Following the entry of protracted bereavement disorder into the Diagnostic and Statistical Manual of Disorders, debates about pathologize– classifying what we might consider typical life experiences, such as bereavement, as disorders requiring specialized treatment – relaunched.
Psychiatry has long figured in these debates, particularly in the case of homosexuality which was classified as a mental disorder until the 1970s. Much less attention has been given to psychiatry’s close cousin, psychotherapy.
There are good reasons to suspect that therapy might also contribute to pathologization. After all, many schools of therapy started as a treatment for specific disorders, but have since expanded to more mundane issues. For example, cognitive behavioral therapy (CBT), was originally developed as a treatment for severe depression, but is now widely available and applied to everything from diet to productivity. As the focus of therapy has shifted from clear cases of mental illness to more ordinary problems, we may wonder whether our understanding of these ordinary problems has also changed.
In a recent article, I show that CBT’s understanding of mental illness–The cognitive model of mental illness-contributes to the pathologization of experiences such as grief, grief and unhappiness. CBT argues that mental illnesses are linked to certain thought patterns, called negative automatic thoughts or cognitive distortions. These distorted thoughts are believed to cause negative emotions and behaviors symptomatic of mental illnesses such as depression. Many CBT therapeutic techniques focus on addressing these distorted thoughts in an effort to address negative behavior and emotions.
Unfortunately, typical experiences such as grief, sorrow, and unhappiness also involve the same distorted thought patterns. It’s not uncommon, for example, to find yourself having overly dramatic thoughts, such as “I’ll never love someone like that again” following a breakup. Most likely, such a thought will turn out to be wrong (or “catastrophic” as CBT texts tend to put it) but it is surely not messy. We find it perfectly normal for people to think such things when they are upset about the breakdown of a relationship. We also find that the accompanying negative emotions and unproductive behavior (eg, obsessively checking their ex’s social media) are fairly typical of a breakup.
Other negative experiences are similar. For example, in light of a bereavement, we may punish ourselves by thinking that we should have spent more time with the loved one before their death. Or, some sort of misfortune, for example, missing out on a long-desired career goal, might lead to bitter questioning whether the decision-making procedure was entirely fair – these thoughts correspond to the cognitive distortions of “should” and “blame” respectively. . However, such thoughts and the negative behaviors and emotions that may accompany them are integral to what it means to have these experiences.
When a “pathological” experience is precious
We might ask whether it is important that ordinary experiences fall within the cognitive model of mental illness of CBT. After all, they are painful and some people might prefer to overcome them with the help of a therapist.
However, this shift to viewing ordinary experiences on a par with more obvious mental disorders is likely to have unintended cultural consequences. Perhaps we are less patient with ourselves and with others when we undergo these experiences. We can expect people to “get over” a loss quickly and get back to their daily routines more immediately.
To view these experiences as pathological is also a failure to see them for what they are – not just a typical or inevitable part of life, but also a value. Sorrow and grief indicate that one has lost an important relationship or a dear person. Unhappiness also indicates that one had something worth losing or aspired to something that one values, such as an ambitious career. These experiences indicate that one has had a life worth living.
Of course, not all therapies pathologize. But the fact that CBT blurs the line between mental disorders and ordinary experiences in its classification of mental illness shows that we need to look at psychotherapy as well as psychiatry when we are concerned with pathologizing a range of human experiences.
To find a therapist near you, visit Psychology Today’s Directory of Therapies.