Doing Harm: The Human Cost of Turning Mourning Into a Disorder

Grief has long been understood as a normal and healthy response to loss. However, over the past decade, American psychiatry has rebranded that time of mourning, altering diagnostic criteria to allow for grievers to be diagnosed with a mental “illness” just two weeks after losing a loved one. This often leads to grief being treated with a prescription for antidepressants or other psychiatric drugs meant to treat addiction.

The first major step towards psychiatry’s repackaging of grief as a disease came in 2013 with the DSM’s removal of the bereavement exclusion for depression diagnoses. This was followed in 2015 by a similar removal of the “uncomplicated bereavement” code in the ICD. This change allowed psychiatrists to diagnose a griever as having a depressive episode just two weeks after losing a loved one.

In addition to a depression diagnosis, the diagnosis of prolonged grief disorder (PGD) was added to the ICD in 2018 and the DSM in 2022. This diagnosis is separate from depression and can be made 12 months after losing a loved one. This effectively limits “normal” grieving to one year. After this time period, psychiatry considers many forms of grief a pathology in need of treatment.

Critics of this rebranding of grief as pathological have noted that it serves the interests of the pharmaceutical industry. Similar instances of this kind of rebranding include hypoactive sexual desire disorder being used to sell addyi and postpartum anxiety’s role in marketing zuranolone. Critics have also observed that the majority of DSM-5 panel members, the people that created the latest DSM and rebranded grief this way, have ties to the pharmaceutical industry.

A new article published in Death Studies pushes back against the framing of grief as a disease in need of treatment. This research, authored by Kara Thieleman and Joanne Cacciatore from Arizona State University, and Vincent Mangiapane from the Michigan School of Psychology, found that most people going through grief do not consider grief related diagnoses helpful. In addition, even the minority of participants who said they would find a diagnosis helpful did so for instrumental reasons, such as justifying time off work or insurance payments for grief counseling. Most participants viewed grief as a normal response to loss, rejecting the idea that it should be treated as a mental “illness.”

“When we medicalize and pathologize grief, we lose sight of what grief actually represents: love, attachment, and the rupture of a meaningful bond,” Thieleman said, in an interview by email. “Bereavement is a universal human experience. We do not grieve those we do not love. Framing grief as a disorder obscures this fundamental reality and recasts a deeply relational experience as an individual pathology.”

Thieleman added:

“Pathologizing grief also narrows our understanding of suffering. Some experiences in life – such as the death of a child, a partner, or a sudden and violent loss – are profoundly painful in ways that are both enduring and proportionate to what was lost. In our study, many respondents emphasized that their grief was intense precisely because their love was deep, not because something was ‘wrong’ with them.”

Methods

The goal of the current work was to explore grievers attitudes towards pathologizing grief. To achieve this goal, the authors recruited participants through bereavement organizations in August 2022. Participants were given an anonymous online survey asking about their demographic information and their loss. Participants also completed the Prolonged Grief-13-Revised (PG-13-R) scale, an assessment tool used to measure the supposed symptoms of PGD.

Additionally, participants were asked “if you were told by a professional that your grief was a mental disorder, how helpful or unhelpful would you find this?” Participants rated their answer on a 5 point scale that ranged from “very unhelpful” to “very helpful”. They were then invited to expand on their answer with the following prompt: “Can you say more about why you answered that way.” The current study presents results from the 755 participants that answered these two questions.

Results

The overwhelming majority of participants were female (91%) and white (89%). Most were between 45 and 64 years old (54%) and reported losing a child (56.8%). More than a third of participants met the criteria for a PGD diagnosis (36%) and 44% reported reduced function as part of their grieving. Nearly every participant (98%) believed their response to loss was normal and understandable.

Most participants reported that a grief diagnosis would be somewhat or very unhelpful (72.2%) with 11.4% saying it would be helpful and 16.4% unsure. These numbers were similar when analyzing only those participants meeting the criteria for PGD, with 68.2% saying the diagnosis would be unhelpful, 13.4% saying it would be helpful, and 18.4% unsure.

The authors also identified four themes present in participants’ explanations of how they rated the helpfulness of a grief diagnosis: grief as the measure of love, emotional and existential harms of pathologizing grief, medicalization and contextualization within systems of care, and finding utility within the language of disorder.

“Collectively, these themes illuminate central tensions in the cultural politics of grief: between the normalcy of grief and its capacity to disrupt functioning, between personal meanings of loss and social expectations of recovery, and between professional authority and the need for compassionate witnessing,” they wrote. “Responses suggest grief is a profoundly personal, painful, yet normal expression of love and, for a minority, an experience whose recognition with a diagnostic label might offer legitimacy or access to care.”

Grief as the Measure of Love

According to the authors, grief as the measure of love was the predominant theme throughout participants’ responses. One participant said “grieving is normal. The deeper the love the deeper the grief.” Replies emphasized the normalcy of grief and insisted it was not a mental health problem: “It’s not a disorder. I wasn’t mentally ill before my child’s death. I’m not mentally ill afterwards. Just heartbroken.”

