Mad in America: Rethinking Mental Health

In March 2022, a new grief-related disorder was officially adopted into mainstream mental health diagnosis nomenclature. Prolonged Grief Disorder (PGD) is a recent addition to the Diagnostic and Statistical Manual fifth edition text revision (DSM-5-TR). A PGD diagnosis is to be used when a person is grieving too long and too intensely.

In this interview, Kaori Wada, Psychologist, grief researcher, and Associate Professor and Director of Training at the University of Calgary, builds upon her recent paper on the Medicalization of Grief in conversation with MIA Science News Writer and Psychologist Zenobia Morrill. Wada articulates a history of institutional tensions and financial conflicts behind the creation of this new PGD diagnosis. She also discusses the ways PGD could shape how we collectively understand and respond to those grieving.

Wada’s work demonstrates that the creation of PGD was not based on scientific findings but appears to be entangled in long-standing arguments between camps of mental health professionals with different stakes in whether the diagnosis became legitimized. Further, PGD, as with other diagnoses, represents elements of mainstream psychological theory that tend to render deviations from Western cultural norms as “unhealthy.” Is diagnosis needed to provide support and care? If so, those most likely to experience marginalization, violence, and unjust loss are also most likely to be classified as having PGD, a mental illness.

At a time when the world is fraught with tragic loss—owing to causes ranging from political failures, state violence, and the COVID-19 pandemic—grieving has been transformed into a mental health disorder. But the complicated question of what a mental disorder is continues to be glossed over. The opportunity for psychiatric professionals to embrace humility seems to have reverted to the familiar “diagnose-and-treat” response. Will pharmacological intervention become the dominant “treat” response to a diagnosis of PGD?

A new grief disorder is a clear departure, however, from the way grief used to be described in the field as an example of something that is clearly not a mental health disorder, Wada shared. She exclaims: “To me, the medicalization of grief is controversial because it may fundamentally shake up the concept of a mental disorder, [how it has] been defined and understood.”

Wada and Morrill explore what this new PGD diagnosis may mean, reflecting on the ways the “diagnose-and-treat” logic seems to of experiences formerly considered part of the territory of being human. The need to pathologize experiences in order to address them represents a paradox. A new ethical and moral quandary befalls professionals tasked with determining when grief is an illness and when expressions of grief are inappropriate.

Will the public embrace this new disorder? Will the medicalization of grief be resisted? Will a pandemic of PGD diagnoses follow a global pandemic? Wada speaks to the personal and professional influences that shaped these curiosities and her approach to researching how grief is being construed in the mental health field.