A young woman in her mid-twenties recently came in for her first visit with me. Three months earlier she had experienced her first bout of anxiety and it had become more acute thereafter. She went on to explain that she had been seeing a psychiatrist who had prescribed four different psychotropic medications, simultaneously. Complaining of a blurred and disconnected feeling, she offered that she was uncertain as to whether the cause was physical, emotional and psychological—or a symptom of the gross invasion of this massive drugging.
I asked her if she had engaged in any therapy with either this psychiatrist or anyone else. “ He told me I didn’t need any therapy, just take the medication.” I gathered myself as I felt my ire arising. This medical professional seemingly appeared indifferent as to what conspired to set off this disorder and equally removed from any healing intervention, other than submitting her to an avalanche of very serious medication. I am increasingly witnessing such abhorrent behavior by many practitioners in the mental health profession.
I must note that I am not opposed to psychotropic medication; simply the indiscriminate and flagrant abuse of it. Moreover, I find the reliance upon and dominance of prescription medication over psychotherapy to be alarming.
During the course of our first meeting it become rather apparent as to why her life had unfolded in this manner and in fact, the anxiety made sense, as she had always struggled with her self value and her relentless measuring and judging of herself had more or less assured such a crisis. We are now working effectively toward reframing her beliefs and thoughts as she seeks to transform her life experience.
Depression, anxiety and other symptoms of emotional and mental distress have become so commonplace that they are literally being institutionalized. What was once considered an abnormality has now become quite normal. We should be asking why that is so. The rates of occurrence are staggering. They indicate the emergence of an epidemic. There is something terribly amiss here. This data indicates that what we refer to as mental disorder is, in fact, quite normative. It's beginning to look as if the disorder is, in fact, the order.
I am suggesting that in part it is the pathologizing of stressful, yet normal human experience, that we indeed create a culture of pathology. I would offer that what would otherwise be a normal experience of the ups and downs of being human, are now viewed through the prism of dysfunction. Every challenge and travail has a diagnostic label affixed to it and we become a nation of victims--both to the malaise and the pathologizing of what it means to be human. Having said this, there are no doubt other contributing factors to this problem—primarily cultural--- that will be the subject of my next blog.
The hegemony of the pharmaceutical industry
The pharmaceutical industry is second only to the military industrial complex in terms of size and revenue. This industry has taken a leading role in the education and training of psychiatrists and the field has become for the most part a profession of diagnosis and medication, marginalizing actual psychotherapy. The overarching force in American culture is profit and there is enormous profit earned from the business of medicating people.
At times, life simply presents challenges and struggles that very understandably cause distress. Yet, when we drug away the symptoms we invariably weaken the individual’s capacity to cope and to grow, as they become habituated to the medication and disempowered in their own ability to transcend their struggle.
Recently, I heard a colleague recount the following story: A new client came in to see him and told him that her husband had just left her and their three young children. She was overwhelmed and anxious about finances. She indicated to him that her previous therapist had recommended anti-depressants. A pill can't cure or alleviate the circumstances that her life presented. Yes, this woman was likely depressed, but for a very good reason. Her depression isn't clinical, but situational and due to real life stressors. She doesn't need medication; she needs support and encouragement to face her challenges. We need to look more circumspectly at the automatic default of prescribing pharmaceuticals and selectively determine when medication is truly advantageous, yet not subscribe blindly to the medicating of a population.
The dysfunction of diagnosis
A diagnosis has become confused with being an actual entity. Diagnosis should be a practitioner’s best effort to describe and summarize an individual’s challenges and circumstances and correlate that evaluation to a DSM descriptor. Instead it has become concretized to be an actual thing. Last week, as I was walking down the corridor from my office I overheard a therapist speaking with another about their client. “Jane has ADD,” she offered. Tongue in cheek, I inquired, “What do you mean?” “My client Jane has ADD,” she once again proclaimed, bewildered by my feigned ignorance.
I corrected her as I asked, “You mean you see behaviors in Jane that conform to what we call ADD?” Diagnoses should not be confused with an actual material essence as much as they ought to be accurate descriptions for the purpose of coherent communication about a person’s circumstances. The diagnosis is a description, our best attempts to summarize the great complexity and inestimable variables that account for a person’s life. The only certainty is a prevailing uncertainty in this most subjective science. It is a cardinal error to aggrandize our inclination to categorize and play master of the universe with people’s lives. When the board of psychiatrists convene to construct new diagnostic language to describe disorders that they see occuring in the mental health community, it may serve a useful purpose; one of describing prevailing circumstances seen through a subjective filter. But we loose sight of the intention to describe rather than to construct. When the person becomes the diagnosis, we loose the ability to see that thought created the diagnosis, makes an attribution of that thought to a human life and then steps back in denial of the whole process.
Of course, this error of categorization or what Alfred North Whitehead referred to as the fallacy of misplaced concreteness, aligns perfectly with the profit driven goals of the pharmaceutical industry. I would offer that an unconscious conspiracy occurs between the hegemony of the drug industry and the loss of the healing capacity of the therapist. They result in what I refer to as the pathologizing of a culture.