Lately, it seems like everyone says they have a psychological disorder. No longer do people forget things, they have ADHD. They aren't sad, they're depressed. They're not haunted by the past, they have PTSD. They don't prefer order, they have OCD. They're not moody, they have bipolar. It seems like everyone is burned out, codependent, or has imposter syndrome, sometimes all three. Mental health diagnoses have become badges of identity. What's behind this sudden infatuation with mental health conditions and therapy talk? Are we more psychologically aware than previous generations? Has mental health stigma truly decreased? Or do diagnoses now offer social and institutional benefits? The answer, I believe, is yes, somewhat, and it depends on the condition. It can also be explained by a tendency of the human mind to characterize suffering as a mental disorder and imagine itself through this afflicted perspective. In other words, to pathologize. At the risk of pathologizing becoming everyone's favorite pathology, let me explain what it is. It's not entirely pathological. To pathologize means to interpret garden variety suffering through the lens of mental illness, essentially turning everyday challenges, emotions, and personality traits into mental health conditions that need treatment. This transformation happens both individually and culturally. When we pathologize, we turn normal human variations into disorders. What’s pathological about pathologizing?Many have argued against the assumption that psychological difficulties are disorders that need to be cured. Influential thinkers like Thomas Szasz, R.D. Laing, Michel Foucault, and Frantz Fanon thought pathologizing served forces of social control by invalidating human experiences. Their critique was straightforward: We don't have to take bothersome people seriously if we can call them crazy. We can dismiss their inconvenient concerns. Their examples remain relevant today: the child labeled with ADHD might be responding naturally to a repressive school environment; the traumatized vet should be consulted the next time we start a war; the worker is not burned out, but exploited. But pathologizing is not just something powerful people do to powerless ones. People pathologize themselves for the same reasons the powerful pathologize the powerless. They'd rather control than accept. We seek the illusion of control that diagnosis provides. Life is messy, psychological difficulties are disruptive, and when you can call the messy and disruptive aspects a disease, then you don't need to consider what they're trying to say. Pathologizing frames what it calls ADHD, depression, PTSD, OCD, bipolar, burn out, codependency, and imposter syndrome, as purely medical conditions requiring treatment, ignoring the deeper meaning they carry. They're not just diseases, but psychologically significant states that can reveal truths about ourselves and what society is doing to us. Rather than symptoms to eliminate, they may be necessary passages in development. For instance, ADHD represents a natural variation in how humans process information, particularly suited to a fast paced world, such as the one we're in. Depression may serve as your psyche's way of demanding that you slow down and reflect. PTSD is a normal reaction to abnormal experiences. Its preoccupation with danger is designed to protect you from harm. What we label as OCD manifests a deep need for order in the midst of chaos. What we call bipolar disorder may reflect the full spectrum of human emotional capacity. Manic states enable creative breakthroughs and depressive states allow necessary introspection. Burn out is often a natural response to imperious demands and a work-life imbalance. Codependency includes a deep capacity for empathy and connection, suggesting that independence isn't all it's cracked up to be. Imposter Syndrome often represents a healthy humility and recognition of room for growth. It shows up when capable people step out of their comfort zone. If you think those are naive things to say about serious conditions, you are correct when we are talking about the more serious forms of those conditions. This brings us to a crucial distinction: there's a fundamental difference between recognizing genuine clinical conditions and turning normal human experiences into medical problems. For instance, being depressed for a day or two gives you a break and affords some time to reflect. It's something else entirely to be depressed for months at a time and experience suicidal thoughts. That degree of depression is nothing short of hell and no one wants to commemorate it on Instagram. Clinical depression and the depression of two thirds of the people who claim to be depressed on Instagram are not the same. The Instagram depressives are tourists to depression. They went, spent a week, have stories to tell about roughing it in the wilderness, and think they know what it's like to live there. True depressives are captured and held hostage. They'd like nothing better than to leave. So, here’s another thing wrong about pathologizing. It’s disrespectful of the people who truly have the condition, as well as to the condition itself. When we pathologize all suffering by calling it a disorder, we trivialize the experiences of those with genuine clinical conditions. If you’re a tourist to pathology, you may be on the spectrum of that condition and feel you can identify somewhat with the people at the darker end, but you really have no idea. Once a person falls into the deepest throes of depression, then only a doctor or a miracle can get them out. Pathologizing makes the most sense then. But everyone who enters