Sunday, September 30, 2012

Not everything is pathological!

Not everything is pathological!  Some of my patients need to be told this repeatedly.  Every session brings a new complaint.  "I had trouble falling a sleep a couple of times last week," one might say.  "I had a nightmare a few weeks ago," another tells me.  "I was really tired on Monday," says another.  Sometimes I recall my own recent experiences and think to myself, "Yeah, I remember feeling tired at least once last week; probably more than once.  And I'm sure there was at least one night when I had trouble sleeping.  It wasn't a big deal." 

Not only are these experiences "not a big deal," they're completely normal.  Who among us doesn't have trouble sleeping from time to time, particularly when we're worried about something?  Who doesn't wake up feeling irritable on occasion?  Who doesn't have a hard time finding motivation to clean the house or run some errands every once in a while? 

At some point we all have these experiences, yet rarely do we become alarmed by them.  Why is it, then, that a substantial minority of my patients find such things concerning enough to bring to my attention?  (At least I assume that's why they share these concerns, since we're there to talk about problems that require treatment). 

When such conerns are raised in session, the first thing I do is to normalize my patient's experience.  I try to explain that not every unpleasant experience is a sign of a larger problem.  In life, I tell them, we all deal with feelings we'd rather not have, events we wish wouldn't happen, and physical aches and pains we'd prefer not to endure.  Such things even occur sometimes without any identifiable reason.  It's important, I explain, to remember that something doesn't have to be problematic just because it's unpleasant.  In fact, labeling something as problematic probably only makes it more unpleasant.

After normalizing, I attempt to help the patient clarify what constitutes a problem and what doesn't.  (While it's not beneficial to classify every negative experience as problematic, neither is it wise to ignore negative experiences that really are problematic). 

So how do we know when something is a problem and when it's just a variation of normal human experience?  When trying to define a somewhat abstract concept, I like to start by consulting a dictionary for a more literal definition.  There are several entries in a standard English dictionary under the word problem.  One entry defines the word problem as "something that causes trouble or difficulty."  Thus, a problem is something that causes difficulty by interfering with your daily functioning or by significantly decreasing your quality of life.  Can you still go to work, pay your bills, or otherwise fulfill your normal daily responsibilities?  Can you still experience pleasure and enjoyment?  Can you maintain at least a few functioning interpersonal relationships?  If so, you're probably doing okay. 

Problem is also defined as "an undesirable condition that needs to be corrected."  The key word here is condition.  A condition is a mode of being or form of existence.  It permeates all aspects of one's life, implying that it exists over a period of time.  Thus, a problem is unlikely to be something that happens just once or even rarely.  Typically, a problem is something that is present over a period of time and in a variety of situations.  (To diagnose a mental illness, the field of mental health requires a set of symptoms to be present for specific minimum periods of time).

Yet another way to define problem is as "something that is difficult to manage."  The implication here is that a problem is something that challenges one's ability to cope.  Those with an average set of coping skills are able to cope with minor annoyances and irritations quite easily.  Something becomes a problem only when a person's usual coping mechanisms aren't effective in dealing with it and the person becomes overwhelmed.

I'm sure I've missed some things and of course, there are exceptions to every rule.  The main point is just that  not everything unpleasant is a problem and that labeling it a problem only makes it more unpleasant.


  1. It comes down to focusing on the problem instead of a solution. Which may mean doing simple things... like eating right or earlier and quitting coffee(in the case of sleep problems).

  2. Yes I view these transient situations as normal. Thankfully I take a long term view. Great post! One big affirmation to anyone is the sense of normalcy. Nothing like showing up to see your shrink and they tell you that you are "crazy"...That would be unnerving.



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