8 We are sorely in need of carefully controlled, long-term, prospective studies of recently bereaved (2 to 8 weeks post-loss) patients with major depressive symptoms, compared with comparably Rho kinase activation depressed, nonbereaved patients. These cohorts would be compared with respect to morbidity, mortality, vocational function, and response to psychosocial and somatic treatment. As far as I know, such studies have never been carried out. Inhibitors,research,lifescience,medical That said, several lines of clinical evidence suggest that post-bereavement depression meeting symptom and duration criteria for MDD does not differ substantially from MDD after other types of losses, or after no loss at all.6,9 Roughly analogous controversies

may arise with respect to the construct of CG. To be sure, Prof Shear’s paper in this issue10 convincingly

makes the case for considering CG as a discrete disorder, distinguishable Inhibitors,research,lifescience,medical from both MDD and PTSD, despite substantial areas of overlap. And yet, critics will undoubtedly complain that still another psychiatric category is being created in the service of “medicalizing” grief—what Thomas à Kempis aptly called, “the proper sorrows of the soul.” A subset of those critics will, predictably, see the reification of CG as another example of “disease-mongering”11—no Inhibitors,research,lifescience,medical doubt arguing that it represents yet another attempt to create a market for pharmacological “treatment.” For these critics, there may be no scientific argument that will persuade them of the contrary. Nonetheless, several papers in this issue make a convincing case for viewing CG as a legitimate diagnostic category, worthy of effective and compassionate treatment. This is so, not because CG necessarily “carves Nature at its joints”; but because it usefully identifies a very real instantiation of human suffering and Inhibitors,research,lifescience,medical incapacity12 Inhibitors,research,lifescience,medical To the extent the construct of CG permits us to reduce such misery in our grieving patients, it will gain “instrumental validity” in the sense I have described. In short, by recognizing and treating this condition, we may “ease the pain of living” for those whose grief has gone painfully awry.
Accompanied by his anxious wife, a middle-aged male patient arrives at a rural Michigan hospital.

He suffers from serious and chest pain. The physician in charge, a compassionate-looking woman, suspects acute ischemic heart disease, but is not entirely sure. Should she assign the patient to a regular nursing bed for monitoring? If it really is acute ischemic heart disease, however, the patient needs to be rushed immediately to the coronary care unit. On the other hand, unwarrantedly sending the patient to the care unit is not only expensive, but can also decrease the quality of care for those patients who need it, while those who do not are exposed to the risk of catching a potentially harmful, hospital-transmitted infection. How humans can solve this, and related complex decision-making dilemmas in the medical world, is the central topic of this review article.