Grief, Health, and Medicalization

Abstract

This dissertation is comprised of three chapters:

Chapter 1 intervenes in debates about the medicalization of grief, focusing on the recent addition of a grief-specific disorder – Prolonged Grief Disorder (PGD) – to the DSM. Opponents of medicalization have been primarily concerned with potential negative looping effects – ways that classificatory processes like medicalization (treating something as a disorder) contribute to harmful social practices or distortions of a person’s self-conception. Contrastingly, I call attention to unappreciated beneficial looping effects that might be achieved by medicalizing (some) experiences of grief. Alongside this, I highlight that the concerns about negative looping effects rest on the philosophically significant and conceptually optional assumption that “normal” parts of human experience should not be medicalized. Consequently, I argue that rather than removing PGD from the DSM, the better path forward is to help grievers reconceive the role of diagnostic categories by moving away from a background understanding of health conditions as pathologies.

Chapter 2 develops an account of healthy grief as a constructive dialectical process – rather than either a state or a healing process aimed at “recovery”. On the account I develop, it is not a condition of healthy grief that it dissipates over time. Endless grief can be both appropriate and compatible with flourishing. In this respect, my account departs from various well-known accounts of grief (of which perhaps the most illustrious is Freud's in Mourning and Melancholia). In addition, my account sets itself apart from others in that it includes respect-for-the-lost-one as a central component of the dialectics of grieving. This move is pivotal, as it sets the stage for a picture of grieving on which grief is a positive component of living a flourishing life. In addition, the account I develop here has implications for our understanding of health, medicalization, and disorder; most notably it reinforces the case against conceptions of health that reduce health and human flourishing to merely the absence of pathology, dysfunction, or disease.

Chapter 3 extends the account of grief developed in the previous chapter to other forms of loss, with a particular focus on anticipatory grief. Considering multiple forms of loss elucidates two notable features of grief (i) object plenitude: in grief, there is never just one object of loss; the objects stand in intimate and overlapping relations with each other such that there are not always boundaries between them and (ii) object generation: the process of grieving partially determines which things are seen as losses. Having elucidated these features, I show how my account sheds light on some of the different ways that we can become “stuck” in our experiences of grief. Finally, I consider the practical (clinical, social, and interpersonal) upshots of my account.