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"A clinician who does not understand the range of grief symptoms is at risk for intervening in a normal process and possibly derailing it."
Tuesday's Trust
Can We Trust the Experts?
Or, Buyer, Beware!
Especially in regard to what's coming down the pike for the DSM-V Manual...
The DSM is the Diagnostic and Statistical manual each psychiatrist (M.D.), psychologist (Ph.D.), or any other psychotherapist (Master's-level psychologist or social worker or professional counselor, etc.) uses to diagnose their patients or clients. Every few years, a committee meets to study the research to determine the best criteria for each diagnosis in the DSM as well as to determine any changes that need to be made in additions or subtractions of any particular disorder based on the current understandings of the different presenting disorders in people. By the way, when Tommy and I were in graduate school, our DSM (at that time, the DSM-II) that we studied consisted of 134 pages. The current DSM (the DSM-IV) consists of 886 pages!
Please note, of the forty studies the committee perused for their determinations I FIND NOT ONE STUDY ON CHILD-LOSS PARENT GRIEVERS. Most of their studies are of bereaved spouses. They have some studies on adolescents whose friend committed suicide, and they have some studies on pre-pubescent grieving children. BUT THERE WAS NOT ONE SINGLE STUDY OF CHILD-LOSS BEREAVERS ALTHOUGH THE PSYCHIATRIC COMMUNITY WOULD BE THE FIRST TO SAY THAT CHILD-LOSS GRIEF IS INDEED THE MOST SEVERE GRIEF KNOWN TO MANKIND.
The biggest controversy is that the current committee is deciding that even though our current DSM recognized Grief is separate from Major Depression and therefore excluded the bereaved from being diagnosed with Major Depressive Disorder while they were sad in the first two months of grief.
In the upcoming DSM (DSM-V), the new committee wants to say that we have Major Depressive Disorder if we are still sad from our grief at the end of the first TWO WEEKS. Both are really ridiculous to me, now that I am in the fourth year of our child-loss grief and am STILL SAD, but I know what depression is, and I know that I am not DEPRESSED! I KNOW THE DIFFERENCE BETWEEN THE GREAT SADNESS AND MAJOR DEPRESSIVE DISORDER! AND IT IS A HUGE DIFFERENCE!
So, in last weeks Thursday's Therapy, you saw where I lambasted some of the members of the committee who want to make such asinine changes (again, the DSM-IV wasn't all that great either in giving us just two months of normal sadness, but let's don't go in the opposite direction please!).
I know it could be confusing that I am up-at-arms with the powers-that-be, so I thought I would give you SOME OF THEIR OWN WORDS from some of the professional articles they have written which attest to MY GREAT CONCERN FOR GRIEVERS WHO GO TO THE EXPERTS EXPECTING TO GET HELP ONLY TO GET HURT!
And by the way, Dr. Therese Rando said that when you are treated by someone who hurts you when you naturally expected that they would help you, such hurt can cause an already-vulnerable griever
A SECONDARY INJURY THAT CAN THEN BECOME A WORSE INJURY TO YOU THAN YOUR PRIMARY INJURY OF LOSS
because it is piled on to your already-debilitating loss.
This is why I do not want Child-Loss Grievers Messed With!
Even, and Especially by the so-called Experts in the field!
So tonight, I am going to use THE EXPERTS' OWN WORDS to show you what I am so greatly concerned about!
The experts themselves WHEN THEY ARE COMPLETELY HONEST, KNOW that they do not understand Grief! The very same expert I lambasted in Thursday's Therapy last week, Dr. Sidney Zisook, in conjunction with his co-author Dr. Katherine Shear made some very interesting observations of their own profession.
Their article is entitled, Grief and bereavement: what psychiatrists need to know (from June, 2009).
Second Sentence of their article says
Psychiatrists often are ill prepared to identify complicated grief and grief-related major depression, and may not always be trained to identify or provide the most appropriate course of treatment.
Fourth sentence of the article:
While uncomplicated grief may be extremely painful, disruptive and consuming, it is usually tolerable and self-limited and does not require formal treatment.
Part of the sixth sentence:
(P)sychiatrists are not immune to complicated grief or grief-related depression when they, themselves, become survivors.
Eighth sentence:
Unfortunately, grief is not a topic of in-depth discussion at most medical schools or general medical or psychiatry residency training programs. Thus, myth and innuendo substitute for evidence-based wisdom when it comes to understanding and dealing with this universal, sometimes debilitating human experience.
Twelfth sentence:
Yet, to this day, the bulk of what is known about grief and its biomedical complications has not been widely disseminated to clinicians.
Further into the article:
Grief is different for every person and every loss, and it can be damaging to judge or label a person’s grief, especially during early bereavement.
{I would add, it can be damaging to judge or label a person's grief AT ANY TIME DURING THEIR GRIEF!}
A clinician who does not understand the range of grief symptoms is at risk for intervening in a normal process and possibly derailing it.
{This statement is HUGELY IMPORTANT!}
And finally,
"Clearly, complicated grief must be taken seriously and treated appropriately.
Psychotropic medications and standard grief-focused supportive psychotherapies appear to have little impact on this syndrome (Complicated Grief such as that that we Child-Loss Grievers have).
By contrast, a targeted intervention, complicated grief treatment (CGT), has demonstrated significantly better outcomes than standard psychotherapy in treating this syndrome. But this intervention requires a vast knowledge of grief, and for us In-Particular, Knowledge of Child-Loss Grief which, to my knowledge the American Psychiatric Association has NEVER had any study of just us Child-Loss Grievers!
*****
Another two psychologists that were in my Thursday's Therapy post did have some wonderful contributions to the DSM committee. Instead of throwing us into the Major Depression camp -whether or not we have Major Depression along with our grief-, Horowitz et. al. (1997) and Prigerson et al. (1996, 1999), argued for bereavement to constitute a ‘pathological grief’ category, distinct and independent from depression in the DSM (APA, 1987). They stipulated that pathology is common after bereavement, but should be classified in the DSM as complicated grief disorder (CGD).
YES! Typically we have COMPLICATED GRIEF, NOT Major Depression!
*****
Just because mental health clinicians have M.D. or even Ph.D., or LPE, or MSW, etc., by their names, we often think, "Then they must be knowledgeable and helpful!" Some therapists ARE good at certain things, and are NOT good at all on others. Some therapists are good with some people, even while they are not so good with others...
Even my favorite psychiatrist in our town makes it very clear,
WE NEED TO BE GOOD CONSUMERS!
WE NEED TO DO RESEARCH ON OUR OWN CONDITION SO THAT WE CAN BE KNOWLEDGEABLE,
WE NEED TO BE READY TO CHALLENGE THE EXPERTS WHEN WE DISAGREE OR DO NOT FEEL HEARD!
Or, in other words,
BUYER, BEWARE!
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2648140/
Grief and bereavement: what psychiatrists need to know June, 2009
by Sidney Zisook and Katherine Shear:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691160/
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