I have been reading several variations on Rumplestiltskin lately. One of the things I take from this story is about the power of naming. It is in being able to correctly identify Rumplestiltskin's name that the Queen is able to undue the bargain she made with him and vanquish him.
The ongoing criticisms on the proposed DSM V bring this issue of naming to mind for me in a new way. While there have been many blog posts objecting to changes proposed, perhaps none has as much fire as the changes in how grief is to be viewed. DSM 5 would encourage the diagnosis of 'Major Depressive Disorder' almost immediately after the loss of a loved one, allowing just 2 weeks of sadness and loss of interest along with reduced appetite, sleep, and energy. This is beyond absurd. 1BoringOldMan of course has written several ties on the issue and is a must read on it -- see his posts here and here. Allen Frances, chair of the DSM IV task force and critic of many of the new proposals, presents his view on Psychology Today.
What I have been thinking about is how odd it is the way we speak of psychological problems. We speak about the diagnostic labels as if they were names. Last week I had a cold -- notice I, and certainly everyone I know, say I "have" a cold. And though in the middle of it, when it seems like my whole being is one stuffed up nose and cough, still it is not WHO I am but something I have.
But people do not say "I have a depression", they say "I am depressed" - and for many, that becomes an essential identity. It becomes a big part of who they are. The DSM V would have it that after 2 weeks, one goes from "I am grieving" to "I am depressed."
One in the throes of grief is apart from his or her usual identity. And deaths of significant others change us, change who we are. We have ways to mark this -- wearing black, sitting shivah, a black armband to show we are bereaved, we have suffered loss. These customs usually carry expected periods of time, allowing for a return from this place of deep suffering and loss to whatever will be the new normal. And indeed that is how things proceed for the vast majority of those who grieve. Grief lingers perhaps forever in pockets to be awakened by anniversaries, holidays and the like, but its intensity lessens and the colors of life return to our lives palettes. We have grief, it possesses us for a period, then it diminishes and we return to ourselves.
But to see the grief process as an illness, to allow such a short time for it before suggesting it be medicated away, blunting feelings of loss and sorrow, is to change it from a natural suffering occasioned by loss into an identity. And one that once made, never goes away as these disorders aren't cured, they can only go into remission. It is true that loss never goes away either, but we don't think of loss as a problem of brain chemistry, as an illness.