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In a Nov. 1, 2026, MedPage Today opinion piece, psychiatrist Devina Wadhwa argues that clinicians should weigh life circumstances and a patient’s history before interpreting distress as a disorder. She also cautions that grief or another clear life event does not rule out serious mental illness, and says screening tools are not a substitute for clinical assessment.
Psychiatrist Devina Wadhwa is urging clinicians to consider a patient’s circumstances, history and safety before diagnosing psychiatric illness from symptoms alone, arguing in a Nov. 1 MedPage Today opinion article that screening questionnaires cannot capture the whole picture. Her argument addresses a difficult clinical distinction: grief, anxiety and sleep problems can arise in response to life events, while similar symptoms can also signal conditions that need treatment.
Wadhwa describes patients who become sleepless after a relationship ends, lose their appetite after a death, or feel anxious and unable to concentrate after losing a job. Symptoms such as sadness, insomnia, reduced appetite and poor concentration can appear in psychiatric disorders, she writes, but can also be part of responses to painful or destabilizing events. Symptoms alone do not settle the diagnosis, in her view.
She notes that screening questionnaires, including the PHQ-9 and GAD-7, can flag depressive or anxiety symptoms, but warns against treating a score as a complete assessment. Clinicians should also ask what happened, how long symptoms have lasted, whether daily functioning has changed, how the response is developing, and whether the patient is at risk. She says understanding what the person was like before the event can help identify a meaningful change.
Wadhwa does not argue that distress should be left untreated or that bereavement rules out illness. Grief and major depression can coexist, she writes, and a major loss does not make severe symptoms harmless. The central point is that diagnosis calls for clinical judgment: clinicians should neither label every painful reaction a disorder nor dismiss warning signs because they have an understandable cause.
Why Diagnosis Needs Context
A psychiatric diagnosis can shape a patient’s understanding of their experience as well as guide treatment. Wadhwa argues that describing a person’s suffering only as a disorder may miss the meaning of what happened; describing it only as a natural reaction may also miss an illness that warrants care. The distinction affects both clinical decisions and how patients interpret their own distress.
The issue is particularly relevant when care relies on brief appointments or questionnaires, which may identify symptoms without capturing their timing or circumstances. Wadhwa’s article is an argument about clinical practice, not a study demonstrating that overdiagnosis is increasing or quantifying how often normal distress is misclassified. It calls for more context in assessment while recognizing that careful evaluation takes time.
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Symptoms That Can Overlap
Wadhwa’s article focuses on overlap between ordinary experiences and symptoms assessed in psychiatry. Sadness can accompany bereavement, worry can follow uncertainty, and insomnia can occur after heartbreak. These examples do not establish a diagnosis on their own; Wadhwa’s point is that clinicians need to interpret symptoms alongside the patient’s circumstances and their effect on functioning.
She also emphasizes that a clear precipitating event does not protect someone from developing a psychiatric condition. A person may become depressed after a relationship ends, or develop serious symptoms while grieving. The article therefore rejects a simple either-or distinction between grief and illness. Clinical assessment must leave room for both, rather than assuming that context proves or disproves a disorder.
Limits of the Opinion Piece
Wadhwa’s article is a clinician’s opinion, not a report of new research, a change in diagnostic guidance, or a measured estimate of how often distress is overdiagnosed. It does not provide data showing that screening tools have caused misdiagnoses or that diagnostic rates have changed. The scale of the concern is not quantified in the material provided.
The article also offers no single threshold for deciding when grief or stress has become a psychiatric disorder. Wadhwa says there is no simple answer in cases such as bereavement, and emphasizes individual clinical judgment. The appropriate assessment and treatment depend on the person’s symptoms, circumstances, functioning and risk, details that cannot be determined from the general examples in the article.
Questions for Clinical Assessment
Wadhwa does not announce a new policy or a specific next step. Her recommendation is for clinicians to keep gathering context alongside symptom information: establish what changed, how long it has been happening, how daily life is affected, whether symptoms are shifting, and whether there is a safety concern. Screening results can contribute to that process, but should not stand in for it.
For readers, the article’s practical implication is limited but clear: a screening score or a difficult life event alone does not establish whether someone has a psychiatric disorder. Wadhwa’s approach calls for an individualized assessment that takes both the possibility of illness and the reality of human suffering seriously. No further clinical guidance or follow-up development is announced in the source material.
Key Questions
What is Devina Wadhwa arguing?
Wadhwa argues that psychiatrists should interpret symptoms in light of a patient’s circumstances and history, rather than relying on symptoms or a screening score alone. She also cautions against assuming that all distress is illness or that distress linked to a life event cannot be illness.
Does grief rule out major depression?
No. Wadhwa writes that grief and major depression can coexist. A loss may help explain distress, but it does not by itself determine whether a psychiatric disorder is present.
Are screening questionnaires useful?
Wadhwa discusses questionnaires such as the PHQ-9 and GAD-7 as tools that can indicate symptoms. Her argument is that a tool should not be treated as the entire assessment because it may not capture life events, history, functioning or risk.
Does the article show that psychiatric overdiagnosis is increasing?
No. The article presents Wadhwa’s clinical concerns and recommendations, but the source material provides no data measuring how often distress is misdiagnosed or whether that rate is rising.
Source: medpagetoday.com
