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The Pathologizing of Human Experience

pathologizing-6Today, if your behavior, thoughts, or feelings begin to concern you or a family member, for a fee many doctors will translate your experiences into mental illness terminology. Synonyms for mental illness, are mental disease, mental sickness, mental disorder, and psychopathology. These terms, as metaphors for experiences someone doesn’t like, have been with us for centuries. When used in this way, it can communicate something about an experience that others relate to. However, when we move from using these types of concepts as metaphors to believing wholeheartedly that they are proper scientific terms, we begin to lose the respect of those well grounded in the principles of science.

Illness and its Synonyms as Metaphor

hamlet-by-william-shakespeare_0Let’s consider The Tragedy of Hamlet, Prince of Denmark, which William Shakespeare wrote in about 1604. This play offers its audience a magnificent tale of adultery, fratricide, revenge, and feigned madness by a protagonist. When reading Hamlet, we see how Shakespeare uses metaphors to vividly evoke in us the experiences of his characters. Thus, when Hamlet becomes dissatisfied that his mind keeps identifying flaws in his plans for action, he describes these plans as becoming “all sicklied o’er with pale cast of thought.” By extension, the reader senses that when Hamlet’s plans become “all sicklied o’er,” he, too, becomes in a sense, “sicklied o’er” with feelings of frustration, anguish, and helplessness.

ralph-waldo-emerson-purpose-of-life-quotesLiterature regularly uses this type of metaphor. Ralph Waldo Emerson, to take another example, once wrote:

Our young people are diseased with the theological problems of original sin, origin of evil, predestination, and the like. These never presented a practical difficulty to any man–never darkened across any man’s road, who did not go out of his way to seek them. These are the soul’s mumps, and measles, and whooping coughs.

metaphor-2I actually liked Emerson’s disease terminology here because the context in which he uses it so obviously reveals that he is using it metaphorically. Notice how he cleverly using diseases associated with childhood to evoke the feeling that individuals who worry themselves over problems of original sin and so on are acting, in his view, childishly. In this context, disease, to Emerson, was a metaphor for immaturity. If he were a man of science, in contrast to a literary personality, we would expect that he would use terms with clearly defined, objective meaning, that avoid value judgements.

metaphors-1

In the science of physiological pathology, a pathologist identifying a tumor is not making a value judgement. The tumor can be seen, measured in size, and its cells observed and described objectively. When pathologists look at a sample of blood to see if a person has a microbe infection, the microbes can be described objectively, and the number present in the blood sample can be counted in a clear, precise manner.

Psychology as a Science

In the late 1800s, William James decided to begin a lengthy project of treating psychology as a science, hoping this would lead to new insights about how the mind works. A few years into this project, he published his Principles of Psychology. There, he laid out his scientific aims, and then he described the sources of error in a scientific psychology, the very first of which “arises from the misleading influence of speech.”

william-james-repeated-is-truth1At the time, medical writers were already heavily pathologizing a great number of experiences. Thus, James cited W. Griesinger, the author of The Pathology and Therapy of Psychological Illnesses, and T. S. Clouston, author of Clinical Lectures on Mental Diseases. As James delved further and further into the experiences being pathologized in this way, he came to believe such terminology was “simple minded” and “superficial medical talk.”

The terms pathology, disorder, disease, and illness, when applied to the types of experiences that get classified as mental illnesses by the psychopathologizers of today, often are meant to suggest suffering, dysfunction, and abnormality. Let’s take a look to see why using pathologizing terms in this way is really way too imprecise for scientific purposes.

Suffering

labor-painsDoes it make sense to say that when people are suffering, they have a “mental disorder?” Well, consider the experience of giving birth. It is typically accompanied by suffering, and yet it makes more sense to classify this experience as a natural part of creating new life rather than a pathological condition.

pathologizing-11When writers receive rejections from publishers, or a loved one dies, suffering often accompanies these experiences. Yet, we do not typically describe them with pathological terms.

In the Buddhist teachings, the first of the four noble truths is that pretty much all of us will be experiencing suffering as we go through our lives. It has been theorized that in some extremely rare persons a state may be reached at which there is no more suffering, but that is far from the norm.

How much suffering, beyond the “normal” amount that one experiences during life’s parade of disappointments, is required to ascribe a diagnosis of some mental disorder? That is left to the subjective view of the pathologizers, rather than by employing sound principles of science.

