On Grief, Diagnosis and Drug Companies

My father has strong opinions about the relationship between drug companies and psychiatrists.

Our family has had its fair share of grief recently, between my father-in-law and stepmother’s declines and eventual deaths.

Each of us in the family has come to terms with these events and their aftermath in our own way, some more private and others more open.

But in a recent Op-Ed piece for The New York Times, Allen Frances notes that there is a possibility that standard grieving could be defined as a psychiatric problem in 2013.  That’s when the fifth version of the Diagnostic and Statistical Manual of Mental Disorder, or DSM-V, is slated to be published.

Such a development could have substantial cultural and financial consequences for drug companies who would seek to capitalize on this new market, he says.

An emeritus professor of psychiatry and department chairman at Duke University, Frances chaired the task force that created the DSM-IV.

Like the one he helped create, the previous versions reflected the culture in which they were written and published. It was not until 1973 that the American Psychiatric Association declassified homosexuality as a mental disorder, for example.

That point aside, while Frances decries the proposed change, he maintains that, it ” is not that psychiatrists are in bed with the drug companies, as is often alleged. The proposed change actually grows out of the best of intentions.”

My father disagrees.

Shortly after the publication of Frances’ piece, Dad wrote the following letter to the Times (Unfortunately, it was not published.):

As a recently bereaved physician who is sad indeed, I endorse the plea of Allen Frances (August 14, 2010)  to desist from medicalizing normal grief by labeling it as a major depressive disorder in DSM V.  Frances’ denial of the role of the pharmaceutical industry in this initiative is naïve, however.  Cosgrove reported that over half of the panel members responsible for revising the previous version had financial ties to the industry.  As the late distinguished psychiatrist Leon Eisenberg stated in his 2008 speech to the APA*,  “I am not reassured by ‘restrictions’ that permit (DSM V) task force members to receive $10,000 annually in consulting fees and to own $50,000 in stock in pharmaceutical companies whose profitability will be greater or less, depending on whether ‘treatable’ diagnoses multiply and whether definitional guidelines are broad or narrow.” Nor should any of us be.

What is your position on the intersection of diagnosis, dollars and culture?  Is Dad right that Frances is naive?  Is Frances right to decry the potential labeling of grief as a mental disorder?

Let the dialogue begin.


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4 responses to “On Grief, Diagnosis and Drug Companies

  1. Really!? Ugh. Classifying normal feeling of grief as a mental disorder? Are you kidding me? What is wrong with a feeling of grief for the loss of a loved one? It would be strange to not feel grief for the loss of a loved one… that I would say is more of a disorder.

  2. I’m cynical enough to buy the money argument, but honestly it doesn’t matter why they want to do it. All that matters is that they don’t. The whole idea is nuts. In my years as a psychotherapist and grief counselor, there have been times I’ve pondered who was crazier, my profession or the clients we serve. This is a case where the pros win out.

    There is absolutley no way anyone could make a differential diagnosis between grief and depression, 2 weeks following a death. There’s no way. It’s not possible.

    Additionally, there are virtually no objective criteria for assessing grief. The only one that matters is impossible to define…is it moving over time? Grief is fluid and all over the map. Then it backtracks on itself. It can’t be defined by time, by intensity, by forward progression, or even by the its symptoms.

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