Thursday, March 6, 2014

The medicalisation of grief – necessary for Prolonged Grief

Diagnostic and statistical manual of mental disorders (DSM)-IV 

I first came across this manual when working on my M.A. in counselling. There is a new one out (DSM–V). I finished a couple of courses shy, as I was not enjoying doing it on-line. If you have any of these symptoms it is important to see a medical practitioner, as they can be cured or relieved through various means: drugs, Cognitive Behavioural Therapy (CBT), a combination of CBT and drugs, and Complimentary Therapies.

What is crucial to note, is that once you have an episode you are more likely to have a more severe one later. I was depressed in high school, and with each major trauma in my life (divorce, work-lace issues, caring for dying parents, moving, bereavement issues) I had a worse episode.

We know that bereavement (the state of having lost a loved one), grief (your feelings)  and mourning (the rituals of bereavement) are separate things. There is a complex grief and grieving process. I must say that after my father died, I experienced a number of these symptoms. I mentally revisited the sights, sounds, smells of his long-term care room with horror, triggered by other smells. I now realize that I needed to give myself permission to heal after caring for my mother and father. It wasn't just one event, but months of worrying about what I needed to do, being afraid of not doing enough, or doing the wrong thing. I was unable to concentrate at work, to make decisions about curriculum, or interact with my principal.

If you have some of these symptoms, see your healthcare professional.

Bereavement (according to DSM-IV)

  • A death has occurred in the past two months
  • You feel guilty, or you feel worthless
  • You've a hard time moving about or feeling motivated
  • You are unable to work, take care of yourself or do simple tasks
  • You see or hear things that are not there

Prolonged Grief

  • You are confused about your role in life, feel diminished, feel part of you has died
  • You are unable to accept the loss
  • You avoid reminders of the loss
  • You cannot trust others
  • You feel bitter or angry about the death
  • You can't get back to 'normal' activities, have lost interest
  • DSM-IV-TR
  • You feel numb, unfulfilled, empty, stunned dazed or shocked

Major depressive disorder

  • You have lost interest or pleasure, nearly every day
  • Your weight has changed by 5% (plus or minus)
  • You have sleep issues
  • You feel restless, lack energy, are tired
  • You feel worthless, guilty
  • You cannot focus mentally
  • You have suicidal thoughts

PTSD Symptoms

According to the DSM if you have experienced, witnessed or were faced with a situation in which death or near-death, injury, or bodily threat, occurred. There are three separate categories.

1. You re-experience the event or situation:

  • You replay images thoughts, or perceptions of an event
  • You have recurring dreams
  • You act or feel as if the event is recurring
  • You experience intense distress when confronted with a reminder of the event
  • You have a physical reaction when the above occurs
2. Avoidance with three or more:
  • You avoid thoughts, feelings, or conversations about the event
  • You avoid people, places or things around the event
  • Your brain has blocked something out about the event
  • You do not participate in activities
  • You feel estranged from others
  • You do not feel a normal range of emotions
  • You feel you cannot live long, or achieve goals
3. You are on high alert with two or more:
  • You cannot sleep
  • You are irritable, angry
  • You are unable to concentrate
  • You're hypervigilant
  • You startle easily

Generalized Anxiety disorder

  • You experience intense anxiety, worry most days (friends, work, money...)
  • You are unable to control the anxiety for at least six months
  • You feel restless, on edge; cranky, irritable, tense
  • You tire easily
  • You are unable to concentrate or think
  • You have sleep issues 
  • Your symptoms get in the way of work, friendships

Panic disorder

You experience four (or more) within a ten-minutes:
  • Pounding or racing heart, heart palpitations, pain or chest discomfort
  • Sweating, trembling, shaking, nausea, stomach pains
  • Feeling dizzy, light-headed, as if you are losing control
  • Chills, hot flushes, numbness, tingling

How do you know what treatments you need? 

See you healthcare professional. Try treatments. If they do not work, stop. I've found that long-term antidepressants work for me. I've also found that therapists help, too. It is my belief that we need to know what is normal, and what is not and, therefore, when to get help. If we are in the depths of mental health issues, reaching out may be impossible, and it is up to family and/or friends to be able to determine when to intervene.

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