What’s the difference between normal grief and depression?

Photo credits: Public domain.

About 20 years ago, I was pastor of two small United Church of Christ congregations in northwestern Pennsylvania. 

Shortly after one of my parishioners, a retiree, died of cancer, his wife came to visit me. She told me that her doctor had offered to prescribe an antidepressant for her. 

She said, “It made me angry. I told him my grief was normal, and I didn’t want any drugs.”

I applauded her decision.

The headline for Allen Frances’s post, Don’t Confuse Grief with Depression, caught my eye this morning. Frances, Professor Emeritus of Duke University, supports the attitude demonstrated by my grieving parishioner with his strong opposition to a proposal that would transform grief into a depressive disorder.

Frances writes:

A front page story by Ben Carey in January 24th's New York Times carries the poetic title: 'When does a broken heart become a diagnosis?' It describes a puzzling proposal by D.S.M. 5 to transform what is now considered normal grief into Major Depressive Disorder. 

D.S.M. IV already recognizes that some people respond to loss with severe problems that warrant immediate attention. It therefore encourages the diagnosis of major depression whenever bereavement is persistent or is associated with severe, impairing, delusional, or suicidal symptoms. D.S.M. IV thus makes a crucial distinction between the transient pain of expectable grief and the severe and/or persistent symptoms of major depression. D.S.M. 5 proposes to eliminate this distinction. It would allow the diagnosis of major depressive disorder after only two weeks of fairly mild symptoms.

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