There are science minded individuals who have been working on the task of providing objective measures of suffering for decades. Such people have used principles of science to measure short term and long term stress within an individual. cortisolFor example, cortisol levels in saliva and heart rate variability has some connection with a person’s self-reports of how much stress they have experienced in recent days, while hair cortisol levels have some connection with longer term exposure to stressful experience. Other measures of stress utilize a list of stressors, such as the recent death of a loved one, living in poverty, etc. The person being assessed places a check mark next to each of the stressors on the list that applies to him or her. These check marks are then used to calculate how much stress the person has been experiencing.

Such measures, which are normed on large samples of people that are somewhat representative of the general population, can give us some objective estimate of someone’s level of suffering. But make no mistake, these types of scientific measures of the constructs of suffering are almost never used by the psychopathologizers. In today’s world, if you are a licensed mental health professional, you typically must declare that a person has a mental disorder to permit the person to access mental health services, and this must be done in one visit typically lasting less than an hour using the professional’s subjective judgement.

Dysfunction

functioningHaving indicated some of the problems of unambiguously, and non-subjectively applying the descriptors of suffering to the concept of mental disorder, we now turn our attention to the descriptor, “dysfunction.” As with the notion of suffering, the pathologizers almost never use the various scientifically validated measures of functioning to determine if someone has a mental disorder. A pretty good such measure is the Scales of Independent Behavior-Revised. It has norms for functioning in such areas as social interaction (communication skills, language comprehension, language expression), personal living skills (eating and meal preparation, toileting, dressing, personal self-care, domestic skills), community living skills (time and punctuality, money and value, work skills), and gross and fine motor skills. Rather than using measures of this type, pathologizers rely on their professional privilege to make a subjective estimate of dysfunction.

Abnormality

pathologizing-2In the most current edition of the DSM, someone who is experiencing abnormal levels of distress might be considered to have a mental disorder. But the issue of the boundary between normal and abnormal experiences lies at the heart of the most contentious disputes in the field of psychopathology today. A major problem with using the term abnormal as one of the defining attributes of mental illness is that it leads us to forget the fact that natural to all organisms is substantial variability across individuals and within individuals. Having above average or below average functioning in various areas of our many areas of functioning is normal. Displaying rare behavior patterns that are highly valued, such as the great altruism of Mother Teresa, are not viewed as mental disorders. Psychopathology is applied when someone does not like a particular experience. Thus, a term that masquerades as a scientific term is really a value judgment masquerading as a scientific term.

Conclusion

pathologizingAlthough there are some fairly well developed scientific measures of the three major factors (suffering, functioning, and abnormality) that the psychopatholgizers tend to claim are usually part of the mental illness experience, these measures are almost never used in their “diagnostic” determination. Instead, subjective indicators of these three factors are combined into an even more subjective abstraction called “mental illness.” This process is not scientific despite claims to the contrary.

pathologizing-3Rather than a scientific concept, the mental illness concept has been very useful as part of a highly lucrative business plan for the pharmaceutical industry and medical doctors, which includes psychiatrists. This plan has doctors first convincing people that the experiences referred to as mental illnesses are scientifically real illnesses just like physiological pathologies. It then provides license for doctors, in as little as fifteen minutes, to declare that they have provided their patients a diagnosis, and to send them on their way with a prescription for pills. With this plan, billions of dollars flow their way.

It is my sincere hope that this post will lead to more people understanding what is going on here. It is also crucially important that more and more people come to understand that there is an alternative to the mental illness labeling process that would be easy to develop–one based on a “mental health concern” construct (see HERE for a more complete discussion of this alternative). A mental health concern approach would not only be more scientific, but also jargon free and less stigmatizing. Moreover, the research that it would generate would lead to dramatically improved services for people struggling with anguish, sadness, and tears.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

 

My 2016 APA Speech On Psychiatric Diagnoses
Are Mental Illnesses Really Brain Diseases?

About the Author

Jeffrey Rubin grew up in Brooklyn, received his PhD from the University of Minnesota and has taught conflict resolution there as well as at a psychiatric clinic, a correctional facility and a number of public schools. He has published articles on anger and conflict resolution and has authored three novels.

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