What's in a Name: Grief vs. Depression

In my last , I wrote about the importance of putting a name to something, and how that name can shape someone’s experience.  This week I’ve been reflecting on the past few weeks, and how they’ve been emotionally challenging for me and for those I love.  In a conversation with my mother, I learned that a beloved family pet had met an untimely ending.  While grieving this unexpected loss, I was contacted by a close childhood friend who informed me of his father’s passing.  While the grief of each is different, I feel each loss acutely.

While trying to make sense of these losses, I read an article about grief and depression on CNN.com. The author discusses the imminent publication of the latest version of the Diagnostic and Statistics Manual (DSM) published by the American Psychiatric Association (APA).  By way of background, the DSM has been controversial since its inception in 1952, and the fifth edition is currently being revised for publication. One of the purposes of the DSM is to give a name to, or label, a person’s experience.  This label is intended to be helpful in several ways: it creates a standard set of criteria to define the label, or diagnosis; it creates a common language for clinicians to facilitate communication in the field; and the diagnosis guides the course of treatment.  An example perhaps in a more familiar medical language:  the criteria helps a physician determine that the pain in my shoulder is muscular instead of an infection.  Because of this, she would recommend that I see an orthopedist.  The orthopedist would then diagnose, or label, the problem, which would then determine if the appropriate course of treatment is surgery, physical therapy, or a combination of both.

As the author in the article summarizes, the proposed new edition of the DSM no longer distinguishes bereavement from depression.  Basically, in the current DSM (IV-TR), when assessing a client for symptoms of depression, one of the questions asked is related to the recent death of a loved one. If the client did lose a loved one to death within the last 6 months, then he or she does not currently fit the criteria for a depressive episode.  Theoretically, this changes the course of treatment—if the client is not clinically depressed, then antidepressant medication is not appropriate.

So the question you may ask: What does this really mean to me?  I think the answer depends on who you ask.  To some people, having a label to name their experience can be comforting: “Oh, you mean I’ve been experience [insert diagnosis here]? So that’s  why I’ve been acting and feeling this way!”  Also, having a diagnostic label can help the clinician and the client know what their options are for moving forward.  “Oh, so I’m depressed.  That means counseling may work for me,” or, “I can go get a self-help book at my local bookstore,” as well as, “I wonder if medication would help, too?” 

For other people, having a label feels limiting and minimizing. “What does it matter what you call it, that doesn’t change how I’m feeling.” (In a future post, I hope to discuss in more detail the potentially limiting nature of diagnoses.)

While the APA discussion of diagnoses is a complicated one, the question for me as a therapist is rather simple: Does what you’re feeling and experiencing interfere with your ability to participate in relationships, work, and fulfilling commitments?  If the answer is yes, then the label may be the stepping stone along the path to helping alleviate these symptoms and get more satisfaction out of life.  Whether it’s about grieving the loss of a pet, the death of a loved one, a concluded relationship, or a job loss, the way the mind is processing the loss is preventing someone from attending to his or her needs and to important commitments. A skilled clinician (e.g., physician, psychiatrist, or counselor) could help people put a name to what they’re feeling, and then collaborate with them on determining the next step in creating change and feeling better.

Regardless of how the APA chooses to define a diagnosis, if you or someone you know is suffering from profound sadness that compromises their quality of life, please reach out for help.