An Antidote to the Pathologizing of Grief: Applying the Power–Threat–Meaning Framework

Abstract

Emerging theories of grief over the last 30 years have represented a shift from the healing of pathology to a focus on the adaptation to loss. Recently, however, there has been an alarming resurgence for a medicalized model of grief, most saliently evident in the removal of the bereavement exclusion from the diagnosis of major depressive disorder in theDiagnostic and Statistical Manual of Mental Disorders(5th ed.;DSM-5; American Psychiatric Association [APA], 2013) and the inclusion of prolonged grief disorder in theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision(DSM-5-TR; APA, 2022). These have predictably opened up opportunities for the pursuit of pharmacological treatment including antidepressants and medication usually offered for recovery from alcohol and drug addiction. A pathologizing approach to grief can have a significant and detrimental impact on individuals and compromises the core humanistic values that underpin my professional identity as a counselling psychologist. I propose that we need a radically different lens, and the power–threat–meaning framework (PTMF), an alternative to psychiatric diagnosis developed by psychologists in the United Kingdom, offers us such an opportunity. Consideration is given to how the PTMF may be applied to grief therapy where it can embrace the uniqueness of grief responses and reframe it as an entirely understandable response to trauma and loss.