Mild Dissatisfaction Disorder: The Pathologization of Human Normalcy
anonymous Asks ...
Nobody is perfect or perfectly satisfied, correct? So that being a given, we can’t say that being not perfectly satisfied is a disorder or deviation from normal. If we can accept that as true, do you think there is a tendency today to over medicalize and treat what is essentially just normal human experience? For example, if I go to get counseling with a psychologist and when asked why I say that I am not perfectly satisfied with my life. After counseling, I’d bet there is a greater than even chance that I’m leaving that office with a diagnosis of some sort and maybe even a prescription for medicines – even though the only thing that is ‘wrong’ with me is that I human. Do you think this is true, and if it’s true is it bad, and if it’s true and bad, what can be done to change this?
Dr. Richard Schultz Says ...
Hello and thank you very much for addressing such a thought-provoking question to me.
There are indeed influences embedded throughout our culture which cause typical, "normal" behavior to be viewed (and worse yet, actually experienced) as pathological, deviant and in need of treatment. This process can occur intentionally (as in the longstanding acknowledgement that Madison Avenue's primary goal is to cause you to feel crummy if you don't use the product being advertised) or unintentionally, as a by-product of the lovely cerebral cortex that has been sitting atop our brains for the past 100,000 years or so, and whose function is to compare, contrast, analyze, fix, criticize, label and judge everything in our experience. Not suprisingly, the ultimate impact of both factors is to increase the likelihood that we are going to look at our lives in a way that doesn't feel so great. As is often said in A.A., "compare and despair."
Another major influence in this realm is so-called "Big Pharma," whose day to day mission involves looking for new conditions to be "treated" with their products and for new products and drugs to replace the previous drugs for which patents have expired. Pharmaceutical companies can also be said to have an interest in widening existing diagnostic formulations such that increasing numbers of people can be said to suffer from a particular condition (and hence widen the market for the drug to treat that condition). By tweaking the diagnostic criteria for a major depressive episode, for instance, the prevalence of that condition could easily double without any change in the underlying condition or the population being studied.
On a larger scope, one could also make the case that Western medicine as a whole is one massive pathologizing, patient-creating machine. As they say, when all you have is a hammer, everything looks like a nail; thus, when your mission is to diagnose and treat "illness," by golly you are going to diagnose and treat illness! Among the many criticisms of the controversial and recently published "DSM-V" (The Diagnostic and Statistical Manual of Mental Disorder, 5th Revision, aka the diagnostic bible for shrinks) is precisely that formulations for many mental health problems have become so broad they would appear to include everyone on the planet! Forgive my hyperbole; I think you get my point.
It may be argued that it is this observable and measureable trend toward the pathologization of imperfect but relatively normal human functioning which first gave rise to the Positive Psychology Movement in the 1990's. In case you haven't seen any of the scads of books, television shows, movies, websites and self-help programs that purport to help you "stumble upon happiness," or achieve optimal life satisfaction, they have flourished more rapidly than gourmet hamburger joints and cupcake shops. Although those of us who have acknowledged our culture's unfortunate bias toward pathologization are likely to appreciate aspects of Poisitive Psychology, the movement can also be said to have indirectly exacerbated the underlying problem it intended to address. For as we begin to zoom in on, and place ever greater value on the concept of "happiness," and study it, write about it, and pursue it, we are also unwittingly disparaging the natural human inclincation to NOT feel so happy on a recurrent basis. We have clarified our preference for happy, and turned everything else into red-headed stepchildren.
If this were simply a matter of changing societal tastes, as might occur with food, cars, clothing, or mobile devices, it would be less likely to impact us on such an intrinsic level. However, when we try to turn away from unavoidable, natural and healthy internal phenomena, such as feelings of sadness, fear or frustration, we are actually rejecting important parts of ourselves, and paradoxically causing an increase in our distress about our distress. This is echoed in the empirically supported cognitive-behavioral princinciple of "that which we resist, persists." So, yes, chasing after happiness is a really great way to become unhappy.
