Grief: Normal, Not A Mental Illness

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Dueling Views: Boon to Psychiatry vs. Benefit to the Bereaved

The two sides of the debate were laid out in an accompanying Perspectives piece by Dr. Arthur Kleinman, a Harvard psychiatrist, social anthropologist and global health expert. Critics of the change contend that with a looser standard, the APA would be creating more patients, and more demand for medications, thus making bereavement "a potential profit center for the business of psychiatry." Supporters of the change contend that bereaved people with disabling symptoms would benefit from the recognition and treatment, he said.

The central problem, as Kleinman sees it, is the lack of "conclusive scientific evidence to show what a normal length of bereavement is." Drawing from his anthropological studies, he said that "across the world, societies differ greatly in what they regard as normal grief: some do regard a year as a marker, and yet others sanction longer periods – even a lifetime."

Kleinman recounted his own experience of losing his wife of 46 years to Alzheimer's disease in March 2011, describing the agitation, fatigue, weight loss and other symptoms that set in. It took 6 months before his grief lessened. Nearly a year since he became a widower, he continues to experience "sadness at times and harbor the sense that part of me is gone forever."

"My grief, like that of millions of others, signaled the loss of something truly vital in my life," Kleinman wrote. "The pain was part of the remembering and maybe also the remaking. It punctuated the end of a time and a form of living, and marked the transition to a new time and a different way of living."

According to the editorial writers, "it is often not until 6 months, or the first anniversary of the death, that grieving can move into a less intense phase." Grieving also is individual, shaped by age, gender, religious beliefs and the strength of the relationship with the lost loved one, they said.

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