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.

One may legitimately wonder what kind of human relationships the APA expects people to have: certainly not very deep ones. Indeed, the APA probably would count having deep and lasting relationships as pathological, as a risk factor for “depression” later on when the objects of these morbid relationships die. Better to keep everything on an even, superficial level; then there will be no cause for grief. Sorry: depression.

The APA seems to view loving relationships as the British working class used to view teeth: better not to have any, since they only give you trouble in the end. In response to criticism, however, the APA has — according to the editorial — conceded the following:

A footnote will be added [to its criteria for the diagnosis of depression] indicating that sadness with some mild depressive symptoms in the face of loss should not necessarily be viewed as major depression.

The tone of regret in this concession, of having been wrung unwillingly from those who have made it, would be comical were there not just a hint of tragedy about it. Psychiatrists, after all, spend their lives observing people: it obviously takes years of study, training, thought, discussion, reading, and reflection to know so little about them. Such ignorance does not come naturally:

O God! A beast that wants discourse of reason

Would have known better!

When I finished reading the editorial, I felt thoroughly depressed — or do I mean unhappy? At any rate, one thing is certain: I need help.