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In a November 1, 2026 MedPage Today opinion essay, psychiatrist Devina Wadhwa argues that clinicians should consider a patient’s circumstances before interpreting symptoms as a psychiatric disorder. She notes that grief and other distress can overlap with mental illness, and that a life event does not rule out serious illness.
Psychiatrist Devina Wadhwa argues that clinicians should consider a patient’s life circumstances when assessing distress, rather than relying on symptoms alone to determine whether a psychiatric disorder is present. In a November 1 MedPage Today opinion essay, she writes that brief assessments and screening questionnaires may not capture the full context. Symptoms such as sadness, poor sleep and difficulty concentrating can follow loss or upheaval, and can also occur in mental illness.
Wadhwa describes patients who struggle after a relationship ends, a death in the family or job loss. They may report insomnia, low appetite, anxiety and poor concentration, or score highly on questionnaires such as the PHQ-9 or GAD-7. Those findings can identify symptoms, she writes, but they do not by themselves determine whether a person has a psychiatric disorder. (The source text refers once to a “PHQ-0,” which appears to be a typographical error; it also discusses the PHQ-9 elsewhere.)
The essay is an argument about how clinicians interpret symptoms, not a study establishing that mental illness is being overdiagnosed or measuring how often that happens. Wadhwa says psychiatric diagnoses can help people understand what they are experiencing and guide treatment. She also writes that medication, psychotherapy, hospitalization and other interventions have changed and saved lives in her clinical experience.
Her example of bereavement highlights the difficulty: crying, disrupted sleep, reduced appetite and loss of interest can occur after a death and overlap with major depression. Wadhwa says grief and depression can coexist, and that a loss does not rule out illness. At the same time, symptoms after a major event should not automatically be treated as proof of a depressive disorder. She calls for judgment that considers symptoms alongside their duration, effects on daily functioning, the person’s history and any safety risks.
Why Context Changes the Diagnosis
A diagnosis can shape a person’s treatment pathway and understanding of their experience, Wadhwa writes. Distinguishing distress tied to a life event from a psychiatric disorder requires attention to both symptoms and context.
The essay’s practical point is that screening tools are best treated as one part of an assessment. A high symptom score may signal a need for further evaluation, but the score alone does not explain what happened, how a person has changed, or whether they face immediate risk. A clear reason for distress does not, in turn, establish that severe or persistent symptoms are harmless.
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Screening Tools and Clinical Judgment
Wadhwa writes that psychiatry differs from many areas of medicine because its symptoms often overlap with common responses to difficult circumstances. Sadness, worry, insomnia and appetite changes can arise in challenging situations, but they can also be features of psychiatric conditions. The overlap makes interpretation dependent in part on a patient’s circumstances and course over time.
The author says questionnaires and brief telehealth appointments can make it harder to capture that context. She does not argue that clinicians should abandon screening or diagnosis. Rather, her essay asks them to look beyond symptom counts and consider what has changed for the individual, while keeping the possibility of illness in view.
What the Essay Does Not Establish
Wadhwa’s piece is a clinical opinion essay, not a prevalence study. It does not quantify whether psychiatric diagnoses are being made too often, identify which settings are most affected, or compare outcomes for patients who are diagnosed immediately with those assessed over more time.
The essay also offers no universal test for separating grief or situational distress from a psychiatric disorder. Wadhwa says the distinction requires clinical judgment and acknowledges that symptoms can evolve. The appropriate assessment for any individual depends on their circumstances, duration of symptoms, functioning and safety; the article does not provide individual diagnoses.
Questions for Clinical Assessments
Wadhwa’s proposed next step is a more complete conversation alongside screening: clinicians should ask what happened, how long symptoms have lasted and how functioning has changed. She also says they should consider whether the response is evolving, whether the person may be at risk, what their baseline was and whether symptoms have changed beyond what might be expected in the circumstances.
The article does not announce a policy change, new diagnostic guideline or formal study. Its near-term implication is a call for practitioners to keep individual context and clinical judgment central when deciding whether to diagnose or treat. Whether that approach changes practice, and how it affects diagnosis rates or patient outcomes, remains unreported.
Key Questions
Is this report evidence that mental health conditions are being overdiagnosed?
No. Wadhwa’s article is an opinion essay making a case for careful assessment. It does not present data measuring overdiagnosis or how frequently it occurs.
Does grief rule out major depression?
No. Wadhwa says bereavement and major depression can coexist. A recent loss is relevant context, but it does not by itself determine whether someone has a psychiatric disorder.
Can a screening questionnaire diagnose depression or anxiety by itself?
Wadhwa argues that questionnaires can identify symptoms but should not replace a broader clinical assessment. The essay says clinicians should also consider circumstances, symptom duration, functioning, history and risk.
What does Wadhwa recommend clinicians ask?
She recommends asking what happened, how long symptoms have been present, how much functioning has changed, whether symptoms are evolving and whether the patient is at risk. She also calls for understanding the person’s prior baseline.
Source: medpagetoday.com
