First off, grief is not a mental disorder. It's part of a healthy process after a tragedy..
In most cases, it is a 'simple' process. However, in some, it is not and grief can progress to some quite serious illnesses/issues, including PTSD and suicide to only name a couple. These people that cannot find closure and reach this point need a lot of help - it will not just 'go away'. A proper diagnostic is needed and meds do help.
You mention the word 'stigma' - I think you hit the nail on the head with that.
in my opinion it sends the wrong message one we are hearing an awful lot these days...
make it go away with a pill
I just don't see that as the message here. A pill doesn't make anything 'go away'--it can correct physiological imbalances and helps some individuals deal with, and more easily tolerate, situations that could possibly otherwise deteriorate into things such as redrock mentioned. When you keep saying 'make it go away with a pill', to me that implies abuse, not pharmacotherapeutics. I do not believe that the psychiatric world consists of a group of pill pushers. Prudent practitioners really do recognize the difference between necessity and escapism.
Having bereavement in the DSM isn't saying that it"s not normal. It's just categorizing a particular emotional experience. In a sense, it's even giving more validity to it, not less.
The DSM doesn't drive medications. Over medicating/inappropriate medicating comes from dynamics between particular M.D.s, insurance companies, and pharmaceutical companies.
All I can say is that I was in serious need of anti-depressants for a good chunk of my life.
I was written off as an unruly brat who wouldn't sit still and wouldn't pay attention or as an adult, a lazy scatterbrain. I'd work harder than all my co-workers and still be incapable of focusing on anything.
When I finally broke down and told my doctor that I Thought I was showing signs of early-onset Alzheimer's, we went through my symptoms and he told me he thought I had severe ADHD. It's a disorder caused by a chemical imbalance that, for lack of a better description, causes your brain to process input at a different speed than you take it in.
Once I was on meds, it was very quickly that I was able to function at a normal level and that's when my career and life took off.
I had refused to take meds for years because of the eye-rolling reaction people have to the mention of them. I bought the bullshit that I was just a loser who wouldn't pay attention and allowed people to tell me that "you'll just have to learn to focus." that's like telling a deaf person "you'll just have to listen closer."
I'm sure a lot of people are on meds they don't need. But many need meds and won't take them because of the stigma.
All I can say is that I was in serious need of anti-depressants for a good chunk of my life.
I was written off as an unruly brat who wouldn't sit still and wouldn't pay attention or as an adult, a lazy scatterbrain. I'd work harder than all my co-workers and still be incapable of focusing on anything.
When I finally broke down and told my doctor that I Thought I was showing signs of early-onset Alzheimer's, we went through my symptoms and he told me he thought I had severe ADHD. It's a disorder caused by a chemical imbalance that, for lack of a better description, causes your brain to process input at a different speed than you take it in.
Once I was on meds, it was very quickly that I was able to function at a normal level and that's when my career and life took off.
I had refused to take meds for years because of the eye-rolling reaction people have to the mention of them. I bought the bullshit that I was just a loser who wouldn't pay attention and allowed people to tell me that "you'll just have to learn to focus." that's like telling a deaf person "you'll just have to listen closer."
I'm sure a lot of people are on meds they don't need. But many need meds and won't take them because of the stigma.
Diagnosing ADHD is something that takes more effort and consideration than most others. I think a lot of the over-prescribing with kids in this area happens when the parent takes the child to the family physician for their annual check and describes typical high energy kid behavior as a problem. The doc just thinks there helping out and prescribes the med, which is of course what they're supposed to do with problems in general. But the issue with ADHD is that information needs to be gathered from different areas of the kid's life, in the house, out of the house, at school, and different social settings, in order to make a valid diagnosis. Then, if meds are prescribed, there needs to be good follow up and monitoring. Often, you're seen these things not happen, and you have kids on ADHD meds who don't need to be, but are just out of a result of the parenting, and you have the eye rolling response from people. Of course, this is unfortunate for the kids who really are spinning out and need something.
