The Nuance

The Drawbacks of ‘Harm Inflation’

Expanding our definitions of harm, trauma, and mental disorder may be a “mixed blessing,” experts say

Photo: Nik Shuliahin / Unsplash

Several years ago, in 2013, the American Psychiatric Association made a controversial change to its Diagnostic and Statistical Manual of Mental Disorders (DSM).

For years, the DSM’s criteria for diagnosing depression had included what was known as the “bereavement exclusion.” In a nutshell, the exclusion stated that people who had recently lost a loved one should not be diagnosed with major depressive disorder because sorrow and other depression-like symptoms are normal and appropriate following a loss.

In other words, there’s nothing “disordered” about feeling sad or distraught when someone you love has died.

But in the new (and still current) DSM, the APA dropped the bereavement clause. Even among people who are grieving the loss of a loved one, the DSM now considers depression a valid diagnosis if certain criteria are satisfied, such as an “inability to anticipate happiness” or “difficulty being consoled.”

Experts in favor of the change argued that although it might stigmatize some people who are grieving it could also help those in need gain access to therapy, medications, and other helpful resources. Proponents also pointed out that bereavement-related depression can be “genetically influenced,” and so likely to recur.

Meanwhile, some opponents viewed the change as part of a larger trend in psychology — and, for that matter, in Western society — that is ongoing today. Their view is that, slowly but surely, the APA and other authorities are broadening their lexicons and diagnostic criteria in ways that pathologize or medicalize an increasingly wide swath of human experience.

The Australian psychologist Nick Haslam is one of the leading voices in this group.

“In psychology, we know that expectations and self-classifications and beliefs and identities really matter.”

Haslam, PhD, is a professor of psychology at the University of Melbourne. In 2016, he published an analysis of what…