Being Human

Grief Is Not a Mental Illness

How do emotions become mental disorders? Well, it depends how you define “mental disorders.”

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Chuck  Colson

Last year, Dr. Marcia Angell began a two-part series in the New York Review of Books by writing, “It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers being treated for it.”

Her use of the word “seems” told readers that Angell, who teaches at Harvard Medical School, was skeptical.

That’s putting it mildly. Obviously, Angell doesn’t doubt the reality of mental illness or the toll it takes on people. Her concern is that it is becoming “harder and harder to be normal.”

Case in point: A National Institutes of Mental Health survey of random adults found that 46 percent met the American Psychiatric Association’s criteria for mental illness at some point in their lives.

Angell calls this finding “astonishing” and asks the obvious question: “Why?”

One answer is the ever-expanding definition of “mental illness.” As Angell pointed out, back in 1968, within most Americans’ lifetimes, the Diagnostic and Statistical Manual, the so-called “bible of psychiatry,” contained 185 diagnoses.

By 1980, it had risen to 265. The 2000 edition reported 365 and the next edition, to be published in 2013, will undoubtedly have more. Among possible new entries is something called “grieving disorder.”

When you think about it, the idea of grief as mental illness is absurd. As the British medical journal The Lancet put it, “Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one.”

Grief is our response to loss and to reminders of our finitude. We grieve because on this side of eternity nothing good lasts forever.

While neither grief nor loss is good in and of themselves, the experience of them can be beneficial: It can help you gain perspective and can make us more resilient. I’m not denying that real suffering is involved, but even if we just muddle through the experience we can become stronger. I’ve given to many friends who are grieving a wonderful book by C. S. Lewis, A Grief Observed.

Of course, there are people for whom grief turns into a debilitating downward spiral. They need and should get professional help. Some people may need medication, but The Lancet is right when it says that, in most cases, “doctors would do better to offer time, compassion, remembrance and empathy” instead of pills.

The journal is also correct when it says that classifying grief as mental illness is part of a larger pattern of “medicalizing” everyday experiences. Instead of being shy, people suffer from “social phobia;” people who were once called “jerks” are now described as having “antisocial personality disorder.”

This is, as Angell tells us, partly driven by our infatuation with pharmaceuticals. A psychiatric label means that there may be a pill that will make it better, and TV ads regularly promote it.

The real problem is that we increasingly see ourselves as biochemical machines with brains instead of souls. What we think and feel is the product of brain chemistry and correcting what ails us is a matter of tinkering with that chemistry.

This worldview has no place for compassion, remembrance, or empathy because, ultimately, it has no room for being human, especially a normal one.

Further Reading and Information

Grief is not a mental illness that should be treated with pills
Lauren Paxman | Daily Mail | February 17, 2012

Grief Is Not a Disorder
Chuck Colson | Two-Minute Warning | February 14, 2012

Living with grief
Editors | The Lancet | February 18, 2012

A Grief Observed
C. S. Lewis | HarperOne | 2001



Mr. Colson, I really appreciate your discussing this issue.

Since February 2011, I have lost my mother, my brother, and a slew of other relatives. Particularly in regard to the first two, my grieving process has definitely not run its course. I am still hit by profound sadness and also a good deal of anger. I hate that my wonderful mother had to go through ALS, and I cannot comprehend why my brother had to live most of his life with a horrible, crippling disease.

Most of the time, I'm doing pretty well. But there are times when it hurts so much that I wish there were a way to get rid of it. That is exactly why what the APA is doing is so dangerous and irresponsible. You are right, Mr. Colson; this is a necessary process for many reasons, and numbing oneself will only ensure that a person doesn't fully deal with it and learn to handle it in an important and meaningful way. Far from being a mental illness, grieving is how we come through this ordeal with our stability and humanity intact.

The prospect of a pill that would make this pain go away is a tantalizing one, even for someone like me who resists taking anything if it's possible to tough it out. Such a medication would be enormously popular--and enormously unethical. The APA has to be the grownup in this situation and tell people that not everything they want is good for them. The role of psychiatry and medicine should not and cannot be to shield us from all unpleasant aspects of life.
Uno momento, por favor
I just have one modest question: What substantial assurance do we have that the people who formulated the APA criteria are "normal"? Blind trust can be a scary thing.
Mental Illness
Everything except being gay, of course. That USED to be an illness and now you're not even allowed to say it's not normal.