Diagnosing ADHD is something that takes more effort and consideration than most others. I think a lot of the over-prescribing with kids in this area happens when the parent takes the child to the family physician for their annual check and describes typical high energy kid behavior as a problem. The doc just thinks there helping out and prescribes the med, which is of course what they're supposed to do with problems in general. But the issue with ADHD is that information needs to be gathered from different areas of the kid's life, in the house, out of the house, at school, and different social settings, in order to make a valid diagnosis. Then, if meds are prescribed, there needs to be good follow up and monitoring. Often, you're seen these things not happen, and you have kids on ADHD meds who don't need to be, but are just out of a result of the parenting, and you have the eye rolling response from people. Of course, this is unfortunate for the kids who really are spinning out and need something.
That's absolutely true.
I remember my mother talking with distain about other kids that were "hyperactive" as if they were just obnoxious brats who needed a good slap. Teachers would say things like "Jasun is the smartest kid in my class but he doesn't try and doesn't apply himself" and my parents (mother especially) would fly into a rage, telling me that I was going to be a "n'er d'well son living with me for the rest of my life." I was 13 and getting a B average, but for the child of two university professors, that just wasn't' going to be good enough.
I dont' tell this story to complain... that was back in the 80s when we hadn't heard of ADHD and just wrote bratty kids off as "Hyperactive" and gave them downers. Luckily we now understand a lot more and people are now seeing mental health as something other than shameful.
in my opinion it sends the wrong message one we are hearing an awful lot these days...
make it go away with a pill
I just don't see that as the message here. A pill doesn't make anything 'go away'--it can correct physiological imbalances and helps some individuals deal with, and more easily tolerate, situations that could possibly otherwise deteriorate into things such as redrock mentioned. When you keep saying 'make it go away with a pill', to me that implies abuse, not pharmacotherapeutics. I do not believe that the psychiatric world consists of a group of pill pushers. Prudent practitioners really do recognize the difference between necessity and escapism.
yes my whole post speaks of the need for medication to address illnesses
mental and otherwise
but of course people are running to the doctor requesting medication to
'make things go away' ...
pain, sleep problems, anxiousness, heartburn, etc etc
I wonder how many office visits result in no prescription written,
I'm guessing not many
and if you are forced to watch the daytime commercials about every other one
is for a drug ... often the latest greatest.
Our country, with the new generation most especially, is very drug orientated,
most would not even consider the home remedies of our fore fathers
and many even visit the Doctor for a bad cold. :?
The message to classify grief as an illness/ mental disorder
is indeed telling people go see your Doctor and in some cases
that is exactly what is needed.
I'm not sure about the mental disorder classification though...
that could come back to haunt when out scouting for new insurance.
What is would concern me is how insurance companies, etc. use this info.....
This is what I was curious about initially as well.
Insurance companies need the diagnosis and usually some sort of case notes, plan, and/or goals. It is curious what they do with it. I'm sure there's some number crunching and decisions around what diagnosis is billable, and what's going to be taken off the list in order to save $.
I'm wondering what pushed the changed in the DSM in the OP. On the one hand, the changed couldn't overtly be due to responding to insurance companies, and they may have presented it as: 'we don't want depression in people to be overlooked when someone is grieving'. The pragmatic, but unconsciously driven, economic reason may have been: "I have client's coming into my office with a loved one who just died and they're depressed/grieving. They want to come in a talk to me about it, but I can't bill their insurance for a diagnosis of 'bereavement. I have to tell them they have to pay cash, or refer them elsewhere."