From this perspective, many participants viewed pathologizing grief as trivializing the love they had for the people they lost. One participant said: “My grief is my love and the ongoing connection I have to my son. Calling it a mental disorder would be hurtful and wouldn’t provide any useful help.”

Some participants acknowledged that grief could lead to mental health issues, such as anxiety and depression, but maintained that grief itself was not a mental health issue. “I think grief can cause mental health challenges like depression or anxiety. But being told my grief was a disorder would make me feel like it wasn’t normal or natural to feel that pain.”

Emotional and Existential Harms of Pathologizing Grief

Many participants were concerned at the consequences of pathologizing grief. Some felt “it would belittle the loss.” Others worried about potential stigma associated with mental health labels: “Being told something is ‘wrong’ with you at the time of a deep loss would further alienate and shame someone.”

Some participants expressed problems with social pressure to place limits on their grief, viewing a diagnosis as lending credibility to this demand. Others believed the label would serve little purpose and provide no benefit outside of questionably useful drugs: “What does it matter what its labeled? I don’t need a label…. I don’t want medication for it but that is all anyone or insurance is willing to pay for.”

Medicalization and Contextualization Within Systems of Care

Participants often resisted medicalizing their grief and expressed concerns about professionals that were willing to do so. One participant argued simply that”grief is normal. It would be a sign that the professional in question doesn’t understand that. ” Many participants also reported that mental health systems were incapable of dealing with grief and were resistant to the idea of taking drugs to treat it. One said “grief is not an illness and can’t be cured through medication.” A few participants also believed only professionals that did not have first-hand experience of profound loss would suggest treating it as a mental health issue.

Finding Utility Within the Language of Disorder

Some participants said a diagnostic label could be useful for things like sick leave from work, and getting reimbursed for grief counseling, but still insisted that grief itself was not pathological. Some also expressed that a diagnosis may legitimize and normalize their pain, making them feel less isolated in their grief.

Limitations

The authors acknowledge several limitations to the current work. The anonymous, online data collection methods means they were not able to ask clarifying questions or obtain additional information from participants that could have made the data more robust. The self-selecting nature of the sample could also have biased the data. As all the participants were recruited from bereavement organizations, they may differ in their beliefs around grief from the general population. A representative sample may provide a better estimate of the general population’s feelings towards the PGD diagnosis. The sample being overwhelmingly female and white also limits generalizability to other populations.

The Costs of Medicalizing and Pathologizing Grief

In their email interviews with Mad in America, both Thieleman and Cacciatore emphasized that this diagnosis is harmful.

“When we pathologize grief, we promote myths and misunderstandings about what ‘normal’ grief looks like, particularly under traumatic circumstances, at a societal level,” Cacciatore said. “People begin to mistrust themselves, in my personal and professional experience, and this can devastate the very structure of self, potentially further injuring grievers. And, we lose something essential and irreplaceable: We lose the recognition that grief is not an illness to be cured, but a profound response to love, attachment, and rupture. Even nonhuman animals grieve. Grief is evidence that a relationship mattered. When we reduce it to symptoms, timelines, and diagnostic thresholds, we risk stripping it of its moral, relational, and existential meaning. We turn a sacred experience into a problem to be curtailed, managed, and medicated rather than a painful journey to be witnessed and accompanied.”

The diagnosis, they noted, recasts memories and bonds to lost loved ones as pathological. This robs the the bereaved of important rites and rituals as well as jeopardizing essential social support systems.

“Many grievers experience pressure to “move on,” to focus exclusively on the living, and to minimize ongoing connection with the dead,” Thieleman said. “This can lead people to hide their memories and bonds, depriving them of communal rituals, storytelling, and acts of remembrance that have long helped humans integrate loss and which can also facilitate meaningful social support.”

She added: “In our data, respondents frequently resisted this framing, emphasizing that remembering and loving someone who has died is not a failure to heal but a reflection of the enduring significance of that relationship. When grief is pathologized, the life and meaning of the person who died can feel diminished alongside the griever’s experience.”

Cacciatore had similar concerns about the lasting harm to our memories.

“The medicalization of grief can also alter how our dead are remembered. When grief is framed as a disorder, the focus moves away from the life that was lived and the relationship that endures, and toward the mourner’s functioning, productivity, and compliance with ‘treatment’. The person who died becomes secondary to a diagnosis assigned to the griever. Grieving is no longer a testament to enduring bonds but a clinical obstacle to be overcome and remedied. In that process, memories of the person who died can become something to manage and suppress rather than something to honor and cherish.”

