Gouveia Afonso
Psychiatry Service, Department of Mental Health, Local Health Unit of Baixo Alentejo, Beja, Portugal.
CHRC, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
Front Psychol. 2024 Feb 5;14:1165421. doi: 10.3389/fpsyg.2023.1165421. eCollection 2023.
The enduring question of whether grief can ever be pathological (and, if so, when) has been shrouding mental health and psychiatric care over the last few years. While this discussion extends beyond the confines of psychiatry to encompass contributions from diverse disciplines such as Anthropology, Sociology, and Philosophy, scrutiny has been mainly directed toward psychiatry for its purported inclination to pathologize grief-an unavoidable facet of the human experience. This critique has gained particular salience considering the formal inclusion of prolonged grief disorder (PGD) in the 11th edition of the International Classification of Diseases (ICD-11) and the subsequent Text Revision 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This study contends that the inclusion of prolonged grief disorder as a diagnostic entity may be excessively rooted in Western cultural perspectives and empirical data, neglecting the nuanced variations in the expression and interpretation of grief across different cultural contexts. The formalization of this disorder not only raises questions about its universality and validity but also poses challenges to transcultural psychiatry, due to poor representation in empirical research and increased risk of misdiagnosis. Additionally, it exacerbates the ongoing concerns related to normativism and the lack of genuine cultural relativism within the DSM. Furthermore, the passionate discussion surrounding the existence, or not, of disordered forms of grief may actually impede effective care for individuals genuinely grappling with pathological forms of grief. In light of these considerations, this study proposes that prolonged grief disorder should be approached as a diagnostic category with potential Western cultural bias until comprehensive cross-cultural studies, conducted in diverse settings, can either substantiate or refute its broader applicability. This recalibration is imperative for advancing a more inclusive and culturally sensitive understanding of grief within the field of psychiatry.
在过去几年里,悲伤是否会成为一种病态(如果是,何时会成为病态)这个持久的问题一直笼罩着心理健康和精神科护理领域。虽然这场讨论超出了精神病学的范畴,涵盖了人类学、社会学和哲学等不同学科的贡献,但审查主要针对精神病学,因为它据称有将悲伤病态化的倾向——这是人类经历中不可避免的一个方面。考虑到《国际疾病分类》第11版(ICD - 11)正式纳入了持续性悲伤障碍(PGD),以及随后的《精神疾病诊断与统计手册》第5版文本修订版(DSM - 5 - TR),这种批评变得尤为突出。本研究认为,将持续性悲伤障碍作为一个诊断实体纳入可能过度植根于西方文化视角和实证数据,而忽视了不同文化背景下悲伤表达和解释的细微差异。这种障碍的形式化不仅引发了关于其普遍性和有效性的问题,还对跨文化精神病学构成了挑战,因为实证研究中的代表性不足以及误诊风险增加。此外,它加剧了与规范主义以及DSM中缺乏真正的文化相对主义相关的持续担忧。此外,围绕悲伤的无序形式是否存在的激烈讨论实际上可能会阻碍对真正在与病态悲伤形式作斗争的个人的有效护理。鉴于这些考虑,本研究建议,在进行全面的跨文化研究(在不同环境中进行)能够证实或反驳其更广泛的适用性之前,应将持续性悲伤障碍视为一个可能存在西方文化偏见的诊断类别。这种重新校准对于在精神病学领域推进对悲伤更具包容性和文化敏感性的理解至关重要。