Is grieving too long a disorder?

What is the correct amount of grief? How much bereavement constitutes an appropriate portion? And when does the expected sorrow of loss cross over into something else to be reckoned with — a mental health problem?

The newest update to the Diagnostic and Statistical Manual of Mental Disorders arrived earlier this month with an expected — if long debated over — addition: the identification of a condition known as “prolonged grief disorder.” The terminology has been over a decade in the making, spurred in part by inquiry surrounding the intersection of bereavement and depression. Yet it arrives now at a moment of uniquely fresh and widepread grief, a time of, as the American Psychiatry Association notes, “several ongoing disasters that have caused death and suffering, such as COVID-19, the wind-down in Afghanistan, floods, fires, hurricanes and gun violence.”

But what makes grief become a classifiable disorder? And should it even really be considered one?

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Grief is an expected — if frequently underestimated — element of all our lives. In contemporary culture, the loss of a loved one may bring a few days off from work, possibly classified as “vacation” time, and flowers and casseroles from friends. Those are all helpful, but there’s often an unspoken expectation to not take too long getting over it. It’s as if it’s somehow excessive to still be actively mourning after a few months.

“The number one thing I hear when people come into my office for the first time is that they think they’re grieving wrong,” author and grief counselor Claire Bidwell Smith told Salon back in 2020. “That’s a lot due to the cultural messages that grief should be short, it should be kept to yourself or hidden, you should get through it quickly. Let’s pack up those boxes. Let’s move on. So people think they’re doing it wrong.”

The external pressure to be productive, to not make others uncomfortable, can make it difficult to conceptualize what healthy grieving is even supposed to look like. But the new parameters for prolonged grief disorder as explicated in the Diagnostic and Statistical Manual of Mental Disorders — considered the psychiatric bible when it comes to defining disorders and diagnosing them — set some clear distinctions for when a person might need help. “The bereaved individual may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents,” says the American Psychiatry Association, “with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

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Dr. Ash Nadkarni, an associate psychiatrist and an instructor at Harvard Medical School, says that she’s observed the phenomenon in her own patients, especially since the pandemic.

“The diagnosis of prolonged grief disorder is indicative of incapacitating feelings of grief,” she says, “with the individual experiencing an intense longing for or preoccupation about the deceased or the circumstances around the deceased person’s death for at least six months after the loss.” Nadkarni adds that “additional symptoms include emotional numbing, identity disruption, disbelief about the death, intense emotional pain and a feeling that life is meaningless.”

Yet as is often the case with the Diagnostic and Statistical Manual of Mental Disorders, or DSM — the publication that used to consider being gay a disorder — there is ample room here to question what is and is not a psychiatric condition. In expanding its criteria over the years for conditions like behavioral addictions and trauma, the publication has spurred debate over overdiagnosis (and ensuing overprescription) and harmful bias. As Sarah Fay, author of “Pathological: The True Story of Six Misdiagnoses,” told Salon recently, “There isn’t a single DSM diagnosis that has an objective measure.” Assigning labels can shape our perception of our emotions and behaviors, so we need to approach the diagnostic process with an understandiing of its limitations.

Kassondra Glenn, a psychotherapist and contributor with Prosperity Haven Treatment Center, says, “The inclusion of prolonged grief disorder has been met with a lot of controversy. On one hand, it has the ability to validate experiences in the context of a diagnosis-centered society. It also has the ability to provide expanded insurance reimbursement to therapists and mental health professionals.”

But, she continues, “On the other hand, there is always the possibility that a diagnosis will be overused. Over-pathologizing grief or abusing the prolonged grief disorder diagnosis has the potential to cause harm. It is always important…