In The Book of Woe: The DSM and the Unmaking of Psychiatry, Gary Greenberg boldly raised the fundamental questions of whether the DSM pathologizes normal human suffering. Case in point is the bereavement exclusion for major depressive disorder.
“When DSM-III came out and the major depression diagnosis was created,” Gary tells us in this brief video clip, “it was immediately clear that many people who were recently bereaved were going to qualify for that diagnosis. So the question became, what should therapists do about that? And the answer, ultimately, was to create an exclusion—to say that if you’re within two months of bereavement, you don’t meet the criteria for major depressive disorder. You can’t be diagnosed. But this doesn’t make any sense at all.” Gary goes on to ask, what if you have lung cancer, are going through a divorce, or grappling with unemployment? Shouldn’t those things be exclusions as well? And, if so, where does this leave major depressive disorder as a diagnosis?
“Research was done showing that there’s no difference between bereavement and any of the other catastrophes that people so frequently meet in their lives,” says Gary. “So there’s no reason to limit the exclusion to grief if we’re going to have an exclusion at all.” In other words, do we base our diagnostic system on understanding the context of people’s lives and the meanings they give their experiences, or do we insist that these disorders are ultimately medical problems whose origin and nature don’t really matter?
Richard Simon, PhD, founded Psychotherapy Networker and served as the editor for more than 40 years. He received every major magazine industry honor, including the National Magazine Award. Rich passed away November 2020, and we honor his memory and contributions to the field every day.
Gary Greenberg, PhD, is a practicing psychotherapist, the author of four books, including The Book of Woe, a contributing writer for Mother Jones, and a contributing editor for Harper’s.