Update: The video clip I’d previously embedded here I’ve now removed because of problems with access.
The above clip from TV’s The Doctors is now dated. This practicing therapist, a vibrant woman who thinks “being alive is a lot of fun” is actually now 102. And this year she received an Outstanding Oldest Worker Award given by an organization named Experience Works.
According to the Experience Works website, Hedda Bolgar actively sees patients in her Los Angeles office and also lectures, writes, and appears in videos. On a website called The Beauty of Aging, in fact, she’s featured along with other older women in their DVD trailer.
Ms. Bolgar has had a distinguished career and apparently currently has no intention of retiring—she loves what she does that much. According to the Experience Works site:
She looks at the future with ideas, hope and curiosity, but lives very much in the present and tries to be aware of the impermanence of things. She says that when you get to the age of 100 and over, wisdom comes from not being too attached to things and learning to live with complexity.
Whether you want to retire younger or older, are male or female, are a shrink or not, what a role model Ms. Bolgar is for us all.
Yesterday’s post took a macro view of the issue of pathologizing. Today I look at the micro view—what if your therapist pathologizes?
For example, say you’re in therapy for depression. You happen to kinda mention that you bite your nails. Look at these nails—gross. Maybe you really want to fix it, maybe not. Some people are nail-biters. Sowhat. Who cares?, as Saturday Night Live‘s imitation of Joy Behar goes.
But your shrink jumps right on it. Or even worse, you’ve never even said anything about your nails, but it’s your therapist who makes a point of it. I seethat you bite your nails. Either way, your shrink takes this info and runs with it—maybe he/she sees in your future a lengthy analysis of your oral fixation habits rooted in infancy. Or maybe he/she assesses anxiety as the source of your nail-biting and suggests yet another medication. Or maybe he/she prescribes a behavioral plan.
Either way, you’ve been unnecessarily pathologized. And you go home wondering what happened to dealing with the fact that you’ve been unable to get up in the morning to go to work.
Whether your shrink sincerely believes in his/her methods and suggestions or whether your shrink is just trying to bilk you out of your inheritance, you as the client are left with needing to decide if this is really worth your while.
A possible analogy is that you notice that the tires on your car are kinda flat. You think, maybe I’ll stop by the garage and put some air in those things. Or better yet, maybe I’ll leave it up to my mechanic. The next thing you know, you’re waiting a couple hours for your car to get four new tires it doesn’t need, and you’re out a big pile of money.
See what you think about this brief clip below in which TV’s Frasier Crane, a psychiatrist, tries to help Woody, the bartender at Cheers (which ran from 1982-93). Is this relevant to the above perspective on pathologizing? (If not, I hope you enjoy it anyway.)
Pathologizing is basically about making an ordinary enough life problem into a mental health diagnosis. An example of this was the subject of the 2007 book Shyness: How Normal Behavior Became a Sickness, by Christopher Lane. I believe the title speaks for itself.
Lane shows how a pharmaceutical company can use pathologizing towards unscrupulous ends and concludes in his book, “Before you sell a drug, you have to sell the disease. And never was this truer than for social anxiety disorder.” Paxil anyone?
A 2010 article by Tyler Woods, Ph.D., reports that 68% of members of The American Psychiatric Association’s task force that is writing the next (2013) edition of the DSM admit to “economic ties with drug companies.” How do you think this might affect their opinions regarding whether something belongs in the DSM as a mental disorder?
Some of the “conditions” that some factions in the mental health field protest as being pathologized and thus inappropriate for inclusion in the revised edition of the DSM are sex addiction, gender identity disorder, premenstrual dysphoric disorder, female sexual dysfunction, parental alienation syndrome, and obesity. Some of these are already in the current edition of the DSM.
If not all of these are controversial because of iffy connections with Big Pharma, some are. As therapists and clients become increasingly aware of the implications of pathologizing, perhaps we can be more careful ourselves about not “buying into” the costly and misguided labeling of our problems.
