ABSTRACT
Medicalization refers to the process of how behaviors that were not seen as medical conditions in the past come to be defined and treated as illnesses. Before the publication of the Diagnostic and Statistical Manual, fifth edition, in 2013, grief after the death of an intimate was a major exception to the psychiatric profession’s medicalization of mental distress. The bereavement exclusion (BE) in previous DSMs, following a long historical tradition, explicitly excluded grieving people who otherwise met the criteria for Major Depressive Disorder (MDD) from a diagnosis. The BE also reflects evolutionary views that grief is a normal biological reaction to a serious loss. This exclusion raised the question of why depressive symptoms that arise after other kinds of losses – for example, romantic, employment, aspirations, or health – should also not be considered to meet the MDD criteria. A number of empirical studies show how the nature and course of these losses are far more similar to cases of excluded bereavement than to cases of non-loss-related MDD. These studies suggest that, rather than being exceptional, the bereavement exclusion should serve as a model for proportionate sadness that develops after many kinds of losses. This chapter views the major controversy that these findings produced and the subsequent elimination of the bereavement exclusion from the DSM-5. The result greatly expanded the medicalization of normal distress.
