Un análisis crítico de los debates acerca del duelo y el trastorno depresivo en la era del Manual Diagnóstico y Estadístico de los Trastornos Mentales

https://doi.org/10.18294/sc.2019.2319

Publicado 24 octubre 2019 Open Access


Francisco Pizarro Obaid Psicólogo. Doctor en Sexualidad, Procreación y Perinatalidad. Profesor asociado, director de postgrado, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile. image/svg+xml , Rodrigo De La Fabián Albagli Psicólogo. Doctor en Psicopatología Fundamental. Profesor asociado, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile. image/svg+xml



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Palabras clave:

Salud Mental, Trastorno Depresivo Mayor, Manual Diagnóstico y Estadístico de los Trastornos Mentales

Resumen


Desde la incorporación del trastorno depresivo mayor en el Diagnostic and Statistical Manual of Mental Disorders (DSM-III) de 1980, hasta su actualización en el DSM-IV-TR, el sistema clasificatorio DSM consideró necesario incluir el criterio de “exclusión por duelo”, con el objetivo de diferenciar la tristeza normal, vinculada a una pérdida, de un trastorno mental, como el trastorno depresivo mayor. En su última versión (DSM-5), esta excepción fue suprimida, dando lugar a una controversia que se extiende hasta nuestros días. El debate ha confrontado a quienes están a favor de mantener y extender la exclusión a otros estresores y aquellos que han querido erradicarla. Nuestra hipótesis es que estas posiciones darían cuenta de dos matrices clínicas y epistemológicas cualitativamente diversas ligadas a las trasformaciones mayores que han experimentado las ciencias de la salud y la psiquiatría. Mostramos que este debate involucró una renovación profunda del sentido de la práctica psiquiátrica, un cambio en la función del diagnóstico y el modo de concebir la etiología de la enfermedad mental, así como, una reformulación del estatuto del sufrimiento del paciente para el acto médico.


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