When Grief Mimics Depression: A Call for Context in Mental Health Diagnosis
A psychiatrist warns against overdiagnosing mental illness in patients experiencing intense but normal emotional responses to life events like loss, job change, or relationship breakdown. The article emphasizes that symptoms such as insomnia, poor concentration, and appetite changes are common reactions to stress and do not automatically indicate clinical depression or anxiety. It urges clinicians to prioritize patient context over standardized screening tools to avoid pathologizing ordinary human suffering.
In November 2026, psychiatrist Devina Wadhwa, MD, published a reflective essay in MedPage Today titled “Do We Diagnose Too Much Normal Distress?” The piece centers on clinical concerns about overdiagnosis in psychiatry, particularly when patients present with symptoms like insomnia, poor concentration, and appetite changes following significant life events such as the death of a loved one, job loss, or relationship breakdown. While these symptoms align with standardized screening tools like the PHQ-9 or GAD-7—commonly used in clinical settings—the article argues that such tools often fail to capture the essential context of a patient’s lived experience. Wadhwa emphasizes that grief and acute stress are not inherently pathological, even when they manifest with clinically recognizable symptoms. The core issue lies in the tension between medicalizing normal emotional responses and missing genuine psychiatric illness. The essay references no specific patients by name, nor does it cite statistical data on overdiagnosis rates, but it draws on clinical experience to question the growing reliance on brief assessments in time-constrained healthcare environments. The broader implications involve a shift in how mental health professionals interpret distress—prioritizing narrative and context over algorithmic scoring.
Wadhwa’s essay could influence clinical practice by prompting psychiatrists and primary care providers to reconsider the role of screening tools in initial evaluations, potentially leading to more nuanced assessments that prioritize patient history. This may reduce the risk of pathologizing grief or stress-related symptoms, especially among vulnerable populations such as bereaved individuals or those experiencing major life transitions. However, it also raises concerns about underdiagnosis—particularly for patients whose symptoms evolve into clinical depression or anxiety after a triggering event. The article echoes earlier debates around the DSM’s inclusion of bereavement in depressive disorder criteria, which was controversially revised in 2013 to allow for diagnosis within two weeks of loss. That change sparked widespread discussion about medicalization and cultural norms around mourning. Today, similar tensions may resurface as digital health tools proliferate and time pressures in