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Medicalization of Grief

For immediate release December 4, 2012

Dear MISS Foundation families, providers, and supporters,

We are saddened and disappointed by the recent announcement that the DSM-5 task force has finalized the decision to eliminate the bereavement exclusion from the Major Depressive Disorder diagnosis in the upcoming edition of the manual. This move will allow clinicians, including counselors, general physicians, social workers, and psychiatrists, to diagnose a major mental disorder in bereaved parents and other grieving individuals as early as two weeks following the death of a loved one should they meet the DSM-5’s criteria for depression. Importantly, many of you will recognize these criteria which include sadness, feelings of emptiness, crying, sleep and weight changes, guilt and regrets, and loss of interest or energy. Yet, all of these symptoms are quite common in grief, and particularly after the death of a baby or child which evokes enduring and intense reactions in parents.

This move has personal implications for the MISS Foundation. The DSM-5 change increases the likelihood that grief will be misdiagnosed as Major Depressive Disorder in the most vulnerable of all populations.1 The possibility exists that bereaved parents and other grievers will be mistakenly treated for a misdiagnosed mental disorder. Recent trends suggest that the most common form of treatment offered for this disorder is psychotropic medication.2-3 While some medications may be effective for some forms of depression,4 there is no sound evidence that they are effective for grief. Research shows that bereaved parents are already medicated earlier than can be justified by current evidence.5-6 We fear the DSM-5 change will exacerbate this trend and cause even more grieving individuals to be prescribed medication for symptoms which are actually a normative response, despite the lack of evidence to support this practice and a lack of information on how such medications may interfere with the grieving process.

The MISS Foundation has actively opposed this proposed change in DSM-5 and will continue to do so. You can read Dr. Joanne Cacciatore’s initial blog post which went viral in March of 2012 on this topic here.  The first open letter outlining our concerns sent to the American Psychiatric Association in March can be read here and another letter sent in April can be found here. Finally, in October the MISS Foundation issued a formal letter on behalf of the organization and can be viewed here. Finally, many links to research and articles about this issue can be found in this blog entry at the end.

We issue a caution to our families: We urge bereaved individuals to be informed about what this change could mean when seeking help from medical and mental health providers using DSM-5, scheduled to be published next year. Should you have concerns about the quality of medical/mental/emotional care you are being provided, please speak with experts who can help guide you. Get help somewhere, indeed.

Please be assured that many other parents are experiencing the same immense suffering and that you are not alone. Seek solace through skilled and highly trained providers who truly care for you and are willing to walk with you through your darkest times: providers who understand the death of a child as life’s worst tragedy and who will be truly present with and available to you. Seek solace through like others in support groups, online support, and through your community.  Seek solace in spirituality and nature and books that help you to cope as you travel this overwhelming road. Seek solace through self-care and compassion. Seek solace through others who are unconditionally loving whether that be your partner, family, children, animals, or your faith based community. Seek solace through contemplative practice such as prayer, meditation, and quiet time and also through action in service and kindness toward others.

We issue an ardent appeal to providers: The bereaved are a vulnerable population. Please, be mindful and conservative in the issuance of diagnoses and medication, and educate yourselves in evidence-based practices as well as culturally influenced interventions. Take personal responsibility to learn what is truly normal, not pathological, after a traumatic death. The DSM-5 gives you much power and influence over the life of another. Please do not take this responsibility to “do no harm” lightly.

Dr. Joanne Cacciatore, Founder Kara Thieleman, MSW, PhD Student
Karla Helbert, LPC, Facilitator Dr. Melissa Flint, Clinical Psychologist
Jennifer Soos, MFT, Facilitator Dr. Trish Wonch Hill, Policy Analyst
Barry Kluger, CEO Kelli Montgomery, Executive Director
Yasaman Parsi, Grief Counselor Rebecca Ong, MSW, Grief Counselor

