Pathologizing the norm

Going in to any introductory psychology course, students are warned that the basic education they are gaining does not make them experts in the field. They are cautioned against diagnosing friends and family members with their scant knowledge and are reminded that there are many nuances of both personality and personality disorders that they are far from privy to. A stirring op-ed piece in the New York Times recently highlighted the perils of the common citizen diagnosing themselves and their loved ones with Alzheimer’s disease or dementia. However, more and more it seems that clinicians and researchers in the field of psychology and psychiatry are at risk of making this same mistake by pathologizing natural neuropsychological slips and common cognitive errors. Neuropsychological assessments involve a series of challenging, and at times painstaking, tests of memory, decision-making and cognitive flexibility, among other executive functions. Standardized ranges are provided for these scores from the wider population, much as for an IQ test. These assessments are particularly useful in neurological patient populations (such as victims of a stroke or a brain tumor) and the elderly to assess cognitive decline, just as the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) and MMPI (Minnesota Multiphasic Personality Inventory) are helpful in a therapist or clinician’s office. However, these tests, as well as “significant” real-life examples are now being used as evidence of disorder in normal individuals.

Nowadays, misplacing your car keys can be seen as a precursor to dementia, and blanking on an old acquaintance’s name is indicative of Alzheimer’s. Likewise, niche expertise is an example of savantism and social awkwardness a sign of long undiagnosed Asperger’s syndrome, which is just a short step away from autism on the spectrum.

But this is what we have to remember and what is getting lost in this dichotomous system of diagnoses: all of these disorders or impairments lie on a spectrum. And the ultimate litmus test for a disorder is not how poor one’s verbal recall is, but instead how much distress this impairment causes. The world of psychiatric and neuropsychological diagnoses is far from clear-cut and these classifications must be based on more than just behavior. The perception and attitude of the patient must be taken into account, including whether this person even considers themselves to be a patient in the first place.

Similarly, over the past twenty years the diagnosis of ADD/ADHD (attention deficit / attention deficit hyperactivity disorder) has risen dramatically, as has the subsequent backlash against over-diagnosing and over-medicating society’s children. Before running to the doctor's office or the prescription pad, it is important to remember that kids are squirmy, and that no one, college students and professors alike, can maintain disciplined attention during a tedious lecture.

Everyone experiences memory loss as they age, just as we all feel sadness over the course of our natural cycle of emotions. Unhappiness is a universal human feeling that everyone must go through from time to time, and is not indicative of the pervasive demoralizing morose of true depression. Emotion, attention and memory are all fluctuating human traits and must be remembered as just that, natural and transient. Our culture is so eager for a quick fix, to get rid of any feelings of discomfort and receive instant release. But sometimes it is important to experience these sentiments, to sit and work through our problems and wrestle with our shortcomings. This is in no way meant to minimize the tribulations that accompany these very real disorders, but to serve as a reminder that all of us are flawed, mentally, physically and emotionally, and if we pathologize these feelings, these struggles, then we may  miss out on the robustness of life.

Dana Smith

PhD student in Experimental Psychology at the University of Cambridge