The disease known as Grief


“When should grief be classified as a mental illness?” asks an editorial in the February 18th Lancet. The question was provoked by the American Psychiatry Association’s (APA) forthcoming fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the book which gives the diagnostic criteria for psychiatric diagnoses. In DSM-5, feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, no appetite, etc., which continue for more than two weeks after the death of a loved one can be diagnosed — and treated — as depression, rather than a normal grief reaction. (!?) DSM-3 ruled that doctors should wait a year after the death of a close relation to diagnose depression; DSM-4 shortened the interval to two months, and now DSM-5 says we’re candidates for medication if we’re still sad after two weeks.

In a poignant and penetrating essay in the same issue of The Lancet, Arthur Kleinman writes, “Is grief something that we can or should no longer tolerate? Is this existential source of suffering like any dental or back pain unwanted and unneeded? My own experience, together with my reading of the literature, suggests caution is needed before we answer yes and turn ordinary grieving into a suitable target of therapeutic intervention.”

Kleinman acknowledges that ” … this resistance on my part may simply be generational, an increasingly historical oddity out of keeping with the brave new world of technology that is remaking life and reframing the story of who we are.”

In a way, Kleinman may be right that it is generational. A prevailing worldview in previous generations held that there was meaning in suffering, that even if the meaning was sometimes inscrutable to us, suffering could somehow exert a beneficial effect in the midst of the pain. “The growing soul is watered best by tears of sadness.” But now it is more common to understand suffering as meaningless, as something to be removed or relieved at all cost.

A perfect storm: the Baconian project to employ technique to alleviate suffering and increase man’s happiness, combined with a materialist worldview that sees no meaning in suffering, combined with technology that hubristically thinks it can relieve all suffering, combined with a pharmaceutical industry that has a pecuniary interest in medicalizing all of life, and voila! You have DSM-5 – and one step closer to Huxley’s world, brave and new, where life is relieved of all suffering and emptied of all meaning. (Pass the Soma!)

As Christians, we have a call to relieve suffering with the love of Christ, but we also follow a Man of sorrows who was acquainted with grief, and knew that some suffering was bettered endured and not medicated away. Maybe this is another important task for Christian bioethics: to find discernment between when medicine should seek to relieve suffering, and when it should seek rather to comfort the sufferer.


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