The Iatrogenic Consequences of Medicalising Grief: Resetting the Research Agenda

When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, there was a firestorm of controversy about the elimination of the bereavement exclusion. Proponents of this change and of the proposed "complicated grief" designation believed that this change would help clinicians recognise major depression in the context of recent bereavement. Other researchers and clinicians have raised concerns about medicalising grief. In 2022 "prolonged grief disorder" (PGD) was officially included in the DSM-5-TR in the trauma- and stressor-related disorders section. Not surprisingly, there has been a push to identify biomarkers and to use neuroimaging to identify the neurobiological basis of PGD. Some researchers have even suggested that PGD is a 'reward circuit disorder' akin to addiction and that naltrexone, an opioid antagonist, may be a promising treatment. The purpose of this paper is to show how medicalising grief reinforces a research agenda dedicated to the search for pharmaceutical and psychological 'magic bullets.' Following George and Whitehouse (2021), we propose that an ecopsychosocial approach-one that incorporates environmental and contextual factors-is needed.