the spectrum of depression begins as tourists, even the ones who get taken hostage. If they pathologize at the early stage, they’re the kind of tourist who won’t meet depression on its own terms. The depression gets pissed off and captures the tourist because it wants to be taken seriously. Then the tourist is in real trouble. He’s no longer a tourist, now he’s a hostage in need of rescue. It would have been better if the tourist had respected the depression, listened to what it was trying to say, and learned something from it. What’s so great about pathologizing?The appeal of pathologizing yourself is real and runs deep. Pathologies come with explanations that can relieve shame. When you attribute difficulties to a condition rather than a failure, you’re relieved from moral judgment and you get words to articulate your inner experience. When you choose a medical label, it validates your suffering by giving it a name and legitimacy in the land of doctors and benefit administrators. It gives you a sense of identity and community with others who share a similar diagnosis. It lets you share experiences and have mutual understanding. You can read about your condition in books. Pathologizing offers a socially acceptable way to discuss personal struggles and advocate for accommodation and understanding. Having a diagnosis gives weight to experiences that might be dismissed or minimized. Whenever I have a client who accepts a diagnosis, they express a deep sense of relief. Their suffering has been noticed and given a name. There are others like them, who also bear this burden. They have something they can tell their friends and family that explains the way they’ve been acting. They have an excuse. Their bad behavior was not malicious. They have a renewal of hope. It's for this reason I'm not opposed to pathologizing, up to a point. I'm in favor of pathologizing for the same reason I think it's a good idea to travel, even as a tourist. When you travel, you learn about other cultures and may adopt their ways. For the rest of your life, you'll have a warm feeling towards the people in whose land you traveled. So, pathologize boldly, if it helps you. I'm only saying, don’t stop there. When I was just learning to be a therapist, I went around diagnosing everyone, myself included. It was the way I had to learn a new skill I had acquired, to understand suffering by pathologizing. However, I soon found that the more I got to know my clients, the less their diagnoses explained them. There was too much for those diagnostic boxes to contain. I’ve continued to make diagnoses, but only in the way a painter sketches out a portrait. It’s a good way to get a general idea of their suffering, but more work is necessary before the portrait comes to life. I’ve found alternatives to pathologizing. Alternatives to PathologizingThe most nuanced critique of pathologizing comes from American Psychologist, James Hillman. Hillman suggested that, rather than pathologize, you should process these matters with alchemy, memory, and myth. I've studied Hillman and found his advice to be wise, but needlessly arcane. Instead of referring you to alchemy, I'd rather suggest something similar that you already know — cooking. Instead of memory, there's storytelling. Instead of myth, there's making friends. Cooking Recognize your symptom as carrying something that needs expression, much like raw food contains necessary starches, proteins, and minerals. Pause on the difficulty rather than rushing to remedy it, allowing the raw material to simmer and reveal its inherent flavor. Then imagine yourself chewing it over, absorbing it, and squeezing out every bit of nutrition before excreting the toxic elements out the other end. There's a lot of good that can come out of your symptom if you apply the magic of cookery and transform something unappetizing in its raw form into something delicious. For instance, when you cook it right, obsessive thinking's ability to recognize patterns and attend to detail yields valuable analytical skills. Its protective nature becomes strategic foresight, while the depth of engagement cultivates genuine curiosity. It can fuel innovation and artistic expression. Working with these thoughts rather than against them contributes to emotional intelligence and self-awareness. Just as a skilled chef knows how to bring out the essential flavors in challenging ingredients, learning to work with obsessive thoughts can reveal their hidden value. Storytelling Rather than treating traumatic memories as purely pathological, storytelling turns them into acts of imagination where you create meaning. Someone experiencing flashbacks isn't just suffering from PTSD. Their psyche is trying to make sense of experience through imagination. Storytelling isn't about forcing positive interpretations onto painful experiences, but about allowing memories to reveal their own meaning through the process of being storied. It is not for me to say what meaning you can get from your traumatic experience; but, whatever it is, it will be profound, and - deeply meaningful. At some point, of course, every metaphor breaks down because nothing is just like something else. We must be alert for being captured by a metaphor. Pathologizing is itself, a story that uses a metaphor, saying that a human experience is just like a mental illness. At some point that metaphor breaks down as well. It's probably best to tell lots of stories and mix our metaphors promiscuously, so that we do not become attached to any one. Making Friends Instead of saying you have imposter syndrome, say you have a trickster on hand. Or, say you have a trickster in you, or are