When And Why Do Symptoms Get Pathologized?

Pathologizing refers to the process, in medicine and psychiatry, where physical symptoms or behavior are classified as unhealthy or abnormal. In medicine, these should not be as a result, or consequence of lifestyle factors or circumstances. When a symptom or a form of behavior is pathologized, it gets classified, and referred to, as a disorder or a disease. When pathologizing behavior in psychiatry and psychology is considered, however, the discourse becomes a bit more complex. Who decides what normal vs. abnormal behavior is, and what are the reasons for these decisions?

What Is “Normal” Behavior?

This is not a question with a simple answer and remains a subject of much debate. The definition of “normal” behavior keeps changing, depending on societal norms and standards. Similarly, what is considered “normal” can differ from one culture to the next. Even within a given community, there can be differing views as to what constitutes “good” and acceptable behavior.

For instance, homosexuality or identifying with the LGBTQIA+ community were considered “abnormal sexual practices” in most Western countries until 1973. In the first Diagnostic Statistical Manual of Mental Disorders (DSM), homosexuality was classified as a “sexual paraphilia” rather than a valid sexual orientation. Today, many modern societies view sexuality, the gender binary, and other related aspects of personal identity as such: pieces of who we are, not examples of abnormal or dangerous behavior. This goes to show how changing social expectations can impact the way we view certain behaviors and experiences. What may seem “abnormal” may simple be a deviation from what we often see. The categorization of some things as “normal” and others as not relies on a fundamentally problematic assumption: there is one correct way to exist or one default state of being.

Is this pathologizing of human behavior still something that happens today, though? Some think so.

What Is “Abnormal” Behavior?

Despite challenges in defining what is normal or not, guidelines for diagnoses and mental illnesses can be extremely helpful when it comes to developing effective treatments. Behavioral patterns that are harmful either to the individual participating in them, others, or both are often of concern to mental health professionals. Rather than being “abnormal,” these behaviors may affect a person’s functionality, quality of life, ability to form and maintain healthy relationships, and more. As such, what is really of interest when it comes to pathologizing symptoms is the impact that said symptoms have.

Internationally, there exist different systems of classification used to help professionals recognize and diagnose symptoms of a potential mental health disorder, with the International Classification of Diseases (ICD) and the previously mentioned DSM, now on its 5th revision, being the most widely used options. Below, we’ll take a deeper dive into each of these guides to discuss how they tend to pathologize certain symptoms (or assign pathological meaning to them).

International Classification Of Diseases (ICD)

The first edition of the ICD was known as the 'International List of Causes of Death.' The International Statistical Institute adopted it in 1893 and entrusted to the World Health Organization (WHO) at its inception in 1948. Since then, the ICD has been subdivided into more classifications, including:

• the International Classifications of Diseases for Oncology (ICD-O),

• the Application of the International Classification of Diseases to Neurology (ICD - 10 - NA),

• the Application of the International Classification of Diseases to Dentistry and Stomatology (ICD - DA), and

• Two ICD Classifications of Mental and Behavioral Disorders - one for clinical descriptions and diagnostic guidelines, and one for diagnostic criteria for research. Mental and behavioral classifications were included in the ICD's sixth edition.

In the 1960's, the WHO mobilized its Mental Health Program to improve the diagnosis and classification of mental disorders in the ICD. The WHO convened this with the help of an international group of representatives from multiple disciplines and various schools of thought in psychiatry. Simultaneously, a network of centers and individuals were established across the world, with the aim being to improve the work of psychiatric classification.

In the words of Norman Sartorius, former Director of the Division of Mental Health, WHO: "A classification is a way of seeing the world at a point in time. There is no doubt that scientific progress and experience with the use of these guidelines will require their revision and updating."

The WHO continues to collaborate with many around the world, including the American Psychiatric Association (APA), which is responsible for the updating and revision of the Diagnostic Statistical Manual.

Diagnostic Statistical Manual Of Mental Disorders (DSM)

In 1952, the American Psychiatric Association (APA) adapted the ICD-6, and this adaptation became the first edition of the DSM. It contained descriptions of the diagnostic categories and is known as the first official manual of mental disorders, with its focus on clinical use in the fields of psychiatry and psychology. 

Since then, the DSM has been revised four times, with the latest (DSM-V) having appeared in 2013. It was compiled by work groups who created a research agenda, starting in 2000. These groups produced hundreds of white papers, monographs, and psychiatric journal articles to provide a summary of the state of psychiatric science relevant to diagnosis. The purpose of this was also to determine where research showed gaps. In 2007, a specially designated DSM-V Task Force was formed to begin revising the previous DSM. 

Symptoms become pathologized through the process of extensive research, evaluation, classification, and categorization that has been an ongoing work since the 19th century. The diagnostic manuals are constantly evolving based on input from expert analysis and research taking place all over the world.

The purpose of classification is to assist clinicians in the understanding and treatment of specific problems. If clinicians do not have a working list of classifications and symptoms, they may be unable to coordinate or understand what treatments might best help the individual. 

ICD and DSM classifications also assist insurance companies and treatment providers in paying and receiving payment for services. Insurance companies determine what illnesses of any type are covered. By requiring doctors and other providers to use a standard set of diagnostic labels and symptoms, insurance companies can determine quickly if treatment will be covered, and if the treatment provided is something they approve of. Insurance companies typically only cover research-driven treatments that have demonstrated helpful with a given condition.

Labeling

Despite the constant growth of diagnostic tools and the helpful purposes of their use, they remain controversial. This controversy stems from the stigma that is associated with some of the diagnostic labels given to patients, and from research that has shown that labels can affect a person's behavior and treatment outcome. Some mental health professionals decline to use diagnostic labels for this reason. If being diagnosed concerns you, it may be best to speak with your treatment provider.

For some people, understanding their diagnosis and the accompanying label feels helpful, as it gives them a name for an experience. How you feel about labels is up to you, but it can be important to remember that just because behavior isn’t “abnormal” doesn’t mean that it isn’t something worth addressing.

A mental health professional, like a therapist or counselor, may be able to help you navigate these topics and discover whether your concerns point to a mental health disorder or not. Online therapy can be a great way to get started thanks to its convenience and accessibility. 

Research supports the effectiveness of online therapy for treating mental health symptoms, including those related to depression, anxiety, PTSD, and more. One literature review of studies analyzing the efficacy of online cognitive behavioral therapy (CBT) found that the treatment led to significant decreases in symptoms of anxiety and depression. It also noted that similar results were found in patients with panic disorder as well as a host of other mental illnesses.

No matter what your concerns related to mental health or your symptoms may be, a licensed therapist can provide some insight and guidance that can help.

Takeaway

Symptoms of mental health disorders and even general behavioral differences can be pathologized as pieces of psychological conditions, a process that’s just as controversial as it is potentially beneficial. Because there are many differing opinions about pathologizing and how it impacts our ability to treat mental health symptoms, it can be helpful to speak with a professional about any concerns you have. Likewise, try your best to keep in mind that whether you’re “normal” or not is far less important than how you feel.