Concept Creep and the Psychiatrization of Everyday Life

[david_myers]

Language evolves. The fourteenth century English poet Geoffrey Chaucer, who lived but 25 generations ago, would struggle to communicate with us.

Word meanings change. Yesterday’s evangelicals who led the abolition of Britain’s slave trade would wince at a particular subset of today’s American evangelicals—Trump acolytes who are infrequent worshippers, and for whom “evangelical” has become more of a cultural than a religious identity.

In political discourse, a “socialist” becomes not just a person who favors public-owned industries, but someone who advocates reduced inequality and a stronger social safety net. And “critical race theory,” a once obscure idea in law journals that has been nonexistent in social psychology’s prejudice chapters and books, has been distorted and inflated as a way to malign efforts to ameliorate racism and teach real history.

Similar concept creep has happened in the mental health world, observes University of Melbourne psychologist Nick Haslam. Concepts with a precise meaning have expanded to capture other or less extreme phenomena. Examples:

• “Addiction” (compulsive substance use) has expanded to include money-depleting gambling, sexual fixations, time-draining gaming, and even excessive shopping and social media use, as in: “I’m addicted to my phone.” Thus, between 1970 and 2020, the proportion of academic psychology abstracts mentioning “addiction” has increased sixfold.
• “Abuse” still refers to intentional physical harm or inappropriate sexual contact, but in everyday use may now include neglectful omissions and painful mistreatments: hurtful teasing, distressing affronts, or overwrought parents screaming at their children. Accompanying this semantic inflation, the proportion of post-1970 psychology abstracts mentioning “abuse” has multiplied seven times over.
• “Trauma” initially referred to physical injury (as in traumatic brain injury), then expanded to encompass horrific emotional traumas (rape, natural disaster, wartime combat, torture), and now has been inflated to include stressful life experiences within the range of normal human experience—to job loss, serious illness, and relationship breakups, and even, reports Harvard psychologist Richard McNally, to wisdom tooth extraction, enduring obnoxious jokes, and the normal birthing of a healthy child. So, no surprise, over the past half century the proportion of psychology abstracts mentioning “trauma” has increased tenfold.

Haslam offers other concept-creep examples, such as broadening the “prejudice” of yesterday’s bigotry to include today’s subtler but persistent “implicit biases” and “micro aggressions.”

And we could extend his list. ADD, ADHD, autism spectrum disorder, and the DSM-5’s new “prolonged grief disorder” all refer to genuine pathologies that have been broadened to include many more people. At least some of yesterday’s normally rambunctious boys, easily distracted adults, socially awkward people, and understandably bereaved parents or spouses are now assigned a psychiatric label and offered mental health or drug therapies.

This psychologization or psychiatrization of human problems serves to expand the mental health and pharmacology industries, entailing both benefits and costs.

Concept creep does have benefits. It represents an expansion of our circle of moral concern. As vicious violence, appalling adversity, and blatant bigotry have subsided in Western cultures, albeit with horrendous exceptions, we have become more sensitive to lesser but real harms—to upsetting maltreatment, dysfunctional compulsions, and toxic systemic biases. Progressive and empathic people, being sensitive to harm-doing, mostly welcome the expanded concepts of harm and victimization

But concept creep, Haslam argues, also risks casting more and more people as vulnerable and fragile—as, for example, helpless trauma victims, rather than as potentially resilient creatures. “I am beginning to think that our world is in a constant state of trauma,” writes one psychotherapist/columnist. “Living with trauma, PTSD, unregulated depression and anxiety is almost the norm these days.” As is common in many professions, mental health workers may sometimes overreach to broaden their reach and client base: “Your hurt was an abuse, and you need me to help you heal.”

Concept creep also risks trivializing big harms, Haslam notes, by conflating them with lesser harms: “If everyday sadness becomes ‘depression’ and everyday stressors become ‘traumas’ then those ideas lose their semantic punch.” If more and more pet-loving people seek to travel with their “emotional support” companions, the end result may be restricted access for those for whom companion animals serve a vital function.

“Many traumas do indeed have severe and lasting effects that must not be minimized,” Haslam and co-author Melanie McGrath emphasize. “However, as the concept of trauma stretches to encompass fewer extreme experiences, the tendency to interpret marginal or ambiguous events as traumas is apt to promote hopelessness, submission, and passivity in response to challenges that might be overcome better if placed in a different interpretive frame.”

The bottom line: Addiction, abuse, and trauma are genuine sources of human suffering. But where should we draw the line in defining and treating them?

(For David Myers’ other essays on psychological science and everyday life, visit TalkPsych.com. Follow him on Twitter: @davidgmyers.)