Could grief be a mental disorder?

Abstract

In the fifth edition of the diagnostic manual of the American Psychiatric Association (the DSM), published in 2013, a new diagnosis for complicated grief was included named “Persistent complex bereavement disorder”. When the World Health Organization will publish its next edition of its system, the ICD, in 2018, it is expected that a new diagnosis called “Prolonged grief disorder” will also be included in this manual. In this article, I first briefly present the emerging diagnostic criteria for grief and situate the rise of the psychiatric grief diagnoses in the context of what has been called the “diagnostic culture” of contemporary society. I then raise the question about the legitimacy of diagnoses for complicated grief. I discuss the diagnoses in light of four general theories of mental disorders: The naturalist theory of Boorse, the harmful dysfunction theory of Wakefield, the phenomenological theory in the tradition of Jaspers and the nominalist theory of Bolton. I end with a general discussion of thinking of grief as a mental disorder and recommend a cautious approach, according to which grief should primarily be thought of as an existential condition that may lead to mental disorders, but which is not a mental disorder in itself.

Keywords:

• grief
• mental disorder
• diagnosis
• complicated grief
• psychiatry

Notes

1. Available at https://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1183832314 (accessed by the author 2 May 2017).

2. The research project “The culture of grief” will do this (among other subprojects related to grief in modern society) in the context of Denmark. See more at: www.sorg.aau.dk

3. I do not want to argue that ”giving away” grief to psychiatry would automatically imply that other approaches to the phenomenon – represented by churches, psychotherapists and NGOs – would thereby disappear. However, research and historical experience shows that whenever some condition is categorized as a mental disorder through a diagnostic term, many societal actors begin to see the phenomenon in this light, in part because it becomes possible to obtain funding and political justification from the influential medical system.