Psychopharmacology
The Pathologizing of a Culture
Are we pathologizing stressful, yet normal aspects of the human experience?
Posted February 1, 2009 Reviewed by Davia Sills
A young woman in her mid-20s 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, or 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. She said, “He told me I didn’t need any therapy, just take the medication.” I gathered myself as I felt my ire rising. This medical professional 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 became 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 actually the order.
I am suggesting that, in part, it is with 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 is now viewed through the prism of dysfunction. Every challenge and travail has a diagnostic label affixed to it, and we have 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 an 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. A 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 attempt 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 convenes to construct new diagnostic language to describe disorders that they see occurring in the mental health community, it may serve a useful purpose: one of describing prevailing circumstances seen through a subjective filter.
But we lose sight of the intention to describe rather than to construct. When the person becomes the diagnosis, we lose the ability to see that thought created the diagnosis, made an attribution of that thought to human life, and then stepped 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.
