Abstract
In a recent trial [1], Cox, Chief Justice, found that the mental state of two people was ‘atypical and abnormal’ and ‘so unusual as to indicate an abnormality of their minds such as can be fairly described as indicative of disease’, even though the diagnostic criteria for a DSM-IV-TR [2] listed disorder were not met.
The case concerned the parents of a 26-year-old man who died in a motor vehicle accident. At the funeral parlour, they spent an hour with the deceased, but then spent the night outside in their car. Three-and-a-half years later, they continue to behave in an ‘atypical and abnormal’ manner. They have maintained their son's flat as ‘a shrine’; they spend 25% of their time there, and 75% at their own home. The father was unable to return to work for two-and-a-half years, and has lost interest in humour and reading. The mother spends most of the day in bed and visits the grave most days of the week. She is sometimes at the grave at midnight and at other out-of-hours times. Further details are available in the trial transcript [1].
One psychiatrist considered both parents were grieving and suffering major depressive disorder. Two other psychiatrists believed that sufficient criteria were not met to support a diagnosis of major depressive disorder, and the judge agreed.
The second psychiatrist stated the parents were experiencing ‘severe bereavement’ and the third stated that they were ‘suffering from an abnormal grief reaction, the correct diagnosis being one of bereavement’. Neither considered that a psychiatric disorder was present, stating that bereavement was a ‘normal process’ and that abnormally arrested grief was not a recognized illness. Counsel for the defendant submitted that if a condition was not tabulated as a psychiatric disorder in DSM-IV-TR, it could not be regarded to be so.
In his judgement, Cox CJ reviewed the precedents. It has been established in law that damages are not recoverable for normal grief. Statements have been made that for recovery, there must be ‘recognizable psychiatric illness’. However, in one case it was decided that damages were recoverable for ‘some form of psychoneurosis or psychosomatic illness’, and in another, for ‘an unresolved and atypical bereavement reaction’.
In the case under discussion, Cox CJ found that ‘their grief was so intense and their ability to adjust to it so unusual as to indicate an abnormality of their minds such as can be fairly described as indicative of disease’. Abnormal grief reaction or a similar designation does not appear in the DSM-IV, and on this basis, it can be argued that abnormal grief reaction is not a mental disorder. However, DSM-IV-TR (p. xxx) admits that ‘no definition adequately specifies precise boundaries for the concept of mental disorder’, and continues that a mental disorder is a ‘clinically significant behavioural or psychological syndrome… associated with present distress… or disability’.
There will probably always be a difference in the legal and medical views of psychopathology. This case encourages psychiatry to re-examine the definition of mental disorder and the status of abnormal grief reaction within the pantheon.