Ronald Pies, MD

Our exchanges be marked by basic respect and civility—and by a willingness to take personal responsibility for what we say and how we say it. Physicians ought to be in the vanguard of such an Internet reformation.

The knock on the door came just after 1 in the morning. A young woman’s panicky voice, muffled through the glass, replied, “I’m looking for my brother’s house! Do you know where he lives?” I pulled back the curtain with the door still locked, and saw a sweaty, disheveled figure . . .

Prejudice is a net that ensnares not only those who suffer from severe psychiatric illness, but also many of us who care for individuals with bipolar and other disorders.

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!”