References

  1. Wakefield, J. C., & First, M. B. (2012). Validity of the bereavement exclusion to major depression: Does the empirical evidence support the proposal to eliminate the exclusion in DSM-5? World Psychiatry, 11(1), 3-10. doi:10.1016/j.wpsyc.2012.01.002
  2. Mojtabai, R., & Olfson, M. (2008). National trends in psychotherapy by office-based psychiatrists. Archives of General Psychiatry, 65(8), 962-970. doi:10.1001/archpsyc.65.8.962
  3. Olfson, M., & Marcus, S. C. (2010). National trends in outpatient psychotherapy. American Journal of Psychiatry, 167(2), 1456-1463. doi:10.1176/appi.ajp.2010.10040570
  4. Kirsch I., Moore, T. J., Scoboria, A., & Nicholls, S. S. (2002). The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment, 5(1), 23a. doi:10.1037/1522-3736.5.1.523a
  5. Cacciatore, J., Lacasse, J. R., Lietz, C., & McPherson, J. (In press). A parent’s TEARS: Primary results from the Traumatic Experiences and Resiliency Study. OMEGA.
  6. Cacciatore, J., & Thieleman, K. (2012). Pharmacological treatment following traumatic bereavement: A case series. Journal of Loss and Trauma, 17(6), 557-579. doi:10.1080/15325024.2012.688699
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The MISS Foundation is an international 501(c)3, volunteer based organization providing C.A.R.E.S. [counseling, advocacy, research, education and support] services to families experiencing the death of a child.
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MISS Foundation · P.O. Box 9195 · Austin, TX 78766 · info@missfoundation.org · 1-602-279-MISS (6477) · 1-888-455-MISS (6477)

Copyright © 2012 - 2017 MISS Foundation · Site by Visage Creative

Daniel John Coleman Memorial Fund

A family who recently lost their beloved son, brother and nephew, in the most difficult days after his death, found the Carefarm. In gratitude for the compassion and kindness they experienced, they created this dedicated fund in memory of Daniel, and have pledged a $75,000 matching donation from the Daniel John Coleman Memorial Fund to help build a family home for those experiencing the enormity of grief.

Your tax deductible donation will be matched dollar-for-dollar up to $75,000 until December 31, 2018. Our goal is to raise $150,000 in addition to the nearly $150,000 raised to date. When we reach our goal of $300,000, construction of Selah Family House will begin!

Frequently Asked Questions about Selah House

Q: What is the Selah House and Carefarm?
A: This is a place where families can go to give and receive connection, compassion and understanding. All the animals on the carefarm have been rescued from abuse, neglect and torture. Our grieving families know what it means to suffer, and so do these animals. In addition, we teach mediation, yoga, bibliotherapy, and will soon have a family house where families can come and stay on site.

Q: How can I help?
A: We need donations to build the family house on the carefarm. We need your help on the carefarm. We need in-kind donations like supplies, landscape materials, tools, animal feed and tack. If you have something to donate or if you’d like to help on the carefarm please contact us at info@missfoundation.org. Read Yahoo’s feature story about the Selah Carefarm here.

Q: When do you expect the family house to be completed?
A: That depends on the success of this fundraising campaign. Our contractor estimates 9 months once we begin construction.

Q: How can I reserve a place and time to come to the Selah Family House?
A: Please check back here. As we get closer to completion, we will have an inquiry form posted. You can also follow our MISS Foundation Facebook page.

Q: Can I visit the carefarm?
A: Carefarm visits are by appointment only. We are not open to the public but we do have work days. If you would like to attend and volunteer at a work day, follow our Selah Carefarm Page here where we will announce upcoming events. We are also on Instagram at Selah_Carefarm!

Q: How will my funds be used?
A: All funds will be used toward the construction of the family house unless designated otherwise.

Q: Is care farming based on any science?
A: Yes! Carefarming, as a whole and in its individual components, has been shown to help many vulnerable population groups. Many countries in Europe utilize care farming as a humanistic approach to human suffering in vulnerable groups with tremendous outcomes that reduce harm and help people improve coping. And, care farming costs a fraction of treatment as usual. The average day at a carefarm costs between $60-$150. The cost of treatment as usual in an inpatient setting is about $1000- $1100 a day. Learn more about the scholarly literature here.

Q: What is the meaning of Selah?
A: The Selah House is named after the Hebrew word selah and after the Selah Grief Model (Cacciatore, 2011), a mindfulness-based framework that recognizes two foci: self and other, the intrapersonal and the interpersonal, in addition to the space between two beings. Selah derives from the Hebrew word celah, often noted in the book of Psalms meaning 1) pause, stay with what you’ve just experienced; 2) reflect, feel deeply what you’ve just experienced; and 3) find meaning, allowing it to unfold in its time without rushing to the next passage.

