General Discussion
In reply to the discussion: Why are people buying the line that this was driven primarily mental illness [View all]HereSince1628
(36,063 posts)I do know a fair amount about the weaknesses of the old DSM's and the weaknesses of the psychiatric community and the debates about pathologizing 'normal' conditions.
The issue you are talking about with grief is the same sort of thing that's been argued over with PMS.
Both debates make more sense if you think about the way that pathology is defined and considered by clinicians and PAYERS.
a pathologic condition is indicated by a transition from normal function to dysfunction.
If you think about respiratory illnesses, they come in different types and severity, this is the pathological spectrum
it goes from sub-clinical dysfunction that doesn't require treatment all the way to virulent dysfunction that kills. You might get a cold and not go to the Dr. that's the definition of subclinical. But you might take an antihistamine or other drug to make you feel better.
If you have grief or serious PMS there are prescription drugs that really help. But the aren't available over the counter. You need a diagnosis and a prescription to get them and that costs money, for most Americans that means help from an insurance company.
The DSM is as much a diagnostic manual as it is a bible for billing for services. If a dysfunction isn't listed a patient won't get insurance coverage for it.
So, a person may have issues with grief that makes them feel very bad but most people get over it without help. If you are out gardening and end up with a bacterial infection on a finger, you might just scrub on it a home and get over it. But you might also want to get an antibiotic for that.
Similarly a person suffering grief might not want to tough it out, they may want, and clinicians may agree, a fast acting anti-depressant would help (more than a bottle of Jack Daniels). Many people couldn't get that without insurance assistance, and that can't happen without it being in the DSM.
Very similar issues surround pre-menstral syndrome, and feminist groups were fairly hostile to the notion that a normal body function could be pathologized. But some women, about 8% experience really life disrupting symptoms from it, and they are much helped by now available medication. But again, many can't afford it without insurance, and without being in the DSM insurance won't pay.
So, yes, there is a debate about whether the DSM-V has gone on to pathologize 'normal' = common conditions of dysfunction.
But the issue isn't normal conditions...it's about getting insurance payments for prescriptions that help people feel better and function normally when they have trouble with a 'normal' = common dysfunction.