In a sense, insurance companies drive the prescribing of medications because bottom line is it's cheaper and can get results by decreasing symptoms of the presenting problem. Like I said earlier, psychotropic meds should be done with ongoing therapy, with consultation between the parties. Insurance companies make this more difficult because they've been decreasing coverage/raising the threshold for what's billable, and what isn't (and limiting # of sessions based on diagnosis and intensity of the problem). The Psychiatrists role gets more and more limited to quick assessments, prescribing from there, and brief check-ins maybe every 4-8 weeks. M.D.'s time is crazy expensive, and they aren't going to accept weekly billing for therapy sessions with the same client. A way to overcome this problem is ongoing consultation between master's level mental health providers, and the prescriber. Downside, I've never seen or have been able to do consultation with family physicians. Either it's not their thing or they don't have time.
My 2 cents side note: Dealing with Medicaid is way more efficient than dealing with private insurance companies, and less ethically challenging.
When we did offer health plans to our employees I had two employees who were not accepted
into the main group plan, this because both were on medication for mental disorders,
both under treatment. I do not know the extent of their illness.
Each time our agent found individual plans for them that were much more costly ...
this is also a problem for those who had sought help for substance abuse
previously.
IL no longer offer health plans as it became ridiculously expensive for both us and employee.
We have all since found individual plans at a fraction of the cost.... half the cost.
I'm wondering what pushed the changed in the DSM in the OP. On the one hand, the changed couldn't overtly be due to responding to insurance companies, and they may have presented it as: 'we don't want depression in people to be overlooked when someone is grieving'. The pragmatic, but unconsciously driven, economic reason may have been: "I have client's coming into my office with a loved one who just died and they're depressed/grieving. They want to come in a talk to me about it, but I can't bill their insurance for a diagnosis of 'bereavement. I have to tell them they have to pay cash, or refer them elsewhere."
In a sense, insurance companies drive the prescribing of medications because bottom line is it's cheaper and can get results by decreasing symptoms of the presenting problem. Like I said earlier, psychotropic meds should be done with ongoing therapy, with consultation between the parties. Insurance companies make this more difficult because they've been decreasing coverage/raising the threshold for what's billable, and what isn't (and limiting # of sessions based on diagnosis and intensity of the problem). The Psychiatrists role gets more and more limited to quick assessments, prescribing from there, and brief check-ins maybe every 4-8 weeks. M.D.'s time is crazy expensive, and they aren't going to accept weekly billing for therapy sessions with the same client. A way to overcome this problem is ongoing consultation between master's level mental health providers, and the prescriber. My 2 cents side note: Dealing with Medicaid is way more efficient than dealing with private insurance companies, and less ethically challenging.
The first part is where my head was on it, too. I also strongly agree with your point about ongoing consultation between master's level providers and prescribers. I think that would be the optimal solution to address the issue with meds and therapy concomitantly. And you are spot on in that, ideally, the family practitioner should be involved; the lack of communication between providers is something that I haven't been able to wrap my head around for a long time.
Comments
You mention the word 'stigma' - I think you hit the nail on the head with that.
I was written off as an unruly brat who wouldn't sit still and wouldn't pay attention or as an adult, a lazy scatterbrain. I'd work harder than all my co-workers and still be incapable of focusing on anything.
When I finally broke down and told my doctor that I Thought I was showing signs of early-onset Alzheimer's, we went through my symptoms and he told me he thought I had severe ADHD. It's a disorder caused by a chemical imbalance that, for lack of a better description, causes your brain to process input at a different speed than you take it in.
Once I was on meds, it was very quickly that I was able to function at a normal level and that's when my career and life took off.
I had refused to take meds for years because of the eye-rolling reaction people have to the mention of them. I bought the bullshit that I was just a loser who wouldn't pay attention and allowed people to tell me that "you'll just have to learn to focus." that's like telling a deaf person "you'll just have to listen closer."
I'm sure a lot of people are on meds they don't need. But many need meds and won't take them because of the stigma.
