Franklin Cook's blog

ADEC, the Association for Death Education and Counseling, has made two valuable resources publicly available on the Internet, which cover important background information on the proposed removal of the bereavement exclusion for depression in the DSM-V (see "DSM Debate Grows over Grief and Depression"). The newly revised and updated Diagnostic and Statistical Manual of Mental Disorders (DSM-V) -- which is the result of several years of intensive and comprehensive review, analysis, and discussion by the foremost experts in the world -- is expected to be completed by the end of the year. The ADEC resources are free to access:

A recent New York Times article highlights a growing controversy over the next version of the Diagnostic and Statistical Manual (commonly called "the DSM"), which is the bible of classifications of mental disorders in the United States.

Even as it is due at the printers in December, new material planned for DSM-V is being intensely debated, including the proposed elimination of the current exclusion from a diagnosis of depression for a person experiencing grief:

Under the current criteria, a depression diagnosis requires that a person have five of nine symptoms -- which include sleeping problems, a feeling of worthlessness and a loss of concentration -- for two weeks or more. The criteria make an explicit exception for normal grieving, which can look like depression (Benedict Carey - "Grief Could Join List of Disorders" - New York Times - 01/24/2012).

On one side of the argument are those who believe the current exclusion does a disservice to grieving people who would benefit from a diagnosis of (and treatment for) depression:

“If someone is suffering from severe depression symptoms one or two months after a loss or a death, and I can’t make a diagnosis of depression, [says Dr. David Kupfer, professor of psychiatry at the University of Pittsburgh School of Medicine,] well, that is not being clinically proactive. That person may then not get the treatment they need” (Carey).

On the other side are those who fear that grief will come to be considered as an illness:

“An estimated 8 to 10 million people lose a loved one every year, and something like a third to a half of them suffer depressive symptoms for up to month afterward,” [says Dr. Jerome Wakefield of New York University]. This [eliminating the exclusion] would pathologize them for behavior previously thought to be normal” (Carey).

The holiday season always comes with numerous news stories intended to help bereaved people take care of themselves during a time that can be difficult for anyone who has lost a loved one. The advice below -- from renowned bereavement expert Kenneth Doka -- stands out for its wisdom, clarity, and usefulness.

During a grief therapy session Doka was facilitating with several widows,

One woman whose husband recently died asked, "Who should sit at the head of the table?" taking her husband's place. [Doka] asked the group how they had handled it. One woman placed her youngest grandchild there to remind the family of its continuity. Another said her eldest son sat there. Another woman said that she sat there since she was now the family leader.

Which response was right? "They all were. Each response met the needs of the person, and each was a comfortable choice," explained Doka.

This is the key to coping with the holidays: Find the way that is right for you.

Grief after Suicide: Understanding the Consequences and Caring for the Survivors, edited by John R. Jordan and John L. McIntosh, is a groundbreaking book featuring in-depth coverage of every aspect of suicide grief support. The book's goals, according to its editors,

are to establish not only what is known about suicide survivors and postvention efforts to assist them, but also to draw attention to vital information that is not known but would help us to better understand and assist survivors of suicide ... [including] recommendations for future research and postvention goals for the future.

The editors and more than 40 contributors to the book's chapters solidly accomplish those goals, covering in-depth and comprehensively the most up-to-date information about an impressive range of topics of interest to people working with the suicide bereaved. The editors begin by asking and attempting to answer several fundamental questions:

• The title of Chapter One asks: "Why study survivors of suicide loss?" And the editors answer: Because "considerable and compelling evidence now shows that exposure to suicide carries with it the risk ... [of] the elevated likelihood for suicide in a person exposed to the suicide of another individual ... [and because] there is also evidence of other negative psychological, physical, and social consequences of exposure to suicide."
• The title of Chapter Two poses this question: "Is suicide bereavement different?" Answer: "Recent research and theoretical advances in thanatology have led us toward what we believe is a more nuanced and satisfying way to address this issue. In short, we propose that the correct answer to the question should be 'it all depends on what aspect of the bereavement experience is being studied.'" And the editors go on to propose a view that emphasizes, at the same time, not only the differences among bereavement after all types of fatalities but also the similarities among people's grief experiences regardless of the mode of death, which indeed is a useful way, practically speaking, to approach assisting the suicide bereaved.

Survivors of suicide loss might want to visit the Lifeline Gallery, where they can listen to everyday people's stories about coping after suicide -- as well as tell their own story of being bereaved by suicide.

• Stories in the "Loss" section are for anyone who has lost a loved one to suicide.
• Stories in the "Turning Points" section are for people who have survived a suicide attempt or have struggled with thoughts of suicide.
• Stories in the "Helpers" section are for caregivers, advocates, or supporters working on behalf of suicide prevention.

When it was launched in 2008, the Lifeline Gallery was described in a Los Angeles Times health blog as a place where...