Pathology

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