutical companies, often to the detriment of our patients’ understanding.3 In truth, the “chemical imbalance” notion was always a kind of urban legend- – never a theory seriously propounded by well-informed psychiatrists.” – Ron Pies, M.D., July 11, 2011

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  • Hi Carina,
    Thanks for your comment! I’m uncertain what “question” is relevant and if you’re wanting a response from me… happy to engage if so but will need some clarification, please. And you are so right- simple does not mean easy, particularly in a world wherein we are rarely truly connected to one another. Alas, perhaps I am an idealist, but I believe and hope that we can change this trajectory!


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  • Moretoit, I’ve worked with more trauma victims in 2o years than you can begin to imagine, and there hasn’t, without a single exception, been one person incapable of “working” or just “being” with me in their grief. Not one. You make an unfounded assumption that, in grief, “medicine” is necessary. In my experience, this has never been the case. In fact, in my experience, and I assure it is vast and wide, the “medicine” of which you speak seems rather to impede their ‘working with’ experience.

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  • Stephen, yes, thank you! Beautifully said, in fact, I just posted this response to Ron Pies on PT site where he, again, continued on and on about the DSM5’s blunder with the bereavement exclusion, MDD, and pathology here

    I was asked, after all this time, to respond to this post. As to not further incite the assumedly boiling contempt Dr. Pies has for me, professionally, I chose not to reply two years ago. But alas, this is the third request I’ve had to respond so here we go:

    Dr Pies,
    As you already know given our previous dialogue, I believe this article to be “misleading and false”, though I credit you for your prolificity on the net. The single thing with which I agree is, first, of course you are correct: “is” should be replaced with “at risk for”– however, if you look at both the research and anecdotal evidence with – for example- bereaved parents, you’d see that “at risk” easily becomes “is.” I cannot tell you the number of parents whose children have died who were misdiagnosed under the DSM IV and now under DSM5.

    Second, with regards to the DSM IV, I also abhor its two month guideline. Had I been “around” back during its formation, I would have been as vehemently opposed. As you know, field tests suggest the veracity of the III BE to be more rigorous in preventing false positives for MDD.

    You also assume that clinicians understand “normal” grief, even when it looks like “abnormal” behaviors, emotions, or thoughts. This is utter trash. As a long-standing death educator, and as a bereaved parent for nearly 21 years, I can assure you clinicians are not comfortable with this degree of grief expression. Yes, yes, they should be, but they are not, and they are not being trained in today’s pedagogical model to truly help. Many masters level graduates are woefully inexperienced, often not dialectically inclined, and not ready to face and be present with this type of horror. Are we to entrust diagnoses of such import in these cases? And how about medical training? How much is covered in medical schools on what is *really* “normal” in terms of the Gaussian curve on trauma and grief?

    Dr. Pies, please consider that for two decades, this has been the *sole* focus of my clinical work, my research, and my practice. I receive between 150-200 emails a day from bereaved parents around the world. The past 7 years I’ve published 50 research studies on bereaved parents from all cultural groups. I’ve listened to their stories, sat with them for hours upon hours upon hours, and witnessed abuse launched against them, adding trauma to trauma, by inexperienced and terrified clinicians who cannot bear to imagine what its like to endure the types of deaths that incite the averted gaze. What we, as a system, are doing to these parents (and likely others who are traumatically bereaved), is a travesty.

    Let me give you an example: It will be a hard one to hear. I work with a woman whose young daughter was abducted. Tortured- and I mean *tortured*— the details of the torture are worse than any horror movie you’ve ever watched- raped- then immolated. Its the kind of story that would keep you, as a clinician, awake at night in fear and terror, for your own children or grandchildren, for yourself, for the world. Truly, no less than horrifying than the worst horror movie you’ve ever seen (and by the way, please remember that this is the work to which I’ve solely committed myself for two decades).

    Four years later, she comes to me for help. I can’t tell much more of the details but I can say that her expression of trauma and loss in front of any other therapist or counselor would have landed her on more meds, polypharmacy, and/or inpatient. Instead, four months after we started seeing each other, she has stopped drinking to cope, she is off medications which were prescribed to her the day her daughter’s few remaining bones were found, and she’s learning how to be with the horror of her death.

