Counting pains and creating pathologies: Exploring the role of quantitative operationalization in the medicalization of grief

Abstract

Over the past century, grief has transformed from a necessarily non-pathological experience into an object of psy-discipline expertise to be clinically defined, tracked, diagnosed, and treated. Even as care for the painful experience is important, it is necessary to understand the possibilities created and denied in this transformation. The present paper builds on previous research into grief’s medicalization by exploring its intertwinement with operationalization- i.e., the formation of quantitative measures. Focusing on the decades surrounding the psy-disciplines’ institutionalization of operationalization, this is a critical discourse analysis of articles published about grief in psy-discipline journals between 1975 and 1995. The data suggest three trends: 1) conceptualizations of grief adopted the language and methods of a new psychiatry, reflecting a shift in power away from psychoanalysis and toward biomedical and interventionist models; 2) examination and prediction of grief as a complex set of symptom components was increasingly emphasized; and 3) definitions of ab/normal grief were categorically reified, and pathological grief expanded to include experiences previously considered normal. The creation and distribution of quantitative measures played a significant role in these changes, both influencing professionals and populations as a tool of the clinical gaze and validating hypotheses through processes of experimenter’s regress. Data suggest that operationalization was produced by and produced medicalization, continually reshaping grief in a process resembling Ian Hacking’s dynamic nominalism. In sum, this study urges consideration of operationalization as dynamically shaping the categorical kind ‘grief,’ and thus the possibilities for its present medical conceptualization.