Merriam-Webster defines as follows:

pathology
noun
pa·​thol·​o·​gy pə-ˈthä-lə-jē
pluralpathologies
1: the study of the essential nature of diseases and especially of the structural and functional changes produced by them
studied plant pathology
2: something abnormal:

a: the structural and functional deviations from the normal that constitute disease or characterize a particular disease
the pathology of pneumonia
b: deviation from propriety or from an assumed normal state of something nonliving or nonmaterial
the pathology of wine
c: deviation giving rise to social ills
connections between these pathologies … and crime Wendy Kaminer
social pathology

“Pathology,” “pathological,” and especially “pathologize” have become politically incorrect and emotionally charged when therapists are trying to discuss what’s going on with our clients, which makes it very difficult to actually define and describe their problems. Therapists will try to avoid “pathologizing” a client and their concerns in the attempt to avoid shaming or blaming them for whatever is happening.

For example, the word “codependence” has fallen out of favor because it is seen as pathologizing the pain and trauma the partner of an addict is experiencing as a result of the addict’s behavior. (see April 2021 newsletter)

Recently, I was following a discussion about the term “sexual anorexia” and one or two therapists were saying that this term “pathologizes” a person’s avoidance of sex as a result of their own or a partner’s sexual behavior.

So, what do we call it when someone comes to us in distress, for whatever reason, and we try to diagnose the problem and then treat it? Is trauma not pathological when it is expected and normal? Should we then just accept it and leave the person suffering? Of course not. Trauma that is an expected, or “normal,” response to an event can still be pathological in that we want our “normal” mental state to be one of emotional balance and absence of pain or distress.

It becomes a bit paradoxical that on the one hand, we therapists want to remove the stigma that surrounds mental health therapy, but on the other hand, we want to refrain from pathologizing clients’ mental health issues so we don’t stigmatize them.

I’m going into the hospital for hip replacement surgery in a few weeks. I have pain and loss of mobility resulting from hip dysplasia that led to arthritis. The arthritis is a normal result of years of dysplasia and it is all pathological in that it causes distress and deviates from optimal physiology. I feel no shame or blame around this. Why can’t we bring that same attitude into our sessions?

At the end of the day, it becomes exhausting trying to keep up with non-offensive or non-triggering language and I find it best when I just define whatever terms I’m using, like “sexual anorexia” and “codependence.” They are useful for conceptualizing what is happening and directing the appropriate interventions. If someone is having a reaction to a particular word or term, then just ask “What is the meaning of this for you?” and go with that. Focus on the words distracts from what is really going on with the person in front of us.

Perhaps the simplest way of looking at this is how I look at everything – disconnection and Connection. Pathology in any presentation is disconnecting and Connection is our natural state.

Pathology                                            Healing                                                Connection

Be In Light

Whatever the cause, the ability to perpetrate suffering and harm on another being comes from being Disconnected. When I am Connected and aware of my Connection to all life, I am unable to cause harm because I feel the pain I am causing. There is no altruism, no lack of selfishness in doing good instead of harm. It is, in fact, selfish to help others and want to bring pleasure to others.

(warning: this article may be disturbing to some readers. Take care of yourself and call the Sex Abuse Hotline at: 800-656-4673 or chat online at: online.rainn.org)

Ask therapists who they definitely don’t want to work with and the majority will say, emphatically, “sex offenders!”

Why? Well, they often have some preconceived about who and what sex offenders are. They think about the guys in the mugshots on the sex offender registry. They think about the celebrities who have been arrested after years of predatory behavior. They think about men and women doing unspeakable acts on children. And they are often victims of sex offenders themselves.

So, when I teach classes on Risk Assessment and Treatment of Sex Offenders and know that I have quite a few sexology/sex therapy students wondering why they need to take these classes, I tell them what I’m going to tell you now.

First, sex offending is an umbrella under which are child molesters, pedophiles, rapists, sex traffickers, sex harassers, voyeurs, and exhibitionists. The predatory, violent child rapist is the one who gets the most media attention and on whom our fears and anger is placed, but that person represents just a small fraction of sex offenders. Making laws and basing our behavior on these few, although extremely devastating, psychopaths does the opposite of what we really want, which is to protect victims, especially children.