    Every time we meet, I listen – deeply – patiently – and excruciatingly – to these expressions. Her expressions are *not* abnormal and *not* disordered. Yet she meets all your “guidelines” for pathology and certainly exceeds the time you will allow.

    I will never accept that she is the one with the problem. Never. And I believe to treat her as such is not to treat her or her dead child with dignity, respect, and honesty. You talk about “ordinary” grief and distinguishing it from abnormity… No clinician has the right to diagnose a mother who has endured this hell. And, I have seen no science that “grief” in this population turns into “depression”… it’s just normal grief playing itself out, in my experience with bereaved parents, while being surrounded by a culture where professionals are terrified to listen and bear witness, where they’ve been oft abandoned by others who cannot tolerate the story, where their experiences are swiftly invalidated and medicalized, and where they are confronted by an economic system that values productivity over compassion.

    These are my feelings, as you well know, and I will continue to express them based on personal experience, and please don’t dismiss that, direct experience for two decades with this single population, research experience, and good common sense and compassion.

    To all the parents who have posted here… I am so so sorry. Sorry for your loss, sorry for the patronization, and so sorry that you endure every day without your child’s physical presence. Thank you for sharing. I hold space for you and all your children.

    And with respect to you Dr. Pies.


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  • Oh Susan– there aren’t any words, and I thank you for sharing so honestly and painfully and deeply here. I am just so profoundly sorry. The world can feel so hostile. We can even experience a distance with those with whom we were close if they don’t recognize and ‘see’ our ongoing grief- provide a place to honor and speak of our child/children.

    I am truly sorry, and please know that in this moment, your precious daughter touched my heart.

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  • Alex,
    Great question! Thanks for posing it! My sense is that communities were much smaller and closer, so perhaps there was a sense of deeper intimacy after loss. I conducted several studies during three years of summer on a Hutterite colony (a small, closed community religio-centric group) and the ways in which they come together after loss, without any “medicalized” help, is astonishing. Mourners get as much time “off” from their normal jobs as they need. People visit every day, if the family wishes, with meals, women sit together and cry with the grieving mothers, clean their homes for them, take care of their children… And, their traditions have changed very very little since the 15th century. Interesting!

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  • Dear Academic,
    I thought I did respond, but let me reiterate:

    Her questions were:
    Why is “traumatic grief” a less stigmatizing term?

    Because traumatic grief is about what happened TO a person, not what is disordered about a person. The implication that longing for or preoccupation with a precious child who died six month later as pathological or disordered is absurd. Of course parents are preoccupied with their child/children. This is normative, even from an evolutionary psychology perspective. Healing comes slowly and over time, and in each person’s own time.

    Why is what you do not considered offering “treatment” for people in distress?

    I don’t seek to abate grief. I don’t seek to cure or to heal. I am merely a helper. Anyone, and I say this often, can do what I do with love, understanding, and compassion in his or her heart. Usually, I find that when grief becomes most unbearable for people who are traumatically bereaved, its because they’ve been to multiple ‘therapists’ or counselors, and have encountered others in their communities, who have pushed them toward healing or “moving on” before they are ready. The most challenging in my work is with chronic avoidance oft borne of understandable fear and we work with that in a non-medical way.

    I hope this answers more clearly.

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  • Yes, there is now a move to include Complicated/Persistent Grief Disorder (and other iterations of the same “cluster” of oft **normal** feelings of grief, particularly when traumatic, made to be abnormal in the next DSM. Beyond disconcerting that this “war on grief” (Stolorow, 2014) continues and, frankly, this war on our humanity. Thank you for being here.

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  • Sandra,
    Thanks for your comment! I appreciate the conversation. Traumatic grief – or let’s not use two words, let’s use more specific descriptors- the outcomes often associated with death of a loved one which occurs with significant bodily injury and/or disfigurement; death with threatened death and/or physical injury of survivor; anachronistic death- is merely a description, a term used to describe what happened *to* a person. It is not a label used to describe a person’s character or being-ness in the world. As the wonderful Eleanor Longden says, ‘it’s about what happened to you, not what’s wrong with you.’ That’s the simplest way I can explain.

    “Someone else” – sounds like a nightmare. I am truly sorry for the abuse of your children.

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