Redefining Pathology

I usually try to stay away from technical terms like this.

But we use the word "pathology" to describe things we think exist outside of the norm. Phrases like "pathological liar" and "pathogen" paint our understanding of people or things behaving as they should not. The first formal family psychotherapy began when a group of psychiatrists recognized that business as usual was not working with patients who suffered with symptoms of schizophrenia.  Noticing some familiar patterns that emerged in family interviews, the psychiatrists changed treatment from a medical framework to a family and behavioral approach. 

Some sixty years later, interests compete to define not just how problems can be treated, but where problems exist. For example, the American Psychiatric Association spends millions to create the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is the foremost authority on mental illness. From this book, millions of doctors across the United States categorize and treat pathological behavior. As a society, we have chosen to empower the DSM-V, largely because within the medical model, we have adopted the belief that not only are behaviors medically pathological, but they are medically treatable. In the 1950s, we began experimenting with trangquilizers to subdue erratic behavior. Before then, psychiatrists treated patients using a variety of drugs that we would consider illicit today. 

Treatments change as culture changes.

A benefit of the psychiatric movement is that categorizing behaviors lets people know that they are not alone. For a long time, mental illness was even more stigmatized than it is now. As a clinician, I'm happy that my clients have a language they understand and can relate to. 

What scares me about the way our culture defines mental illness is that we've added another big jargon word: etiology.  Etiology just means how things begin. We've decided that behavioral problems exist like diabetes or cancer might, at the cellular level. As a result, we fail to recognize the relational and behavioral components of common diagnoses like depression and anxiety.

Where do problems come from?

This is usually the first question I ask students who are learning family therapy for the first time. As a family therapist, I challenge myself and others to treat erratic or hazardous behaviors as symptoms of both mental and relational pathology.  The problem does not always lie exclusively within us, sometimes the problem is between us too. Depression can be maintained by the closest distance between a parent and a child. Anxiety is propped up by the silence between you and I. As a family therapist, I value both the internal and relational features of behavioral health. 

What should that mean to you, the consumer, the one looking for someone you can trust? There are a lot of us to choose from. When I look for someone for my friends and family, I find someone with a lot of experience and an open mind. I want someone who will keep the DSM-V in their back pocket, but who also has a natural curiosity about my loved ones' lives. How they live. Whom they love. Etc. All of these are pieces of a puzzle. You and I are the puzzle, but together we create something much more complex than the sum of our parts.

Dr. Mathis Kennington