As experts in the field of sexology, we want to understand the nature of sex offending so that we can best protect the public. Helping the offender is with that primary goal in mind, so it’s a win/win. We want to know what motivates each type of offending, so we can tailor our treatment to that. For instance, a rapist is motivated primarily by power and control while a voyeur is motivated by sexual excitement.

Here's something a lot of people don’t know: Not all child molesters are pedophiles and not all pedophiles are child molesters!

Treating them both the same will not be the most effective way of helping them to not offend again.

There is a segment of the population referred to as MAPS – Minor-attracted persons, or non-offending pedophiles. People, almost all men, who fall into this category of recognizing their urges but resisting acting on them have, until recently, been completely invisible. They have been scared to death, rightly so, to seek professional help because most therapists wouldn’t want to treat them, would judge them and be repulsed by them, and would be thinking that they have to report them (they don’t if the person has not acted out). Fortunately, there are now websites dedicated to supporting MAPS (https://www.b4uact.org/ and https://www.virped.org/) and therapists who are specializing with MAPS to help them live healthy lives and never touch a child.

Next, even if a therapist doesn’t work with sex offenders, they will undoubtedly work with victims of sex offenders, whether children, parents, partners, or others whose lives have been affected. Not everyone who has been a victim is willing or able to just cut all ties with the offender and knowing the nature of the offenses can help us treat all of our clients. If I am working with a person who was the victim of a parent and is still trying to have a relationship with that parent, it will be critical to know if that offender is a pedophile or a child molester who is not a pedophile.

Finally, certified sexologists/sex therapists are experts in this field and need to be voices of reason. Sex pushes people’s buttons in many ways, as evidenced by restrictions on sex education, censorship, and shaming coming from religious and other groups. This intensifies when people talk about sex offenders. Fear and anger replace rational thinking, with the result that not only are people harmed directly, but we fail to effectively protect children. We need to speak up and speak out as knowledgeable experts whenever and wherever we can.

So go ahead and sign up for a Free Class and gain more insight and understanding into this misunderstood area. Maybe, like a few of my students, you will even decide to specialize with MAPS or sex offenders.

Until then

Be In Light,
Carol

For the past couple of weeks, I have had several people ask me how I am. I have replied that I’ve been really busy, because the amount of work coming at me from all directions has been all I can think about. Without exception, they all reply “Busy is good, right?” As if there is something wrong with not being busy, as if my life would not be full or satisfying if I was not busy, or as if not being busy meant that there was something wrong me!

When I have occasionally said that being busy isn’t always great, they will say, “But you chose this!” Well, yes, I have chosen my life and career and yes, busy means that both are thriving, but……

In my first book, Addict America: The Lost Connection, I write about how Americans in general pride themselves on being busy and being “go-getters” and pushing themselves to extremes. That’s why I chose the title “Addict America.” These qualities can be great and can result in personal and professional achievements and can garner admiration and respect from other Americans, but they can also lead to unhealthy stress, unhappiness, distraction from what is meaningful in life, and to addiction.

The way I conceptualize addiction is that it is a state of being where a person has elevated the amount of stimulation they need just to feel normal to a heightened level that requires constant seeking of activities and/or drugs that provide that stimulation. It takes over the person’s life.

Obsessive, compulsive, out-of-control behavior done in spite of negative consequences to self or others.

That is the definition of addiction and so when I say I’m really busy, it is a red flag for me and anyone else to ask if I am taking care of myself, finding balance in my daily life, spending time with my loved ones, and am able to know when to stop and relax. If you ask me any of that and I get angry or irritable, that is another red flag.

The reality for me, right now, is that I am really busy and I am also paying attention to those other questions. I have learned the difference between being in an addictive, or disconnected, state and a recovering, or Connected, state (see A New Working Definition of Recovery) and I choose recovery and Connection. So now I am going to save this article, go have some lunch, and enjoy some quality time with my husband. Work can wait.

Be In Light,
Carol