The American Psychiatric Organization is considering a controversial move to reclassify grief as depression. The decision could have lasting implications on the treatment of grief, and it already has the psychiatric community deeply divided.

The American Psychiatric Organization may change the way grief is regarded and treated in its revision of the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M. Specifically, the criteria for diagnosing depression would be broadened to include bereavement. Previously, bereavement was excluded from the diagnostic criteria for depression if a patient had experienced the loss of a loved one within 60 days. The revision to the DSM would change that and allow physicians and therapists to bill for treatment of depression during the first 60 days following a death.

Not surprisingly, the issue has touched off a furor. Proponents of the change—psychiatric researchers at Columbia and New York Universities who wrote the recommendation—argue that millions who are excluded from a diagnosis of depression because they are grieving would be helped. Dissenters claim that the change labels a normal part of life as a disorder and represents a move toward unnecessary, inaccurate “medicalization” of something that everyone experiences at some point.

“Psychiatry is making a gigantic mistake to open the floodgates to the main criticism that they treat everyone with drugs for normal reactions to stressful life events,” says Holly G. Prigerson, Ph.D., associate professor of psychiatry at Harvard Medical School. “It’s pathologizing a normal reaction to loss.” Prigerson points out that no data support the contention that people suffering the loss of a loved one are at increased risk if their depression is not treated within that initial 60 days following the death. The risk lies not in people who need help missing treatment, she says, but in the reverse—in the false diagnosis of a psychiatric disorder and overtreatment.

Prigerson has done extensive research and developed criteria for diagnosing prolonged grief disorder, which will be included in the D.S.M. revision. Prolonged grief disorder differs from the normal mourning that follows a death—it significantly interferes with functioning after six months.

“We want grief to be recognized,” Prigerson says. “But saying that it needs to be diagnosed and treated within 60 days is almost an abuse of authority.”

Many worry that the move to include bereavement in the criteria for depression marks a slippery slope.

“Grief should not be a diagnosis,” says Susan K. Beeney, R.N., of New Hope Grief Support Community. “Grief is a time when a person is experiencing the natural circumstances of life. Those who are grieving need to be supported by people who walk alongside them on this portion of their journey.”

It makes sense to distinguish prolonged or complicated grief from the normal response to loss, says Rev. Diann Davisson, a chaplain at Long Beach Memorial Medical Center and Miller Children’s Hospital who facilitates bereavement groups.

“Complicated grief often follows a suicide or homicide,” Davisson says. She observes that a person in a very dependent relationship, who has difficulty navigating the world without his or her loved one, may experience complicated grief after the loved one dies. “Delayed grief can also be complicated grief,” she says, as when a young woman with small children loses her husband. “She doesn’t have time to grieve, because she has to raise those children.” Someone in this type of situation may be rocked by delayed grief years later, says Davisson.

Some who participate in Davisson’s bereavement groups get there by way of a treatment program for addiction. “They realize that they had been coping with unresolved grief by turning to drugs or alcohol,” she says.

Anyone who has experienced the loss of someone dear knows too well that grieving is a form of suffering as well as a way of honoring the person who is gone. The discussion about whether and how mourning fits into a medical category is a messy and complicated one. The D.S.M. revision will not be final until December, so the dustup is likely to continue through the year.