TL;DR
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Psychiatrist Devina Wadhwa argues in a MedPage Today opinion article that clinicians should consider a person’s circumstances before diagnosing a mental disorder from symptoms or screening results alone. She also cautions that grief and other identifiable stressors do not rule out serious psychiatric illness; the distinction requires individual assessment.
Psychiatrist Devina Wadhwa argues that clinicians should weigh life circumstances and clinical judgment before labeling distress as a mental disorder, in a Nov. 1 opinion article published by MedPage Today. Her argument addresses symptoms such as sadness, insomnia and poor concentration, which can follow loss or upheaval but can also occur in psychiatric illness.
Wadhwa describes patients who may seek care after a relationship ends, a family member dies or a job is lost. They may report sadness, anxiety, exhaustion and difficulty coping, and screening questionnaires can register symptoms associated with depression or anxiety. She warns that a questionnaire or brief telehealth assessment should not stand in for understanding what has happened to the patient.
The article does not argue that clinicians should avoid diagnosing or treating mental illness. 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 she diagnoses and treats psychiatric illness, and has seen medication, psychotherapy, hospitalization and other interventions change or save lives.
Her concern is that symptoms alone may not explain a person’s condition. A bereaved person, for example, may cry often, sleep poorly, eat less and struggle to concentrate—experiences that overlap with depression. Wadhwa says grief and major depression can coexist, while grief-related symptoms do not automatically establish a depressive disorder. She frames that distinction as a matter for careful clinical judgment, not a screening score alone.
How Context Shapes Mental Health Care
The distinction matters because a psychiatric diagnosis can shape a patient’s understanding of their experience, as well as influence treatment decisions. Wadhwa contrasts the account “I am devastated because someone I love died” with “I have a psychiatric disorder,” while stressing that both descriptions can be true at once. The label should not erase the circumstances around a person’s distress.
Her argument also identifies a risk in relying heavily on brief assessments: they can record symptoms without fully capturing their timing, cause or effect on daily life. Wadhwa says clinicians should ask what happened, how long symptoms have lasted, whether functioning has changed, how the person is responding over time and whether there is a safety risk. These questions may help distinguish distress that calls for support from illness that needs psychiatric treatment, while recognizing that the two can overlap.
The stakes run in both directions. Treating every painful response as illness can medicalize ordinary suffering, Wadhwa argues. But assuming that distress is simply an understandable reaction can miss serious illness or risk. Her central point is that context should inform assessment, not settle it in advance.
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Symptoms Can Follow Major Loss
Wadhwa’s article is an opinion piece, not a report of new research, clinical guidance or a change in diagnostic policy. It makes a practice-focused case about how psychiatrists interpret symptoms that appear in response to events such as bereavement, relationship breakdown or job loss.
The article notes that sadness, worry, insomnia, appetite loss and concentration problems are not unique to psychiatric disorders. At the same time, a recognizable trigger does not rule out a disorder: Wadhwa says someone facing a marriage breakdown can develop major depression, and a bereaved parent can become suicidal. A person’s circumstances are part of the assessment, but they cannot by themselves determine a diagnosis.
Wadhwa also questions whether screening questionnaires and short telehealth visits can capture enough of that context when used without broader assessment. She does not present data showing how often such tools lead to overdiagnosis, nor does the supplied article establish that overdiagnosis is increasing. Its claim is a clinical caution about how tools should be used, rather than a quantified finding about current practice.
No Estimate of Overdiagnosis Given
The opinion article does not quantify how frequently ordinary distress is diagnosed as a disorder, compare diagnosis rates across settings or provide evidence that screening tools themselves cause overdiagnosis. It also does not offer a specific threshold for when grief or other distress becomes a psychiatric illness. Wadhwa presents the boundary as one that requires individual clinical judgment.
The article does not set out a formal protocol for screening, telehealth assessments or follow-up, and it does not propose changes to diagnostic criteria. Its discussion is a clinician’s perspective, not a systematic review or new study. The extent of the issue across psychiatric practice therefore remains unmeasured in the source material.
Clinical Judgment Remains Central
Wadhwa calls on psychiatrists to keep asking about a patient’s history, the duration and course of symptoms, changes in daily functioning and possible risk, rather than treating a screening result as a complete assessment. Her proposed next step is not a new test or policy but more sustained attention to context during clinical care.
The article does not announce a formal follow-up, research project or change in guidance. Whether its concerns reflect wider patterns in diagnosis would require evidence beyond the opinion piece, including data on assessment practices and outcomes. For now, Wadhwa’s message is that clinicians must remain alert both to the possibility of serious illness and to the fact that painful experiences are not automatically disorders.
Key Questions
What is the central argument in Wadhwa’s article?
Wadhwa argues that clinicians should consider a patient’s circumstances and the course of symptoms before diagnosing a disorder. She says screening results can inform an assessment but should not replace clinical judgment.
Does the article say grief cannot be depression?
No. Wadhwa says grief can coexist with major depression, and that a bereaved person can develop a serious psychiatric illness. Her point is that grief-related symptoms alone do not automatically establish a depressive disorder.
Does the article provide evidence that overdiagnosis is widespread?
No. It is an opinion article and gives no estimate of overdiagnosis rates or data showing how often screening tools lead to a diagnosis. Wadhwa raises a concern about assessment practices, not a quantified finding.
What does Wadhwa say clinicians should assess?
She says clinicians should ask what happened, how long symptoms have lasted, how functioning has changed, whether the response is evolving, whether the patient is at risk and what the person was like before. She says those questions help put symptoms in context.
Source: medpagetoday.com
