Hmm, ironic that just after I tried to debate with Dr Ronald Pies at his post from Psychcentral Blog (link below) how the matter is not so simple as he continues to allude, that this recent Psychiatric periodical then arrives in my mailbox. This is what he wrote last month:
Here was my reply that never made it, forwarded the day after Dr Haney’s comment near the end of the comment thread:
First of all, thank you to Dr Haney for echoing my concerns. Yes, unfortunately from colleagues like Dr Pies who are not practicing psychiatry on an active basis anymore, like probably over 75% of the authors of DSM5, I don’t think they really care should there be consequences for directing bereavement to be an active mood disorder diagnosis that WILL lead to medicating. Nah, being sad and distraught is now an illness, until proven otherwise, and their rationalizing and minimizing is quite the read at sites like this.
And in his last comment here in the thread:
“Moreover, the risks that you cite–while important–do not outweigh what is for me the greater risk in failing to diagnose MDD after bereavement: the risk that the potentially suicidal patient will not receive adequate treatment. (And this emphatically does not mean “antidepressants” in all cases; psychotherapy would suffice for many patients).”
Umm, how many of these PCPs/NPs/FPs/other non psychiatrists are going to be providing psychotherapy? Referring out is nice in theory, but will people really make the effort to follow up, and how many therapists will view the DSM 5 recommendation to just “pharm out” the patient for meds after the initial visit? I am in the trenches, and I know the beast of catering to quick fix mentalities. People being told meds will lessen the pain of grief, yeah, they will hesitate and talk more. NOT!
Again, how many patients have you met, Dr Pies, in all those travels doing CL work, did you meet patients in the midst of acute bereavement who met the criteria of MDD, and how many were acutely suicidal with intent and plans? I am sure the answer is at least one, but, does that justify turning a societal reaction into a mood disorder diagnosis as a whole? And why is it my point about the way our non psychiatric colleagues are over prescribing antidepressants is basically swept under the rug in your replies?
People can say whatever they want about the way I write at sites refuting this madness to just overdiagnose acute struggles and disruptions that are not creating profound dysfunction and day to day discord in life. Frankly, saying it nicely and politically correct to “leaders” and academicians, who are being shown in greater numbers to be misleading and grossly profiting from catering to business interests who are not fellow clinicians, is both a waste of time in the efforts to dialogue and just heinous to witness the further carnage.
Please, tell us all, if you are willing to engage with me further here, how publishing a version of DSM 5 for somatic care providers will encourage returning psychiatric patient care needs to psychiatric providers. I truly am waiting to hear how this will diminish overprescribing. As I am sure equally and eagerly all the people out there who have been overdiagnosed and overmedicated and now dealing with these consequences as commenters have offered in posts like these.
And also frankly, per Dr Haney’s comment how her state’s medical board seems to handle mental health issues among colleagues, I truly do not see the logic in your rebuttal, how stigma will not change as is, how this is a defense to make bereavement a psychiatric diagnosis. What am I missing from your reply that offers some sense of solace and compassion? The irony is in the end of your comment: “…only to say that the solution will not lie in manipulating our diagnostic criteria.”
That one is true to me, just not the way you intended it! Sorry I am so harsh on you, but, equally sorry for me to interpret your writings as a sell out. Truly sad to read.
Well, I can’t link to the article in the Psychiatric Annals journal by Drs Alana Iglewicz et al (but here is the link to the site to those interested to pursue further: http://www.healio.com/psychiatry/journals/PsycAnn/%7B6A1A5F4C-96BF-4911-A950-DBF8857D440D%7D/The-Bereavement-Exclusion-the-Truth-between-Pathology-and-Politics ) without joining the net site, so I will cut and paste the Conclusion section for you, the readers to decide if the opinion fits:
Note in their article, they highlight two comments within it:
Diagnosing MDD in someone who is acutely bereaved remains a challenge, even to the most seasoned clinicians, and
One major limitation that has been noted in each of these studies has been their failure to control for severity and duration.
They even note as a reference the blog by J Cacciatore and quote her saying “a document–what is known euphemistically as the Bible of Psychiatry–which sanctions the use of psychopharmaceuticals as a first line treatment for bereavement.” (which I will link as well: http://drjoanne.blogspot.com/2012/03/relativity-applies-to-physics-not.html )
So, why am I still battling this issue when many say it is moot with DSM5 now out? Gee, why battle things that are “in place” just because the majority of people are complacent, unconcerned, lazy, or just plain indifferent because it isn’t affecting them TODAY?!
One reason why people who become doctors need to think and act and not just bow to peer pressure, or worse, profit oriented attitudes. Pies is wrong, and I think he is so out of touch with the issue, I really have to offer if he is paid off. Bereavement is never depression, but people who are consumed with grief can develop major depression, that is NOT an argument here. But, as I asked at his most recent post and others, who is really going to be determining this? It won’t be psychiatrists almost 75% of the time. And that is what bothers the hell out of me with these defacto speakers for the DSM5, they know that nonpsychiatrists will be asked to assess this matter first.
Please, anyone can comment and note I am wrong, how many times has a person gone to a PCP/NP/Family Practitioner/OB/other nonpsychiatrist and not only had a chance to talk more than 15 minutes talking about mental health concerns/symptoms, but also left WITHOUT a prescription?
Big Pharma is counting on the status woe, er, quo. And that is sad.
Does that mean I am depressed!?!? That is a tough concept to swallow!
Sometimes puns don’t have the full impact to them, eh?