It is a refrain of mine that skillful humanistic counseling is far too potent to reserve solely for those in a state of crisis. I believe that well timed therapeutic counseling interventions can assist all of us in navigating challenging experiences, find meaning in difficulty, navigate what previously seemed unnavigable and emerge from the experience stronger, wiser, and more connected to ourselves and those around us. And of course, for those suffering from unusually strong, diagnosable mental and emotional distress, psychotherapeutic counseling can likewise be a tool of transformation. But what happens when the human experience itself becomes pathologized?
The newly released DSM-5 (that would be the 5th edition of the Diagnostic and Statistics Manual of Mental Disorders produced by the American Psychiatric Association) has been released and, since January of 2014, is being used by clinicians across the country in diagnosing mental health disorders in the general public.
As per the criteria of the DSM-5, it is believed that about 50% of U.S. Citiznes could be diagnosed as “mentally ill” at some point during their lifetime. Are you experiencing grief at the death of a loved one? Is your child throwing tantrums three or more times per week? Are you over eating? Do you experience PMS? Are you experiencing chronic yet difficult to diagnose pain? An affirmative answer to any of the above can now add you to the ranks of the mentally disordered.
When the common experiences of life (death and loss, sadness, common anxiety, pain etc.) become pathologized, it impacts not only the very functional, yet temporarily distressed person experiencing such, but takes vital resources away from those truly struggling in the depths of unusual mental and emotional malaise.
Dr. Allen Frances—who chaired the task force committee for the previous version of the DSM (the DSM-IV ) and author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life states, “Funding for mental healthcare has already been cut in many states, and many people who are mentally ill or even suicidal aren’t getting the help they desperately need.”
Yet the American Psychiatric Association has dismissed DSM-5 opponents as overly alarmed. "All the good epidemiological studies unfortunately show that one in five people have a psychological disorder. ... They're prevalent, they're just all over the place, and that's very disturbing to some people," said Dr. Carl Bell, a Chicago psychiatrist and University of Illinois School of Medicine director of public health and community psychiatry.
However, Dr. Joel Paris, professor of psychiatry at Mcgill University and author of Prescriptions for the Mind: A Critical View of Contemporary Psychiatry counters this view, stating, "The DSM-5, in many ways, reflects the politics of psychiatry these days...Everybody has a kind of investment in certain diagnoses. Those who are studying a particular disorder often are saying, 'Well, this is much more common than you think they are. Oh, the prevalence is very high.' But we risk losing legitimacy because of over-diagnosis...The fact is that most people get by with bad patches in their lives. They recover."
And it is to this sentiment that I turn. All of us will experience emotional challenges and difficulties in our lives. Some more than others. We live in a profoundly fractured and all-too-frequently alienating society. Yet to pathologize the human experience itself strips the very meaning from our lives. It is through challenge and difficulty that character is built and strengths emerge. In extremely challenging situations, supplementation and pharmaceutical medication have their place, I'm not denying it. However, when the common experiences of human life become pathologized, then the meaning of what it is to be human becomes muddy and unclear. And when we are medicated in an effort to insulate ourselves from the common pains of human existence we threaten the very core of what makes us human. The only “winners” of such a zero sum game are those who stand to profit from the over diagnoses of our times.
Being a human being in the 21st century isn't easy. Therapeutic counseling is a tool that can be utilized to assist in moving through the confusion and disquiet of difficult emotional times and a great boon to personal growth and human potential. Never doubt it. But overpathologization need not be a criteria. You are a free, whole and wondrous entity. Never doubt that, either!
Bryan Dieterich, MA, LPC