‘Watchful Waiting’ Not Answer

I endorse the position attributed to Jan Fawcett, M.D., and Ken Kendler, M.D., in “Bereavement Exclusion May Be Gone From New DSM Edition” in the October 21, 2011, issue that diagnosis provides the “possibility” but not the “requirement” that treatment for any psychiatric disorder be initiated. However, in light of the massive education campaign that has been conducted in recent years that depression is an eminently treatable disorder, it is disingenuous, or naive, to think that “watchful waiting” would be adopted as a management measure for major depression any time soon, especially in the subgroup in which bereavement may take its normal course of restitution and remission. It would be even less likely in the case of a majority of patients who are identified by their PCPs.

By removing the last holdout in the meaningful (pun unintended) practice of psychiatry, whether it is logically defensible or not, DSM-5 would play right into the hands of those of our colleagues who consider “psychiatric treatment” synonymous with “psychopharmacology.”

It is ironic that in this very issue of Psychiatric News, the continuing rise of stimulant use for ADHD among teens is lamented.

DILIP RAMCHANDANI

Philadelphia, Pa.