As I am a clinical psychologist in private practice, I am in a unique position to see how these trends do and do not translate into mental health treatment and diagnosis all day, every day. After all, that is where the rubber meets the road; where the impact of broader cultural and societal influences affect how people are diagnosed and treated. Based on my experience, your assumption that, if you were to present for treatment with a psychologist but were not in significant distress, you would still most likely leave with a diagnosis and perhaps even a prescription for psychotrpic medicine, may be lacking in accuracy (and I'm not sure if you ever actually experienced this, or if it is merely a speculation).
I have found that, despite the above-described tendencies toward pathologization of normal behavior, the desperate pursuit of happiness, and the unintended dissatisfaction with "normal" in which this may have resulted, I don't have many patients coming in who aren't actually in significant distress. In case you hadn't noticed, the average American is not in any huge hurry to seek mental health treatment. This is supported by robust data on the underutilization of mental health services, due mostly to the perceived stigma of having any type of psychological problem, and problems with access. So, although the inlfuential cultural factors discussed here are substantive, I think they have more of an impact on how people feel than they do on how mental health treatment is delivered or consumed. In case you don't know first hand, accessing therapy isn't easy. Finding a GOOD therapist takes time (and luck, sadly), and using therapy requires even more time, as well as energy and a good bit of money. The therapeutic process itself, while ultimately of significant benefit (we hope), tends to be a rather challenging and at times painful endeavor if done correctly. So, while it is true that there are MANY people with significant psychological struggles who don't seek treatment (as I am sure you have noticed), the reverse is pretty rare.
Since psychologists do not typically prescribe mediciation (there are exceptions to this), I have less of a view into the process that occurs at my psychiatrist colleagues' offices. Based on what I hear and know, via patients and psychiatrists, however, the statements above generally hold true there as well. This does not include patients who may be termed "drug-seeking," and who are after the quick and often addictive fix of opiates, benzodiazepenes, hypnotics and stimulants as a means of achieving "better living through chemistry," but this speaks more to the patient's motivation than to the provider's intent to turn everyone into a patient. That said, I am sure that there are mental health practitioners out there who are at times guilty of keeping patients in treatment owing more strongly to their need for income versus the patient's need for treatment. I like to think this is a rare occurrence, however I cannot be sure. Nonetheless, this would be motivated by the provider's greed or financial concerns and not by cultural influences that pathologize normal.
So, you finally ask what can be done about this phenomenon (which isn't all that new; if you don't believe me, go ahead and read "The Myth of Mental Illness" by Thomas Szasz, written in 1974). Although this is the simplest aspect of the equation, it is also the most challenging and complex. For it is up to each of us, within our relationships with ourselves and toward our experience, that we are most empowered to discover and determine our essence, our value, and our view of our lives and our world. Eleanor Roosevelt wrote that "nobody can make you feel inferior without your consent," and so it is incumbent upon all sentient beings to practice the art and science of being free. We do this by using moment to moment experience as a ground versus our memories, feelings, fleeting thoughts, analyses and constructed meanings. We examine our values and do our best to calibrate our behavior with them. We take what our brain tells us throughout the day with liberal skepticism, and take care not to immerse ourselves within the trance of miserable storylines of inadequacy, hatred, trauma, terror or addiction. We watch how we behave and try to gain awareness of how this shapes our self-concept. We acknowledge that we are not our thoughts and our thoughts are not us. Maintaining an engagement in such awareness and internal process renders us less vulnerable to being pidgeon-holed by anybody's view of us, including our own.
Finally, I can only say that, as humans, we will never be free of the ability to make a hell of heaven and a heaven of hell. We can, however, be increasingly attentive to our tendency to do both, and to get ever more proficient at coming back to the fundamentally impermanant and groundless condition of life. Strangely, it is here that we can be most at peace. Most of the humans on this earth would benefit from getting better at what I have just described in these last two paragraphs. For the most part, this is what I help my patients do, all day, every day.
Thank you again for your wonderful question. I wish you peace.
Richard E. Schultz, Ph.D.