The arrival of prolonged grief disorder (PGD) as a medical diagnosis - a blessing or a burden?
Earlier this year, the American Psychiatry Association officially included prolonged grief disorder (PGD) as a medical diagnosis in the revised version of Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5-TR. Its addition has sparked a heated debate among grief communities and scientists about the medicalisation of grief in society.
Why was it added?
Grief is a common human experience, which everyone will likely face at one point or another in their life. Nonetheless, researchers like Holly Prigerson from Harvard University argue for a distinction between healthy and pathological bereavement. They believe this distinction could result in better and more appropriate care for those experiencing debilitating symptoms of grief.
Symptoms of pathological grief are considered clinically distinct from symptoms of grief-related depression, since they do not respond as well to antidepressants and psychotherapy. This provides the strongest argument for adding PGD to the DSM as a medical diagnosis - people seeking psychiatric help for grief-related symptoms could otherwise end up with an unhelpful diagnosis, such as depression.
Public controversy - PGD as a form of addiction?
Nonetheless, since PGD was officially included in the DSM text revision, many have expressed their criticism and concern. A particular point of concern is the link that has been made between PGD and addictive disorders. Namely, researchers suggest PGD might be related to a disruption of the reward system in the brain, similar to addiction. Trials have now started to test whether naltrexone, used to treat conditions such as opioid and alcohol addiction, could be used to treat PGD. In the study describing this trial, the authors hypothesize that people with PGD may ‘continue to “crave” their loved ones after they have died, due to the positive reinforcement provided by their memories of loved ones’. Language is powerful and such descriptions of PGD are loaded, leaving a risk of stigmatisation of grief.
Society’s problem with grief
Most importantly, as the researchers have emphasized, PGD was defined to describe only a small portion of bereaved people, and was not intended to medicalise healthy grieving processes. Nonetheless, it may put a large burden on the individual, and leaves out the role of society in providing support for grieving people. As Dr Lucy Selman, associate professor at the University of Bristol in palliative and end of life care, noted in an article by The Guardian, ‘the inclusion in the DSM of a disorder that will only apply to a minority of people is not the answer to the bigger problem: that our society is not good at grief.’ This idea also arose during the talk Good Grief: How do we Support Bereaved People better? at the Cambridge Festival in April of this year. As one of the members in the audience expressed fittingly: she received more support and understanding from her surroundings when she was diagnosed with cancer than when she shared the news of the death of her mother. Whereas a cancer diagnosis still left space for those around her to hope for a better outcome, death is like a full stop. Can modern Western society become more comfortable with the finality of death, and - most importantly - truly make space for the grief that comes with it?
What exactly the PGD label will mean for grief communities remains to be seen, but there is no doubt there is a need for more conversations about grief in society.