Ronald Pies, MD

If claims in the non-professional media can be believed, there is a “raging epidemic of mental illness” in the US, if not world-wide—and, in one version of this narrative, psychiatric treatment itself is identified as the culprit.

Opponents in the now well-worn, “Bereavement Exclusion” debate can probably agree on one thing: of all the proposed changes in the DSM-5, the move to eliminate the bereavement exclusion has ignited the most intense emotional reaction among the general public.

Much of the controversy on the relationship between grief and depression following recent bereavement has focused on whether the so-called “bereavement exclusion” in DSM-IV should be eliminated, as some have proposed, in the DSM-5.

The recent spate of Op-Eds in the New York Times says it all: both the psychiatric profession and the general public have strong feelings about the pending DSM-5—what many in the media like to call “Psychiatry’s Bible.” These emotions are certainly understandable.

The New York Times recently ran a front-page story regarding numerous controversies surrounding the DSM-5, most notably, the issue of eliminating the so-called bereavement exclusion in diagnosing a major depressive episode. Here, Dr Pies responds to Dr John Grohol, Psychologist and Editor of the Psychcentral Web site.

Some months ago, I received a stern admonition from my family doctor. My fasting blood sugar of 99 mg/dL was “right on the border”, he said, and I had better work on bringing it down. “But,” I protested, “when I was in medical school (in the 70s), the normal FBS range went up to 110 mg/dL!” "Well,” he replied a bit huffily, “they changed the criteria!”

When I was a first-year resident, a revered supervisor of mine made the statement—half-facetiously—that, “In psychiatry, you can do biology in the morning and theology in the afternoon!”

I do not hear loud applause for our current antidepressant armamentarium. I believe I hear the sound of one hand clapping.

Dear Mrs. —— You have asked me about the cause of your mood disorder, and whether it is due to a "chemical imbalance."

I am not one who easily loses his temper, but I confess to experiencing markedly increased limbic activity whenever I hear someone proclaim, “Psychiatrists think all mental disorders are due to a chemical imbalance!” In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it.