The Loss of Grief: Science and Pseudoscience in the Debate over DSM-5’s Elimination of the Bereavement Exclusion

Abstract

Was the DSM-5 revision process based on careful evaluation of scientific evidence, as the DSM-5 Task Force repeatedly claimed? The counterfeit of science is pseudoscience, the systematic motivated deviation from basic canons of rational scientific evaluation of evidence to create the false appearance of scientific support for a favored hypothesis. In this chapter, I consider the arguments that were used to support the DSM-5’s controversial decision to eliminate the bereavement exclusion (BE) to major depressive disorder (MDD). I consider three central arguments: that the BE had to be eliminated for reasons of consistency; that the BE excluded cases from MDD that would respond to treatment; and that the BE leads to missing suicidal cases. The analysis reveals forms of rhetoric by which the question at issue was obfuscated or misconstrued, and the scientific evidence sidelined, rendered impotent, or outmaneuvered to make it seem to support elimination, despite strong evidence to the contrary. I conclude that the arguments for elimination of the BE were largely pseudoscientific and the BE’s elimination unwarranted by the evidence.