TThe American Psychiatric Association last week officially presented a new diagnosable mental health condition: prolonged grief disorder. The news, while welcomed by some doctors and researchers, has also been controversial.. At the center of the debate it is the long-standing question of how to define suffering, as well as how best to help people cope with the inevitable reality of experiencing loss.
Prolonged grief disorder was codified in a revision to the fifth edition of the APA’s Diagnostic and Statistical Manual of Mental Health Conditions (DSM), although it was previously announced last fall. The basic definition of prolonged grief, according to the APA, is when someone experiences “Intense longings for the deceased” that last longer and are more disruptive to a person’s daily functioning than typical grief. Specifically, prolonged grief should only be diagnosed in children if they are still experiencing these feelings at least six months after a death or loss, and at least a year later for adults.
Some mental health professionals have called for the disorder to be added to the DSM for more than a decade. His research has argued that a small percentage of people—perhaps less than 5% of the population—experience feelings of grief that are profoundly different, longer-lasting, and far more damaging than the “normal” grief we feel after the death of a loved one. Moreover, they add, this duel can be reliably distinguished through screening tools for other conditions that could arise or be triggered by the loss, such as depression or post-traumatic stress disorder.
“So it differs from normal grief in its duration and intensity, as well as its impact on everyday life,” Maarten Eisma, an assistant professor of clinical psychology at the University of Groningen in the Netherlands who has studied, told Gizmodo. the condition a E-mail.
But while prolonged grief has been considered in the DSM, there have been some professionals horrified at the idea of making it an official status. Despite reassurances from advocates, they fear the diagnosis will undoubtedly blur the lines of how we talk about and handle grief to no avail.
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“The criteria unfairly target a subset of grieving people to be diagnosed with a mental illness,” Joanne Cacciatore, a trained social worker, researcher, and grief counselor for over 25 years, told Gizmodo in an email. “For example, the criteria states that at one year, you can be diagnosed with PGD if you are intensely yearning for the person who died. What parent would not yearn for a child who died? Intense emotional pain? After such traumatic losses, what person would not feel intense emotional pain one year later?”
Cacciatore’s own research with bereaved parents has suggested that most of them may experience the kind of symptoms that could result in a diagnosis of prolonged grief disorder or other psychiatric diagnoses up to four years after your child’s death. And if so many parents can feel this amount of pain that isn’t considered normal, she asks, then “perhaps it’s the measures that fail, not the mourners.”
There has also been some data to suggest that the inclusion of PGD will further stigmatize those who visibly have more difficulty coping with their grief than others. of eism Research has found that members of the general public who read cartoons were more likely to stigmatize people diagnosed with prolonged grief after the death of a loved one than after hearing about someone in a similar situation who was not diagnosed with the disorder. another study of his found a higher level of public stigma for PGD patients compared to those mourning the loss of someone to suicide, which has previously been shown to cause stigma in other studies.
“Compared to people with normal grief reactions, people judge people with severe grief more negatively, reacting with anger, anxiety, and they pity them, preferring to stay away from them. To the extent that the PGD diagnostic label gradually comes to indicate such severe grief reactions, we can expect such a label to lead to stigmatization,” he said. At the same time, he added“Many grief experts consider such stigmatization a necessary evil.”
For a long time there has been a tension on the meaning of illness in medicine, with prolonged grief disorder only the latest to provoke discussions between practitioners. This debate is not simply academic. Insurance companies will rely on DSM codes, as well as those of the much broader International Classification of Diseases (ICD), to decide whether cover treatments for a person’s symptoms. So even if the PGD criteria aren’t perfect or their validation might have some unintended consequences, proponents argue that their inclusion will at least allow some people in severe pain to get help they might not otherwise have been able to access.
There’s something to be said for that need, according to Sheila Vakharia, a former clinical social worker and now deputy director of the Drug Policy Alliance’s Department of Research and Academic Engagement. But she argues that the diagnosis is far from being a true structural solution.especially today. She notices that in a world where thousands of Americans a week continue die To An Ongoing Pandemic, How can someone’s continued grief over the losses they have experienced be considered abnormal?
“For a diagnosis like this to be released at this time just feels deaf and decontextualized, both within the larger political environment and with the fact that we are in an event of mass disability and mass death, we’re in a pandemic. global,” he told Gizmodo for telephone. “I think that in the midst of a global pandemic, there is a reasonable degree of shock and disbelief that the conditions that allowed our loved ones to pass through have been allowed to continue.”
For the foreseeable future, prolonged grief disorder is here to stay. Not only is he now in the DSM, but he was aggregate to the ICD in 2018. There are already some dedicated existing treatments, as grief-focused therapy, available to those newly diagnosed with it, while Eisma is participating in several randomized clinical trials testing online forms of cognitive behavioral therapy. Elsewhere, researchers plan to test whether naltrexone, a drug used to treat alcohol and opioid dependence, could help people with prolonged grief; the theory is that severe grief may work along the same neural pathways as addiction.
Even though Vakharia may have problems with PGD, at least hope it can shed light on the larger forces animating our collective pain, like the pandemic or worsening overdose crisis, as well as the way we are allowed to express it.
“If we’re going to make prolonged grief disorder a diagnosis, for example, are there human resource policies and policies for employment and school education?based policies we need to have, so that people can have the space to even cry during that period of time when it happens right away? Because if we don’t give people enough space to grieve at the moment of loss, it will never go away. and it gets worse,” he said. “I think another problem is that we’ve all been told to keep moving. In terms of covid, in terms of the overdose crisis, there hasn’t been a lot of room for people to process and feel pain. Instead, there have been many calls for us to get back to normal, for us to get back to work, for us not to let so-called fear take over.”
For his part, Cacciatore argues that we shouldn’t have to settle for the best of a flawed system and flawed diagnoses like prolonged grief disorder..
“The system is absolutely broken, and we need an ethical change. Psychological care should not be based solely on a diagnosis,” he said.. And these reforms should not extend only to psychology. but to our world in general, he addedin order to address underlying factors that can lead to serious grief, such as lack of social support.
“We need better grief support education in our culture. We need more facilitators and facilities to care for people who are grieving, genuine care and support, without judgment or coercion, and we need an overhaul of the insurance payment system.” Cacciatore said.
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