capable of being a trickster. These thoughts are empowering, while the thought of imposter syndrome is not. You're not entirely a trickster, but you can become one when you need to be, and be authentic when it's safe to do so. True friendship involves mutual respect. Just as you wouldn't try to fix or cure a friend of their essential nature, the goal isn't to eliminate the trickster but to develop a relationship with it. You'd set boundaries on your friend if needed, but you'd also appreciate what he brings to your life. The trickster is your wingman when you go beyond your comfort zone. Hillman was big on Greek Mythology and liked to say that the gods of that time have not retired to their home on Mount Olympus, they've become diseases. What ancient cultures recognized as divine or daemonic forces, the various gods and their attributes, we now interpret as disorders to be diagnosed and treated. We can understand depression as Hillman says an ancient Greek did; not as a disease, but personified by the goddess Persephone, when she was taken by Hades into the underworld. While gathering flowers in a sunlit meadow, she was abducted to the dark realm below, torn from her mother Demeter who searched the earth in grief, causing winter to fall upon the land. This story reveals depression as what it feels like to be sown into darkness, leading ultimately to growth and renewal - just as Persephone's annual return brings the spring, transforming from maiden to Queen of the Underworld in the process. A depressed ancient Greek, Hillman says, would feel a special affinity to Persephone. He would visit her temple and leave offerings to her. By doing so, he'd be making her his friend. I'm not saying you should worship Greek gods, although Hillman would. I'm saying that when you encounter a powerful force in your life, it's better to make it your friend than your enemy. MedicalizingI want to distinguish pathologizing from its close cousin, medicalizing. It's hard to tell them apart. Pathologizing is when you treat an ordinary suffering as a mental illness. Medicalizing is when you treat a psychological illness as a medical illness. There are good arguments for and real benefits when you medicalize, just as there are benefits when you pathologize; they're the same benefits. But everything I've said about the pitfalls are true for medicalizing, as well as pathologizing; they're the same pitfalls. Sometimes people will take both steps at once in a giant leap. They go to the doctor to treat a condition within the range of normal human experience and the doctor treats it only as if they had a medical condition. Insurance companies will not pay for your therapy unless your doctor adopts the medical model, or at least appears to do so when communicating with the insurance company. We can't blame the insurance company. They offer medical insurance, after all. We can't blame the doctor. She is, after all, a doctor. We can't even blame you if insurance funded health care is the only way you can address your suffering. However, this means the doctor must put your problem in a category of approved diagnosis and treat it with evidence-based therapy. This all works as it should if you truly have only the condition, but it completely misses the point if you don't. For example, let's say a man goes to the doctor because he's just gone through a bad breakup. He can't sleep, can't eat, cries all the time, has no energy, can't concentrate, and nothing is pleasurable anymore. He checks enough of the boxes for the doctor to say he has major depressive disorder. This is not a case of pathologizing. He's truly been captured and held hostage by depression. The doctor writes him a prescription for an antidepressant, which is the evidenced-based thing to do. The man takes it, which is the sensible thing to do. However, if that's all they do, they're missing something important. He needs to cook and digest his experience. He needs to tell the story of it so he can figure out where the relationship went wrong. Then he needs to make friends with his depression because it will be those feelings that can prevent him from making the same mistakes in his next relationship. He'll feel better in a few weeks if he takes the medicine and everyone will say he's cured, but he’ll be cured only in the narrow medical sense of the word. The doctor got him released from prison, but he hasn't even begun to address how he got there in the first place. I don't want to suggest that mental illness isn't real or that diagnosis and treatment aren't sometimes necessary. Rather, I question our cultural enthusiasm for pathologizing and medicalizing. I want us to consider whether, in a rush to claim psychological difficulties as illnesses, and psychological illnesses as physiological illnesses, we miss their deeper meaning and value. Perhaps what we call pathology is sometimes the psyche's way of expressing truths that can't be conveyed through normal functioning; truths that get lost when we're too quick to translate psychological experiences into diagnostic categories and then to treat them before we know what they're all about. ReferencesHillman, James. (1975). Re-Visioning Psychology. Harper & Row.
Szasz, Thomas. (1961). The Myth of Mental Illness. Harper & Row.
Laing, R.D. (1967). The Politics of Experience. Pantheon.
Foucault, Michel. (1961). Madness and Civilization: A History of Insanity in the Age of Reason. Pantheon.
Fanon, Frantz. (1952). Black Skin, White Masks .Grove Press. And, The Wretched of the Earth. Grove Press
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Monday, 10 February 2025
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