Cacciatore recalls her own experience with traumatic loss, reporting that psychiatry had little to offer other than a diagnosis:

“When my own daughter died, I sought psychotherapy. I saw four or five providers in 1994/1995 and walked out of every office before the session was done. Within minutes, every one of them explicitly or implicitly suggested that I was (capital d) depressed (in other words, Major Depressive Disorder). But my child had just died, I had very little social support, I had social stressors (low socioeconomics), and so a wiser voice in my head just could not accept that I was, what they called, mentally ill … not everyone knows, intuitively, how to push back against an oppressive system, against diagnostic coloniality. And what happens to those grievers is shameful and heartbreaking …

I just wanted someone to listen; to listen to the story of the trauma of her death, and the intense emotions I was feeling, and the thoughts that swirled in my head. I needed a safe place to be witnessed. Instead, I was met with an emotionally zygotic system of providers who did not know how to create a safe and intimate relationship with me and my grief. I got the same responses from society in general. It was the loneliness of grieving that was one of the most painful things for me in the early years.”

Pathologizing grief, Thieleman said, threatens to cover up systemic and societal failings around making space for rituals of mourning.

“Medicalization further shifts attention away from social, relational, and structural factors that shape how grief is experienced and supported. Rather than asking how families, workplaces, communities, and cultures respond to loss, we focus almost exclusively on the individual. This risks overlooking how inadequate support, social isolation, time pressures, and cultural discomfort with grief can compound suffering.”

A Callous System

Participants reporting that a grief diagnosis would be helpful often did so not because they believed grief to be a mental health issue, but for instrumental reasons such as getting time off work or reimbursements for grief counseling. Some also believed that a diagnosis may legitimize their suffering. This reveals something deeply wrong with the systems in place that refuse to accommodate un-pathologized grief.

“It is concerning that the well-documented emotional, cognitive, and physical impacts of grief must be cast as a mental disorder in order to be taken seriously,” Thieleman said. “It is unfortunate that our systems often require a psychiatric diagnosis before offering care or accommodation. Framing grief as a disorder also narrows what we imagine as appropriate responses, privileging medications or individual therapy aimed at correcting a perceived deficit in the person while eclipsing addressing relational, communal, and structural forms of support many grievers say they need …

A more humane approach would be to recognize bereavement itself as a significant life stressor deserving of care, flexibility, and support without requiring it to be labeled as a mental disorder. Suffering does not automatically equal pathology. Our current systems often fail to recognize this distinction.”

Cacciatore added: “The system is clearly broken.” She points to the removal of the uncomplicated bereavement code from the ICD as a root of systematic demands for pathologized grief. This code allowed for the bereaved to receive counseling without being diagnosed with a mental disorder. The removal of this code, which Cacciatore fought, means that many grievers must receive a diagnosis before they can use certain services, and that the bereaved can be diagnosed with a mental illness just two weeks after losing a loved one. Cacciatore observes “to me, that’s almost like an article in the The Onion. It’s so absurd that it can’t be real: yet it is.”

She continues:

“The finding that many of the minority who reported a grief diagnosis as helpful do so because it provides access to basic protections like sick leave, disability benefits, or time away from work, not because it reflects their lived experience, is disturbing. Fewer others described feeling that the diagnosis legitimized their emotional pain. This too should deeply trouble us. In the systems we inhabit, grief is not taken seriously unless it is framed as a disease. Suffering must be translated into medical language before it is granted credibility. Love alone is not enough. Loss alone is not enough. One must be diagnosed to be believed. This feels disastrous to me as a grieving mother, and should be a call for legislative change.”

Indeed, the authors of this study see a need for our society to go beyond critiques of the diagnosis, and to confront the social factors that made this diagnosis possible.

“As a field, we should be asking harder questions about power,” Cacciatore said. “Who benefits when grief is pathologized? Who is protected, and who is at the highest risk of being harmed? We should be asking why our social and economic systems are so inhospitable to grief that people must adopt a ‘noble lie’ to receive care and benefits. And we should be asking how we can reorient practice, policy, and workplace norms toward presence, flexibility, and dignity rather than surveillance and judgment.

Perhaps the most important question is not whether grief should be diagnosed, but what kind of world requires grieving people to be labeled before they can receive care. Grief should not need to be legitimized by medicine. It is already legitimate because love is legitimate. Our task is not to fix grief, but to create communities and systems capable of bearing witness to life’s most catastrophic losses.”

The bereaved want understanding, not labels, Thieleman concluded.

“One thing our findings make clear is how deeply bereaved individuals want to be understood, not categorized. Many respondents were not rejecting help – they were rejecting a framework that felt invalidating, reductive, or disconnected from their lived experience. Grief care that is trauma-informed, context-sensitive, and relationally grounded aligns far more closely with what most bereaved people say they need.”

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Thieleman, K., Cacciatore, J., & Mangiapane, V. (2025). “I would feel misunderstood and diminished:” perceived helpfulness of a grief diagnosis among grievers. Death Studies, 1–11. (Link)