Grief, depression, and the DSM-5: A review and reflections upon the debate

Abstract

Every side in the debate about eliminating or retaining the bereavement exclusion for diagnosing major depressive disorder agreed that the DSM-IV was inconsistent. It exempted symptoms of depression from a depressive disorder diagnosis if they were a response to the loss of a loved one, but diagnosed depression symptoms in response to any other kind of loss or stress as a disorder. The participants in the debate did not agree how to resolve the inconsistency — eliminate the exemption for bereavement, leave it in place, or extend it to all cases with loss & stress-triggered depression symptoms. The difference between how the debate was presented to the general public and the issues debated in the scientific literature is described, as are the facts upon which the various sides readily agreed. Scientific research that casts doubt upon some common assumptions about the psychology of grieving is also reviewed. The article concludes by taking note of both the scientific-empirical and metaphysical facets of the debate, and suggests a pragmatic, verbal solution for one of the metaphysical facets.