Pathologize Hardship, and the Rest of Us Are Off the Hook

fires

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To know someone you love died trapped, their body scorched and melted by wildfire? To stand and watch a home that has been your sanctuary for thirty years burn to the ground? To then comb through the rubble and find nothing you can salvage, or worse, see an album of wedding photos so charred, it falls apart when you pick it up, taking half your memories with it? People in Los Angeles will be grieving the loss of their homes, and the woodsy hills that surrounded them, for years to come.

That said, I bristled when I heard reporters and experts on National Public Radio jump immediately to post-traumatic stress syndrome and psychological interventions and how there are not enough trained professionals to get people through this disaster. Yes, there will be people who need professional help; existing conditions and vulnerabilities of all kinds will be exacerbated by the crisis. But instantly pathologizing an existential challenge has become a reflex, and it might do us more harm than good.

Life is hard and precarious; that is not an automatic risk for mental illness. Though the media toss around “anxiety and depression” as diagnostic labels, feeling shaky, heartbroken, numb, even paralyzed for a time, is a perfectly normal human reaction. (Just as feeling anxious or a little sad about the world in general is the only sane response of late.) Pathologize any intense, unwelcome emotion that lingers longer than a few days, and you will find yourself “sick” for much of your life.

This probably sounds like an exhortation to “pull on those bootstraps.” It is not. I just worry that more and more, we seem to cast life’s biggest challenges in terms of illness and recovery. Childbirth, menopause, grief, dying, disaster—these are all natural events, known to humankind for eons. They call for knowledge, wisdom, and vigilance, but they only need to be clinicalized when there are complications or extra vulnerabilities. We had to come full circle to remember that it is more comfortable to give birth as naturally as possible, grow old without panicking into chemicals and neurotoxins, and die at home, not strung up with tubes and surrounded by white-coated professionals.

At most times of crisis, we need extra love from those closest to us and sturdy help from neighbors and strangers. None of them needs to have a degree in psychology or psychiatry. Professionalize every hardship, call in the experts as standard protocol, and the rest of us are left standing on the sidelines, watching with concern but helpless to really help. It is not our place, this practice implies, to lend support. We are, after all, untrained. If we are moved to sympathy, we might write a check or donate some supplies, but then we need to step back and let the pros handle the messy emotions.

So much for the cohesive sense of community that used to kick in at times of hardship. Sociologists construct entire careers on its absence, but they forget that professionalization has played a role, as has excessive litigation, as has the jittery, no-doze version of wokeness. We are scared to help other people’s lost or troubled children; afraid to say the wrong thing to a friend in distress; quick to label any grief that outlasts our patience as “depression” and urge the person to “talk to someone” (meaning a professional, not us).

We have come to feel fragile. Or maybe we have been gradually made to feel fragile. So instead of turning to one another, we turn to psychiatrists, who turn to pharmaceuticals. Both of which can be lifesaving, if genuinely needed. But as a first resort? I would shuffle through the ashes of my beloved home and want any drug that could distract me, but in the end, I would have to summon my own resolve.

Article after article warns of “rising rates of anxiety and depression” among young people—instead of saying that many have lost hope in the future, or they’re so constantly overstimulated that they cannot calm themselves. A therapist at the Birchwood Clinic in Chicago notes that “overpathologizing might lead people to seek quick fixes rather than developing long-term coping skills. Instead of learning how to navigate difficult emotions, individuals might come to rely on external solutions, like medication or therapy, for issues that could be managed through lifestyle changes, problem-solving, or simply giving themselves time to heal.”

After a divorce, parents are urged to get their child into therapy. Great, if the child can benefit and is willing. But will the therapy take the place of both parents stepping up, being even more present for the child, talking through what changed in their own words, reassuring the child about what will not change? Or will the parents now just play it safe, parroting whatever the therapist tells them to say and then, relieved to have handled this so well, going back to their own new life?

For schools, after a tragic or violent death, the protocol is to bring in a counselor, or a team of counselors. Instead of talking with a teacher they know well, someone who also loved the child who died and can share the shock and together make some sense of it, children are clumped into group sessions or hauled in for probing one-on-ones with a stranger. Yes, the stranger has skills, and is, one hopes, gentle and capable of building trust and rapport swiftly. But why not let kids work this through with people they already know and trust? Because administrators are scared that teachers untrained for crisis management will say the wrong thing? Because what ought to be a basic compassionate response has been professionalized to the point that the teachers are afraid to speak?

In time, shock and sadness, anger, or fear will abate. If they do not, that is the time for professional help. But while life’s blows knock us down, test us, even scar us, they do not automatically sicken us. As a species, we are amazingly resilient. When I talked to survivors of the Joplin tornado, every one of them said they would not choose to undo what had happened. They were proud of the way they had risen to the challenge, and they liked the way they had rebuilt their lives. Everyone does that at their own pace, in their own way. But sweeping diagnoses of anxiety, depression, or post-traumatic stress syndrome pop you into one of three boxes. No room is left for the subtle variables that make your experience different and change what you need to get through it.

What someone might need most of all is to feel resilient, capable of rebuilding their life. Being told you need professional help is not empowering. I know diagnostic labels are often applied simply to make sure insurance will cover whatever meds or treatment are temporarily necessary. But this wink and nod, yet another consequence of an inadequate healthcare system, can still make the recipient feel branded as chronically ill. Meanwhile, harm is done to those who are ill, because if we all have PTSD, no one has PTSD. Generalize and diffuse the import, and those with genuine, crippling cases of the disorder become easier to ignore.

Skilled therapists are invaluable, and we need more of them, during disasters and every day. But we also need some confidence in our own ability to heal and to help one another. Since the 1950s, we have swung from buttoned-up perfection, refusing to acknowledge any emotional vulnerability or rage, to a hyperawareness of our responses and an overreliance on the psychological jargon that pathologizes them. Imagine if the message on the news had not been, “There won’t be enough therapists to help everyone,” but instead, “The nation is rallying around the survivors of these fires. A local network has been set up so people can offer childcare, eldercare, petsitting, and other forms of respite while those who lost their homes do the hard work of rebuilding. Survivors of similar disasters are arriving to share their experiences….”

I hope the national and community response is robust and sustained, not just temporary goodwill and good PR. If my home had burned, I would feel a lot stronger and more resilient with that kind of safety net, not just insurance forms to fill out and a therapist to help me identify the ways I am not coping.

 

Read more by Jeannette Cooperman here.

Jeannette Cooperman

Jeannette Cooperman holds a degree in philosophy and a doctorate in American studies. She has won national awards for her investigative journalism, and her essays have twice been cited as Notable in Best American Essays.

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