Gurley-Green Sarah, Cosgrove Lisa, Kostic Milutin, Koa Lauren, McPherson Susan
University of Massachusetts, Counseling and Psychology, BEAHR Lab, Boston, Massachusetts, USA.
Department of Psychiatry, Faculty of Medicine, University of Belgrade, Beograd, Serbia.
Sociol Health Illn. 2025 Feb;47(2):e13866. doi: 10.1111/1467-9566.13866. Epub 2024 Nov 28.
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.
2013年，《精神疾病诊断与统计手册》第五版（DSM-5）出版时，关于取消丧亲排除条款引发了一场激烈的争论。这一变化的支持者以及提议的“复杂性悲伤”命名法的支持者认为，这一变化将有助于临床医生在近期丧亲的背景下识别重度抑郁症。其他研究人员和临床医生则对将悲伤医学化提出了担忧。2022年，“持续性悲伤障碍”（PGD）被正式纳入DSM-5-TR的创伤及应激相关障碍章节。不出所料，人们一直在努力寻找生物标志物，并利用神经影像学来确定PGD的神经生物学基础。一些研究人员甚至认为，PGD是一种类似于成瘾的“奖赏回路障碍”，而阿片类拮抗剂纳曲酮可能是一种有前景的治疗方法。本文的目的是展示将悲伤医学化如何强化了一个致力于寻找药物和心理“神奇疗法”的研究议程。继乔治和怀特豪斯（2021年）之后，我们提议需要一种生态心理社会方法——一种纳入环境和背景因素的方法。
