Ep 3.12 - Into the Hall of Mirrors: Deciding What (and When) to Pathologize

A Therapist Can't Say That

As I’ve been trying to wrap up this season of the podcast, I’ve been reflecting, in particular on my conversations about psychiatric diagnosis with Dr. Awais Aftab and Dr. Miri Forbes.

I keep coming back to this question: How do we decide what human traits, behaviors, and subjective experiences to pathologize? What makes something about a person a problem that we try to fix?

It’s a deeply complicated question, with few, if any, absolute answers. Yet I still think we have to wander that hall of mirrors, and I believe that how we conceptualize and approach the question is actually more important than any conclusions we might make.

Because when we are able to articulate the various factors that influence what we pathologize and when, we actually increase our ability to apply those factors across contexts without needing to have an ultimate conclusion that is true for all people, in all contexts, at all times.

Listen to the full episode to hear:

• How even using suffering as a metric for a problematic trait is often complicated by context
• Why we cannot discount the sociocultural context for an individual’s expression of traits
• Why pathologizing states as problematic across the board falls apart in real life
• How the medical model of optimal human functioning fails to translate to psychopathology
• Why we have to stay open to uncertainty in viewing our clients’ suffering and how we can help ease it

Learn more about Riva Stoudt:

• Into the Woods Counseling
• The Kiln School
• Instagram: @atherapistcantsaythat

Resources:

• Season 3 Ep 9: Epistemic Justice in Diagnosis: Exploring Borderline Personality Disorder with Dr. Awais Aftab
• Season 3 Ep 10: What We Talk About When We Talk About Diagnosis
• Season 3 Ep 11: Redefining Psychiatric Constructs with Dr. Miri Forbes
• Effective Reaction to Danger: Attachment Insecurities Predict Behavioral Reactions to an Experimentally Induced Threat Above and Beyond General Personality Traits, Tsachi Ein-Dor, Mario Mikulincer, and Phillip R. Shaver