Another very interesting interview by @awaisaftab with "Peter Zachar, PhD., current President of the Association for the Advancement of Philosophy and Psychiatry. His primary area of scholarship is philosophical issues in psychiatric classification." psychiatrictimes.com/view/psychiatr…
"Aftab: Your discussion of the bereavement exclusion debate in DSM-5 was very illuminating. I don’t think a lot of people realize that there was agreement...that grief-triggered depressions are clinically similar to all other stress-triggered depressions." /1
Aftab, continued "So, there were 3 options: keep the exclusion for grief in place, eliminate the exclusion, or extend the exclusion to all other stress-triggered depressions. The first option was recognized as conceptually inconsistent...." /2
Aftab, continued "but I suppose there can be good pragmatic reasons for a classification system (any classification system) to tolerate conceptual inconsistency in the service of some practical outcome (such as concerns about medicalization of grief)." /3
Zachar: "After the book was published Ken Kendler, Michael First, and I interviewed many of the participants in the bereavement and depression debate and wrote a history of it.7 So far Ken and I have written five of these interview-based histories of the DSM." /4
Zachar: "But in all honesty, the debate helped psychiatrists develop a better understanding of how to distinguish between severe grief and major depressive disorder, which they articulated in the DSM-5." /5
Zachar: "people in severe grief alternate between having sad & happy memories of the person, while in major depressive disorder it is sadness & anhedonia most of the time. Also, in grief, the sadness is focused on the loss, while in depression, the dysphoria encompasses...." /6
Is that how #psychiatrists distinguish between normal but severe grief & major depressive disorder? This is a profession that can diagnose depression in a ham sandwich. All "depression" is subsumed in the DSM-5 under major depressive disorder (MDD), few questions asked. /7
DSM-5 p155 "Major depressive disorder...characterized by discrete episodes of at least 2 weeks' duration....Bereavement-related depression tends to occur in persons with other vulnerabilities to depressive disorders, & recovery may be facilitated by antidepressant treatment." /8
Aftab: "My concern is that there doesn’t seem to be a natural limit to the expansion of the imperfect community [of #psychiatric diagnosis] since much of the psychological landscape is dimensional and similarities may never end." /1
Aftab: "Kraepelin, I imagine, might be astonished if he found out that psychiatrists a century later consider gambling and binge eating to be disorders. I sometimes wonder about the future directions our domain will take." /2
Aftab: "We increasingly view aggression & violence in our society (think mass shootings) as products of obscure/irrational/“pathological”.... This is conceivably just a few steps away from creation of new psychiatric constructs surrounding violence....cause for concern?" /3
Zachar: "Yes...but because of some inherent vagueness in the fuzzy boundary between the normal & the abnormal, there is no magic bullet solution [to creation of diagnoses]....there is no law dictating that the [#psychiatry] domain must always expand. It could also contract." /4