Whereas most people who seek therapy or treatment for psychological disorders are on the up and up, some are not—they may actually be malingerers.
Malingering, as defined in the DSM-IV-TR(Diagnostic and Statistical Manual of Mental Disorders), involves “the intentional production of false or grossly exaggerated physical or psychological symptoms” for some kind of desired external result. It’s not considered a mental disorder but a condition “that may be a focus of clinical attention.”
When such individuals show up at your therapy door, in other words, they don’t really want or need your help of the therapy kind; they want to manipulate you into getting something else—something they presumably feel they can’t get otherwise.
There’s Corporal Max Klinger, on the TV show M*A*S*H (1972-83), for example, whose plan for getting out of the Army involved trying to prove that he was psychologically unfit. Despite all his bizarre antics, however, he couldn’t achieve his goal and eventually gave up.
And then there’s Liz Lemon, played by Tina Fey on the current TV sitcom 30 Rock. Her goal is to escape jury duty.
A malingerer presenting at a mental health setting could also be driven by such motives as getting out of work, obtaining disability insurance, and seeking drugs.
According to an article in Scientific American last year, though, a recent study showed that a person who fakes symptoms of mental illness can actually start to believe the illness is real. Put into action, this means Klinger would start to really believe that he can fly (in his pink bathrobe and slippers), while Liz Lemon would settle into the delusion that she’s a Star Wars character. Sheesh—isn’t malingering already hard enough to detect?
On a more positive note, psychologist Elizabeth Loftus is quoted in the same article as envisioning:
…therapeutic potential in the new study, musing on a hypothetical strategy she calls ‘feigning good,’ which could motivate patients by helping them believe in improved cognitive skills and diminished symptoms of illness. ‘Should clinicians be prescribing a form of feigning? You wouldn’t want patients to feign anxiety, but maybe they could feign the opposite. Maybe they could feign crystal clear concentration.’
Let’s see now…Maybe I can feign writing an effective way to end this post.
Writer and actress Carrie Fisher has not been one to shy away from disclosing—to the world—her various mental health and substance abuse issues. In fact, by writing and speaking out candidly about her struggles, she has stared down the threat of mental health stigma and has won.
Carrie Fisher’s first novel was the semi-autobiographical Postcards From the Edge (1987) in which the main character, Suzanne, is addicted to drugs. One of her most memorable quotes: “Instant gratification takes too long.” Despite this attitude, Suzanne does eventually wind up in treatment and on the road to recovery.
By the way, the movie adaptation (1990), available on DVD, features Meryl Streep as Suzanne and Shirley MacLaine as her famous-actress mom with an affinity for both booze and the spotlight.
While promoting her 2008 book, Wishful Drinking, CarrieFisher spoke with Matt Lauer on The Today Show. Below is a brief clip (unfortunately a bit out of sync) in which she addresses her lack of fear of mental health stigma. Please note: although it may appear that she has no legs, they’re just tucked underneath her.
Fisher has performed her one-woman show of the same title in various U.S. cities, including on Broadway in New York. She’s currently, in fact, on stage in Chicago through October 16th. (The filmed version of the show, which has aired on HBO, has been available on DVD since 2010.)
…the real strength of this piece is how well Fisher’s personal stories speak to greater societal and existential truths. ‘Wishful Drinking’ is intended to be fun, and indeed it is, but the real nut of the night is this: ‘If you claim something, it has less power over you…’
The following video clip, representing different parts of her show, illustrates Fisher’s unique approach to her own serious mental health issues:
Although in Wishful Drinking Fisher has already publicly aired her use of electroconvulsive therapy (ECT), her soon-to-be-released book Shockaholic apparently delves even deeper into this. From the product description on Amazon:
…the electro-convulsive shock therapy she’s been regularly undergoing is threatening to wipe out (what’s left of) her memory.
But get ready for a shock of your own. Not only doesn’t she mind paying the second electric bill, but she loves the high-voltage treatments.
Hence, the implication in the title that ECT may now qualify as her most—brace yourself for another pun intended—“current” addiction.