Most recently bereaved individuals will not meet full DSM criteria for MDD; do not have a “disorder”; and do not need clinical treatment. Furthermore, there are profound phenomenological differences between ordinary grief and MDD that the experienced psychiatrist will recognize. For example, the ability to be consoled, as Kay Jamison has observed, is typically present in ordinary grief, but rarely in MDD.

That said, many of us believe that the 2-week minimum duration is too short, in most cases, to make a confident diagnosis after bereavement or any other major loss, such as divorce. However, this is irrelevant to the validity of the bereavement exclusion, (BE) and focusing on the 2-week minimum both misses the real point of the debate, and obfuscates the many underlying problems with the BE; e.g., there are no controlled, clinical studies (as contrasted with community survey data) of bereaved, MDD patients to support the BE.

The 2-week minimum is a separate problem that must be addressed separately, and in no way justifies continuing the BE. Leaving the BE in the DSM-5 will not fix the general problem of the 2-week interval. Indeed, elimination of the BE from DSM-5 would also rid us of the bogus, 2-month limit on the duration of “normal” bereavement, for which there is no scientific or clinical basis. Ordinary grief related to bereavement is quite distinct from MDD, and may go on for months or even years; it is not a disorder, nor does it require treatment, if the grieving person functions adequately in the social, vocational, and interpersonal spheres.

I hope that readers will take a look at my upcoming blog on the Psychcentral website, entitled, “Grief, Bereavement, and the DSM-5: How the Public is Being Misinformed.” Also, I have developed a preliminary screening instrument, called the PBPI, aimed at helping clinicians distinguish, phenomenologically, between ordinary grief and MDD. It may be found on the Psychiatric Times website, after a free registration step, under the title, “After Bereavement, Is It “Normal Grief” or Major Depression? The PBPI, A Potential Assessment Tool.”

Sincerely,
Ronald Pies MD

For further reading:

Pies R. The two worlds of grief and depression. http://psychcentral.com/blog/archives/2011/02/23/the-two-worlds-of-grief-and-depression/. Accessed January 27, 2012.

Zisook S, Shear K: Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009;8:67-74.

Zisook S, Reynolds CF 3rd, Pies R, et al. Bereavement, complicated grief, and DSM, part 1: depression. J Clin Psychiatry. 2010;71:955-956.

Lamb K, Pies R, Zisook S. The Bereavement Exclusion for the diagnosis of major depression: to be or not to be? Psychiatry (Edgmont). 2010;7:19-25.

Jamison KR. Nothing Was the Same. New York: Vintage Books; 2011

Most recently bereaved individuals will not meet full DSM criteria for MDD; do not have a “disorder”; and do not need clinical treatment. Furthermore, there are profound phenomenological differences between ordinary grief and MDD that the experienced psychiatrist will recognize. For example, the ability to be consoled, as Kay Jamison has observed, is typically present in ordinary grief, but rarely in MDD.

That said, many of us believe that the 2-week minimum duration is too short, in most cases, to make a confident diagnosis after bereavement or any other major loss, such as divorce. However, this is irrelevant to the validity of the bereavement exclusion, (BE) and focusing on the 2-week minimum both misses the real point of the debate, and obfuscates the many underlying problems with the BE; e.g., there are no controlled, clinical studies (as contrasted with community survey data) of bereaved, MDD patients to support the BE.

The 2-week minimum is a separate problem that must be addressed separately, and in no way justifies continuing the BE. Leaving the BE in the DSM-5 will not fix the general problem of the 2-week interval. Indeed, elimination of the BE from DSM-5 would also rid us of the bogus, 2-month limit on the duration of “normal” bereavement, for which there is no scientific or clinical basis. Ordinary grief related to bereavement is quite distinct from MDD, and may go on for months or even years; it is not a disorder, nor does it require treatment, if the grieving person functions adequately in the social, vocational, and interpersonal spheres.

I hope that readers will take a look at my upcoming blog on the Psychcentral website, entitled, “Grief, Bereavement, and the DSM-5: How the Public is Being Misinformed.” Also, I have developed a preliminary screening instrument, called the PBPI, aimed at helping clinicians distinguish, phenomenologically, between ordinary grief and MDD. It may be found on the Psychiatric Times website, after a free registration step, under the title, “After Bereavement, Is It “Normal Grief” or Major Depression? The PBPI, A Potential Assessment Tool.”

Sincerely,
Ronald Pies MD

For further reading:

Pies R. The two worlds of grief and depression. http://psychcentral.com/blog/archives/2011/02/23/the-two-worlds-of-grief-and-depression/. Accessed January 27, 2012.

Zisook S, Shear K: Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009;8:67-74.

Zisook S, Reynolds CF 3rd, Pies R, et al. Bereavement, complicated grief, and DSM, part 1: depression. J Clin Psychiatry. 2010;71:955-956.

Lamb K, Pies R, Zisook S. The Bereavement Exclusion for the diagnosis of major depression: to be or not to be? Psychiatry (Edgmont). 2010;7:19-25.

Jamison KR. Nothing Was the Same. New York: Vintage Books; 2011

There is no exact date, but I found this: Mental Health Among Natives: A Collection of Articles and Reports from Various Sources. 1900s. May only be available at a university in Nova Scotia, though…

Also, maybe Carla Joinson, author of the Canton Asylum for Insane Indians blog, may have some leads: http://cantonasylumforinsaneindians.com/history_blog/

Daisy