Is Grief Always Depression?

The word "unhappy" has been virtually abolished from the English language. For every person who says “I’m unhappy” there must now be a thousand who say “I’m depressed.” The change in semantics is important: the person who says he is unhappy knows that there is something wrong with his life that he should try to alter if he can; whereas the person who says “I’m depressed” is ill, and it is therefore the responsibility of someone else -- the doctor -- to make him better.

It cannot be said that doctors are altogether unwilling to shoulder this heavy and important burden -- quite the contrary. An editorial in the May 17 New England Journal of Medicine by a psychiatrist at Cornell points out that the new Diagnostic and Statistician Manual of the American Psychiatric Association proposes that people who are grieving after the death of a loved one should quickly be diagnosed as suffering from depression.

The symptoms of grief and depression are similar, of course. Apart from depressed mood, they include loss of appetite, poor concentration, insomnia, tiredness, slowed movements or agitation, loss of purpose, and ruminations on death or thoughts of suicide. The APA proposes that if these last longer than two weeks, the person who has four or more of the above in addition to depressed mood -- that is to say sadness or misery -- should be considered seriously depressed, whether or not they have been bereaved shortly before.

Has no one in the APA read Hamlet? Can no one there recall his first soliloquy?

... and yet with a month --

Let me not think on’t -- Frailty, thy name is woman! --

A little month; or ere those shoes were cold

With which she followed my poor father’s body

Like Niobe, all tears; why she, even she --

O God! A beast that wants discourse of reason

Would have mourned longer ...

Frailty, thy name is doctor!

For the psychiatrists of the APA, the healthy thing after someone’s death is for his close relatives or friends simply to “move on” and to resume normal life as if nothing much had happened.