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When the American Psychiatric Association added prolonged grief disorder to its Diagnostic and Statistical Manual of Mental Disorders last fall, the organization’s president, Vivian B. Pender, explained that “the circumstances in which we are living” have made people more susceptible to prolonged bouts of grief. The association noted that in addition to Covid deaths, Americans faced many ongoing disasters, including, at the time, “the wind-down in Afghanistan, floods, fires, hurricanes and gun violence.”

“Check in with yourself” if you’ve lost someone, Dr. Pender recommended. “Grief in these circumstances is normal, but not at certain levels and not most of the day, nearly every day for months. Help is available.”

Dr. Pender’s comments marked the culmination of a process that began about a decade ago, when the association identified prolonged grief as a possible mental disorder, a designation that encouraged researchers and the pharmaceutical industry to fund studies into such matters as the brain chemistry of protracted mourning, the difference between prolonged grief disorder and depression and the merits of various talk and drug therapies. They have identified neural circuits, sharpened diagnostic criteria and developed treatment regimens. There’s even an app for it under study called My Grief.

Critics, including me, have called this yet another intrusion of psychiatry into normal life, pointing out that there are no biological markers to distinguish prolonged grief disorder from normal grieving, whatever that is, and that no one has yet come close to figuring out how neural circuits give rise to any experience, let alone one as complex as grief.

But we must acknowledge that the new diagnosis is already doing exactly what a diagnosis is supposed to do — garnering resources for suffering people and attention to their suffering. The occasions for grief, prolonged or otherwise, do seem to be multiplying, and there is more to mourn than the loved ones lost to Covid or war or climate change. Coupled with our polarized, paralyzed politics, these calamities seem to threaten the foundations of our cultural, political and natural worlds. Turning grief into a mental disorder at least draws notice to the enormousness of the losses we face and to the bereavement that underlies all of them: the loss of the familiar.



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