Psicólogo. Doctor en Sexualidad, Procreación y Perinatalidad. Profesor asociado, director de postgrado, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile.
Psicólogo. Doctor en Psicopatología Fundamental. Profesor asociado, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile.
Salud Colect. 2019 Oct 24;15:e2319. doi: 10.18294/sc.2019.2319.
Since the incorporation of the major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, and until its update in the DSM-IV-TR, the DSM classification system considered it necessary to include the criterion of "bereavement exclusion", with the aim of differentiating normal sadness linked to a loss, from a mental disorder, such as the major depressive disorder. In its latest version (DSM-5), this exception was removed, giving rise to a controversy that continues to this day. The debate has set those who are in favor of maintaining this exclusion and extending it to other stressors against those who have intended to eradicate it. Our hypothesis is that these positions account for two qualitatively diverse clinical and epistemological matrices, linked to major transformations in health sciences and in psychiatry. We show that this debate involved a profound renewal of the meaning of psychiatric practice, a change in the function of diagnosis and in the way of conceiving the etiology of mental disorders, as well as a reformulation of the patient's suffering status for the medical act.
自 1980 年《精神障碍诊断与统计手册》（DSM-III）纳入重性抑郁障碍以来，直至 DSM-IV-TR 更新，DSM 分类系统认为有必要纳入“丧亲排除”标准，旨在区分与丧失相关的正常悲伤与重性抑郁障碍等精神障碍。在其最新版本（DSM-5）中，这一例外被删除，引发了至今仍在持续的争议。这场争论使那些支持保留这一排除标准并将其扩展到其他应激源的人与那些打算消除它的人形成了对立。我们的假设是，这些立场反映了两种性质不同的临床和认识论矩阵，与健康科学和精神病学的重大变革有关。我们表明，这场辩论涉及到精神病学实践意义的深刻更新，诊断功能的变化以及对精神障碍病因的理解方式，以及对医疗行为中患者痛苦状态的重新表述。
