Kayla Bonkowski | Why Grief Is Not a Disorder

Grief was added to the DSM. The clinical community is still debating whether that was the right call. The distinction has real consequences for how bereaved people are helped.

In 2022, the Diagnostic and Statistical Manual of Mental Disorders added Prolonged Grief Disorder as a formal diagnosis. The criteria: persistent grief lasting more than twelve months after a death, producing significant distress or functional impairment. The intent was to identify bereaved people whose grief is genuinely pathological and provide a clinical pathway to treat it.

The debate that followed has not settled. For the patients who will encounter hospice social workers, the distinction matters.

Kayla Bonkowski holds a Cum Laude psychology degree from Rochester College and is completing her MSW in Sterling Heights, Michigan, with a focus on hospice and palliative care. Grief sits at the center of the work she is preparing for. Whether a particular grief is normal or disordered is not an academic question. It determines what kind of response is clinically indicated.

Normal grief is the appropriate response to significant loss. It is intense. It disrupts sleep, concentration, and appetite. It is preoccupying. It produces periods of acute sadness that can be disabling for days at a time. All of that is normal. None of it requires clinical intervention. It requires presence, time, and the social support that grief historically produced -- the rituals, the community acknowledgment, the sustained attention from people who care.

Complicated grief, now categorized in the DSM as prolonged grief disorder, is different. It does not follow the trajectory that most grief follows. It stays acute past the point at which most people have begun to integrate the loss. It interferes with functioning in sustained ways. It may require specific therapeutic interventions that differ from standard grief support.

The twelve-month threshold is contested because grief does not observe a uniform timeline. A person who lost a spouse of forty years may grieve intensely for longer than a year without that grief being disordered. It may be proportionate to the magnitude of the loss. A clinical framework that pathologizes that grief misidentifies the situation and introduces a treatment framework where what was actually needed was support.

Kayla Bonkowski's concern with this distinction is practical. In hospice settings, the social worker is supporting grief before, during, and after the death. The clinical skill required is to distinguish accurately between normal grief following a difficult but healthy trajectory and grief that is genuinely stuck and producing sustained impairment. Getting that wrong in either direction is a clinical failure.

Applying intervention to normal grief is not neutral. It can communicate to a bereaved person that their natural response to loss is pathological. That communication has consequences for how the person understands their own experience.

Kayla Bonkowski trains in CrossFit and has lost more than 70 pounds. She fosters dogs in Sterling Heights and is raising her son alongside her graduate work. She brings a personal life to her clinical preparation that involves real relationships and real commitment -- the kind that produce real grief when they are lost. She does not approach grief as an abstraction. The first careful question is whether what is being observed is a disorder at all.

Kayla Bonkowski also notes the cultural dimension of this distinction. Grief practices vary significantly across cultural backgrounds, and what constitutes typical or extended grief differs meaningfully between communities. A twelve-month threshold derived primarily from Western clinical research may not account for those differences. A hospice social worker working with families from diverse backgrounds needs to hold the clinical framework loosely enough to account for what is culturally appropriate and what is genuinely pathological. That requires clinical training, cultural humility, and the willingness to ask rather than assume. The psychology background Kayla Bonkowski holds gives her the theoretical framework for understanding individual grief trajectories. The social work training she is completing gives her the practice orientation for holding that framework in context.

What she is building, through the combination of psychology and social work training, is the ability to hold the clinical and the human dimensions of grief simultaneously -- to see the patterns in what she is observing without reducing the person in front of her to a case presentation. That is harder than it sounds. Clinical frameworks create the temptation to categorize. The discipline of hospice social work is to use the framework without allowing it to replace the person. Kayla Bonkowski's psychology background gives her the framework. Her personal life -- raising her son, fostering dogs, training consistently in Sterling Heights -- grounds her in the human dimension that the framework must serve.