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In a November 1, 2026, MedPage Today opinion essay, psychiatrist Devina Wadhwa argues that clinicians should not equate distress after events such as bereavement or job loss with a psychiatric disorder without considering context. She also cautions that a life event does not rule out mental illness, and says assessment should include symptoms, duration, functioning and safety.
Psychiatrist Devina Wadhwa argues that clinicians should look beyond symptom checklists before diagnosing psychiatric illness in people experiencing distress after events such as bereavement, a breakup or job loss. In a November 1 MedPage Today opinion essay, she says life context matters to diagnosis while warning that understandable causes do not rule out serious illness.
Wadhwa describes people who cannot sleep after a relationship ends, lose their appetite after a death or struggle to concentrate after losing a job. Such experiences can overlap with symptoms of depression or anxiety, she writes, but symptom overlap alone does not settle the diagnosis. She questions whether brief telehealth assessments and screening questionnaires can capture enough about what has happened in a patient’s life.
She does not argue that screening tools or diagnosis have no place. Wadhwa says psychiatric conditions can cause severe suffering, and that diagnosis can help patients make sense of their experiences and guide treatment. She writes that medication, psychotherapy, hospitalization and other interventions have changed and saved lives. Her concern is that a questionnaire should support, not replace, clinical assessment.
In grief, Wadhwa says, the distinction can be complicated: bereavement and major depression may occur together, but depressive symptoms after a loss do not automatically establish a depressive disorder. She calls for clinicians to consider what happened, how long symptoms have lasted, changes in functioning, whether symptoms are changing and whether the person is at risk, as well as how the patient was doing before the event.
Why Context Shapes Psychiatric Diagnosis
The distinction matters because a diagnosis can influence how patients understand their experience, as well as their treatment and care. Wadhwa contrasts seeing oneself as devastated by the death of someone loved with seeing oneself as having a psychiatric disorder, while noting that both descriptions can be true at once.
Her argument points to a clinical balance: treating every painful response as illness could medicalize ordinary suffering, while dismissing distress as an expected reaction could miss a serious condition. Wadhwa says clinicians must avoid both errors, particularly when symptoms are severe, persistent, impairing or connected to safety concerns. The essay is a psychiatrist’s perspective, not a new study measuring how often patients are overdiagnosed.
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Symptoms Can Follow Life Events
Wadhwa’s essay concerns a challenge specific to mental health assessment: many symptoms used to identify psychiatric conditions, including sadness, worry, insomnia and poor concentration, can also occur during difficult life events. A symptom score can identify experiences that warrant attention, but, she argues, it cannot by itself explain their cause or determine whether they meet the threshold for a disorder.
The author presents diagnosis as useful when it helps guide care, while cautioning against treating it as merely a billing code or automatic label. Her proposed focus is the patient’s full account, including the timeline, degree of change and effect on daily life. She emphasizes that context informs judgment but does not provide a simple rule for deciding whether someone is ill.
Where Distress Becomes Illness
The essay does not set out a new diagnostic test, a fixed timeline for grief or a universal threshold separating ordinary distress from a psychiatric disorder. Wadhwa says there is no simple answer in cases such as bereavement, and that clinical judgment is needed. The article also provides no data establishing how frequently clinicians overdiagnose normal distress or how screening practices affect diagnosis rates.
It remains a case-by-case assessment whether symptoms reflect a psychiatric condition, a response to a life event or both. The presence of an identifiable cause cannot, by itself, determine the answer; severity, duration, functioning and risk are among the factors Wadhwa says clinicians should examine.
Assessment Beyond the Checklist
Wadhwa’s essay calls on psychiatrists to keep asking about context rather than treating a screening result as a final answer. For clinicians, the next step she describes is a fuller assessment of the patient’s history, symptom course, daily functioning and safety before deciding on a diagnosis or treatment plan.
The piece does not announce a policy change or a new clinical guideline, and it gives no timetable for further action. Its practical message is that diagnosis and treatment decisions should follow careful evaluation; when symptoms are severe or safety is in question, clinicians should assess those concerns rather than assume distress is simply an expected response.
Key Questions
What is Devina Wadhwa arguing?
Wadhwa argues that clinicians should consider a patient’s circumstances and symptom history before diagnosing a psychiatric disorder. She says symptom questionnaires can help but should not substitute for a fuller clinical assessment.
Does distress after a loss rule out depression?
No. Wadhwa says grief and major depression can coexist. A recent loss may help explain distress, but it does not by itself rule out psychiatric illness.
Which factors does the essay say clinicians should assess?
Wadhwa points to what happened, how long symptoms have lasted, how much functioning has changed, whether symptoms are evolving, potential risk and the person’s earlier state of health.
Does the essay show that psychiatric disorders are being overdiagnosed?
No. It is an opinion essay about diagnostic judgment, not a study measuring overdiagnosis rates or proving that screening tools cause misdiagnosis.
Source: medpagetoday.com