Q: What if I or my business wants to make a very large contribution? Are there naming opportunities?
A: For donations of $5,000 or more, please contact MISS Foundation Executive Director Kelli Montgomery, 512-922-3104, kelli.montgomery@missfoundation.org for special dedication requests.

Q: How will the Selah Family House work?
A: Currently, traumatically bereaved people, most often parents, grandparents, and children, come from around the world to work with Dr. Cacciatore. Right now, our facilities can only hold one family at a time, and suffering families in the local area and also from around the world, must wait until the space opens before they can come to get help. There is often a 6-9 month waiting list. When the family house is completed, Dr. Cacciatore and our team will be able to serve more grieving people. In addition, the carefarm will incorporate more rescue animals, a therapeutic farm-to-table program, and other health enhancing activities that an agrarian environment allows.

Q: Though you have a clear, twenty year history of helping people endure traumatic grief, with your current plans, how will you know if the carefarm is helping people in the long term?
A: This is an excellent question. We are fortunate to have already begun to build our core research team with some of the top scholars in their field, including Dr. Joanne Cacciatore, Dr. Rich Gorman, Dr. Jen Huberty, Kara Thieleman and Dr. Trish Wonch-Hill.

This means that we will collect data and longitudinally interview those who have been through our programs. We will be publishing those data in order to encourage more NGOs and agencies seeking to help others learn about care farming. We are also advancing a training program for providers who may want to begin their own carefarm in their communities.

Q: Is the Selah House green and sustainable?
A: Yes. We commit to environmental health, social and economic equity, animal welfare, and overall consciousness raising in our therapeutic community.

Q: What model or framework is going to guide the Selah House?
A: The model (Cacciatore & Gorman, 2016) is based on current carefarming practices, research in therapeutic spaces, and 20 years of experience working with traumatized people from around the world.

 

 

Frequently Asked Questions about Selah House

Q: How can I help?
A: We need donations to build the respite center on the carefarm. We need your help on the carefarm. We need in-kind donations like supplies, landscape materials, tools, animal feed and tack. If you have something to donate or if you’d like to help on the carefarm please contact us at info@missfoundation.org. Read Yahoo’s feature story about the Selah Carefarm here.

Q: When do you expect the respite center to be completed?
A: That depends on the success of this fundraising campaign. Our contractor estimates 9 months once we begin construction.

Q: How can I reserve a place and time to come to the Selah House?
A: Please check back here. As we get closer to completion, we will have an inquiry form posted. You can also follow our MISS Foundation Facebook page.

Q: How will my funds be used?
A: All funds will be used toward the construction of the respite center unless designated otherwise.

Q: Is care farming based on any science?
A: Yes! Care farming, as a whole and in its individual components, has been shown to help many vulnerable population groups. Many countries in Europe utilize care farming as a humanistic approach to human suffering in vulnerable groups with tremendous outcomes that reduce harm and help people improve coping. And, care farming costs a fraction of treatment as usual. The average day at a carefarm costs between $60-$150. The cost of treatment as usual in an inpatient setting is about $1000- $1100 a day. Learn more about the scholarly literature here.

Q: What if I or my business wants to make a very large contribution? Are there naming opportunities?
A: For donations of $5,000 or more, please contact MISS Foundation Executive Director Kelli Montgomery, 512-922-3104, kelli.montgomery@missfoundation.org for special dedication requests.

Q: Can I visit the carefarm?
A: Carefarm visits are by appointment only. We are not open to the public but we do have work days. If you would like to attend and volunteer at a work day, follow our Selah Carefarm Page here where we will announce upcoming events. We are also on Instagram at Selah_Carefarm!

Q: What is the Selah House Carefarm?
A: This is a place where families can go to give and receive connection, compassion and understanding. All the animals on the carefarm have been rescued from abuse, neglect and torture. Our grieving families know what it means to suffer, and so do these animals. In addition, we teach mediation, yoga, bibliotherapy, and will soon have a respite center where families can come and stay on site.

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