TL;DR
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In a November 1 opinion article, psychiatrist Devina Wadhwa argues that clinicians should distinguish ordinary distress from psychiatric illness by considering patients’ circumstances, history, functioning and risk—not relying on screening scores alone. She also cautions that grief or a clear life stressor does not rule out a mental disorder, and says careful assessment must avoid both overdiagnosis and dismissal.
Psychiatrist Devina Wadhwa argues that clinicians should not treat symptoms or screening scores as enough to diagnose a mental disorder when a patient is experiencing grief, heartbreak or other major life stress. In an opinion article published November 1, she says careful assessment must account for context while recognizing that distress triggered by an event can still coexist with serious psychiatric illness.
Wadhwa, writing in MedPage Today, describes people who lose sleep after a relationship ends, lose their appetite after a death, or feel anxious and unable to concentrate after losing a job. Those experiences can overlap with symptoms of depression and anxiety disorders. A questionnaire such as the PHQ-9 or GAD-7 may flag symptoms, she writes, but it cannot by itself establish what those symptoms mean for a particular person.
Her argument is not that psychiatric diagnoses are unnecessary. Wadhwa says conditions including major depression, anxiety disorders, post-traumatic stress disorder, bipolar disorder and psychotic illnesses can cause substantial suffering. Diagnosis can help people make sense of their experiences and guide treatment; she says she has seen medication, psychotherapy, hospitalization and other interventions change or save lives.
She uses bereavement to show why symptoms need interpretation. Someone grieving a spouse may cry frequently, sleep poorly, eat less and struggle to concentrate—symptoms that can also occur in major depression. Grief and depression can coexist, Wadhwa says, but a painful loss followed by depressive symptoms does not automatically mean the person has a depressive disorder. The distinction calls for clinical judgment, not an automatic label.
Diagnosis Can Shape a Patient’s Story
A diagnosis can influence more than treatment decisions: it can shape how a person understands their own experience. Wadhwa contrasts the explanation “I am devastated because someone I love died” with “I have a psychiatric disorder,” while emphasizing that both descriptions can apply at once. Treating the two as interchangeable risks reducing an individual’s experience to a label before the circumstances are understood.
The issue matters as care increasingly uses screening questionnaires and brief telehealth assessments, which Wadhwa worries may leave less room to explore a patient’s history and situation. Her article does not establish how often clinicians overdiagnose or quantify how frequently tools lead to mistaken diagnoses. It presents a clinical concern: symptom checks can inform an assessment, but should not replace it.
There is a risk in the other direction, too. Calling distress understandable does not establish that it is harmless. A person facing a divorce may develop major depression; a bereaved person may become suicidal; and a new parent under strain may have a serious mood disorder. Wadhwa’s point is that clinicians need to avoid both pathologizing every painful response and overlooking illness because a stressful event preceded it.
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Symptoms Overlap With Life Events
Psychiatric assessment can be difficult because many symptoms used to identify disorders—sadness, worry, insomnia, appetite changes and problems concentrating—also arise during ordinary human hardship. Wadhwa says the circumstances matter, but do not settle the diagnosis. A recognizable reason for distress is not proof that a mental disorder is absent.
She argues that clinicians should ask what happened, how long symptoms have lasted, how much a person’s functioning has changed, whether the response is evolving, whether the patient is at risk, and what they were like before. Those questions place a screening result within a fuller picture. The article is an opinion piece by a psychiatrist, not a study measuring diagnostic rates or a change to formal diagnostic guidance.
How Often Are Labels Misapplied?
Wadhwa’s article does not provide data showing how frequently normal distress is diagnosed as a disorder, whether that frequency is increasing, or how often screening tools contribute to an incorrect diagnosis. It also does not compare outcomes for patients diagnosed early with those assessed over a longer period. The article sets out a concern and a clinical argument, not a measured estimate of overdiagnosis.
There is no single symptom or life event in the article that resolves whether someone has grief, a psychiatric disorder or both. How long symptoms persist, how they change, their impact on daily functioning and any safety concerns all require individual assessment. The article does not offer patient-specific guidance or a replacement diagnostic standard.
Assessment Must Go Beyond Screening
Wadhwa’s conclusion is a call for clinicians to keep asking questions after a questionnaire identifies symptoms: what happened, how the person is functioning, whether the response is changing and whether there is risk. A screening tool can be one part of that process, but, in her view, the next step is an assessment that gives context and clinical judgment room to matter.
The article announces no policy change or formal next milestone. Its practical point is directed at psychiatric care: sometimes symptoms warrant diagnosis and treatment; sometimes a patient’s distress needs to be understood before it is named. If a person’s symptoms are severe, worsening or raise safety concerns, the possibility of illness should not be dismissed simply because a stressful event came first.
Key Questions
What is Wadhwa arguing in the article?
She argues that clinicians should interpret symptoms in light of a patient’s circumstances and history, rather than relying on a screening score alone. She also says a stressful event does not rule out psychiatric illness.
Does the article say grief cannot be depression?
No. Wadhwa says grief and major depression can coexist. She cautions both against automatically diagnosing depression after a loss and against assuming that bereavement makes serious symptoms harmless.
Are screening questionnaires enough to diagnose a disorder?
Wadhwa says questionnaires such as the PHQ-9 or GAD-7 can identify symptoms, but should not constitute the entire assessment. Her article emphasizes questions about duration, functioning, change over time, personal history and risk.
Does the article measure how common overdiagnosis is?
No. It is an opinion article, not a study estimating how often normal distress is diagnosed as a disorder or showing that screening tools cause misdiagnosis.
Source: medpagetoday.com