Diagnosing ADHD is something that takes more effort and consideration than most others. I think a lot of the over-prescribing with kids in this area happens when the parent takes the child to the family physician for their annual check and describes typical high energy kid behavior as a problem. The doc just thinks there helping out and prescribes the med, which is of course what they're supposed to do with problems in general. But the issue with ADHD is that information needs to be gathered from different areas of the kid's life, in the house, out of the house, at school, and different social settings, in order to make a valid diagnosis. Then, if meds are prescribed, there needs to be good follow up and monitoring. Often, you're seen these things not happen, and you have kids on ADHD meds who don't need to be, but are just out of a result of the parenting, and you have the eye rolling response from people. Of course, this is unfortunate for the kids who really are spinning out and need something.
That's absolutely true.
I remember my mother talking with distain about other kids that were "hyperactive" as if they were just obnoxious brats who needed a good slap. Teachers would say things like "Jasun is the smartest kid in my class but he doesn't try and doesn't apply himself" and my parents (mother especially) would fly into a rage, telling me that I was going to be a "n'er d'well son living with me for the rest of my life." I was 13 and getting a B average, but for the child of two university professors, that just wasn't' going to be good enough.
I dont' tell this story to complain... that was back in the 80s when we hadn't heard of ADHD and just wrote bratty kids off as "Hyperactive" and gave them downers. Luckily we now understand a lot more and people are now seeing mental health as something other than shameful.
mental and otherwise
but of course people are running to the doctor requesting medication to
'make things go away' ...
pain, sleep problems, anxiousness, heartburn, etc etc
I wonder how many office visits result in no prescription written,
I'm guessing not many
and if you are forced to watch the daytime commercials about every other one
is for a drug ... often the latest greatest.
Our country, with the new generation most especially, is very drug orientated,
most would not even consider the home remedies of our fore fathers
and many even visit the Doctor for a bad cold. :?
The message to classify grief as an illness/ mental disorder
is indeed telling people go see your Doctor and in some cases
that is exactly what is needed.
I'm not sure about the mental disorder classification though...
that could come back to haunt when out scouting for new insurance.
Insurance companies need the diagnosis and usually some sort of case notes, plan, and/or goals. It is curious what they do with it. I'm sure there's some number crunching and decisions around what diagnosis is billable, and what's going to be taken off the list in order to save $.
I'm wondering what pushed the changed in the DSM in the OP. On the one hand, the changed couldn't overtly be due to responding to insurance companies, and they may have presented it as: 'we don't want depression in people to be overlooked when someone is grieving'. The pragmatic, but unconsciously driven, economic reason may have been: "I have client's coming into my office with a loved one who just died and they're depressed/grieving. They want to come in a talk to me about it, but I can't bill their insurance for a diagnosis of 'bereavement. I have to tell them they have to pay cash, or refer them elsewhere."
In a sense, insurance companies drive the prescribing of medications because bottom line is it's cheaper and can get results by decreasing symptoms of the presenting problem. Like I said earlier, psychotropic meds should be done with ongoing therapy, with consultation between the parties. Insurance companies make this more difficult because they've been decreasing coverage/raising the threshold for what's billable, and what isn't (and limiting # of sessions based on diagnosis and intensity of the problem). The Psychiatrists role gets more and more limited to quick assessments, prescribing from there, and brief check-ins maybe every 4-8 weeks. M.D.'s time is crazy expensive, and they aren't going to accept weekly billing for therapy sessions with the same client. A way to overcome this problem is ongoing consultation between master's level mental health providers, and the prescriber. Downside, I've never seen or have been able to do consultation with family physicians. Either it's not their thing or they don't have time.
My 2 cents side note: Dealing with Medicaid is way more efficient than dealing with private insurance companies, and less ethically challenging.
into the main group plan, this because both were on medication for mental disorders,
both under treatment. I do not know the extent of their illness.
Each time our agent found individual plans for them that were much more costly ...
this is also a problem for those who had sought help for substance abuse
previously.
IL no longer offer health plans as it became ridiculously expensive for both us and employee.
We have all since found individual plans at a fraction of the cost.... half the cost.