Summary
Through Xiaoming’s hesitation to seek counseling, this article examines diagnostic boundaries, the language of stigma and an author’s proposal to center suffering and impaired functioning when considering therapy.
At a glance
The article proposes considering therapy when thoughts, emotions or behaviors cause substantial suffering or interfere with ordinary life. In this view, someone can seek help anywhere along a continuum, provided the difficulty genuinely affects their life. Calling psychological difficulties ordinary does not make them unimportant, and a recommendation for counseling does not itself establish a diagnosis.
Xiaoming hasn’t been feeling like himself. For the past month, all he has wanted to do is sleep. He has little appetite, avoids spending time with friends and often feels worthless. He is suffering, and his studies, work and everyday life are suffering too.
He wonders whether to seek therapy. Then a friend hears what has been happening.
“You haven’t seemed yourself lately. If you have time, you could see a psychiatrist. I know this might be hard to hear, but I think you might have depression.”
“Depression?” Xiaoming thinks. “I’ve been miserable for a month—is this an illness? Is it because I’m not strong enough, because I can’t manage my own life?”
The more he turns it over, the more his shortcomings crowd into view. He cannot bear the thought of letting someone see him like this: someone who cannot even keep his own life together.
Does Xiaoming have depression? Is he experiencing a psychological problem? What should he do now?
Before returning to him, it helps to examine the framework through which we have learned to understand psychological distress.
How the medical model took hold
In this historical account, early nineteenth-century psychologists discovered that infections such as syphilis and typhoid caused some severe psychological problems. These infections could be treated with medication and other medical methods; curing them also resolved the psychological problems they caused.
The possibility was striking: psychological problems could respond to medical treatment.
Western countries consequently began applying the medical model—the framework underlying medical treatment—to psychological difficulties. Psychologists adopting this framework argued that people with mental illness needed treatment from specialist doctors rather than supervision by asylum personnel without relevant training.
But the medical model’s explanatory power proved limited. Beyond infections such as syphilis and typhoid, researchers did not seem to find other infections that explained psychological problems in the same way. Even after those infections were cured, much psychological distress remained unexplained. Infection and psychological difficulty did not correspond one-to-one, and the medical model could not provide a complete explanation.
Should a model with limited explanatory power be abandoned? Perhaps not yet—it was still useful.
The book’s author describes how the medical model continued to shape thinking as medicine developed: psychological illness was understood as a mental syndrome without an identified biological disease, while syndromes with a known biological disease provided the comparison. Supporters considered the analogy reasonable because they expected that a corresponding biological condition in the brain would eventually be found for every mental disorder.
The medical model also provides the context for the development and repeated revision of the Diagnostic and Statistical Manual of Mental Disorders, or DSM. In this historical account, its publication is attributed to the American Psychological Association, and the fifth edition, DSM-5, is described as the edition most commonly used clinically at the time of writing.
Under DSM-5’s definition, a mental disorder is a syndrome involving clinically significant disturbance in cognition, emotion regulation or behavior, reflecting dysfunction in the psychological, biological or developmental processes underlying mental functioning.
The book discussed here uses feeling somewhat allergic to the world as its title image and addresses the prevalence and stigmatization of psychological difficulties. Its author argues that replacing mental or psychological “illness” with “disorder” softens the terminology without abandoning the medical model: the continued use of words such as “symptoms,” “diagnosis” and “psychopathology” shows that the underlying framework remains.
The author’s concern goes beyond whether that framework fully explains the causes of distress. It also concerns where we draw boundaries.
Where does ordinary anxiety become a disorder?
Imagine being invited to a team gathering where you know no one. Some outgoing people arrive confidently. Some more reserved people feel a little nervous. Others worry intensely about meeting someone who dislikes them. Some attend but quietly endure the misery of unwanted socializing. Others feel so anxious that they refuse the invitation altogether.
These experiences lie along a continuum. Can we draw a line across it that clearly separates people who have a psychological problem from those who do not?
The book’s author argues that the medical model runs into difficulty precisely because it tries to draw that line. This criticism acknowledges that the professionals revising DSM-5 worked to make its criteria reflect real experience. Nevertheless, the author finds the resulting boundary unclear and believes it can make the distinction between social anxiety and social anxiety disorder more complicated.
Consider one of the diagnostic conditions at issue: social situations must almost always provoke intense anxiety or panic. Now imagine someone who experiences intense anxiety in social situations only occasionally. Its unpredictability is nevertheless agonizing, and the person feels compelled to leave a well-paid job because of it.
Under this interpretation of the cited criterion, this person would fall outside the diagnostic threshold because the anxiety does not occur almost every time. Yet the suffering is real, and the person’s ability to function has been impaired. The categorical threshold leaves someone with substantial distress and impairment without a social anxiety disorder diagnosis.
The author’s criticism therefore has two parts. First, the medical model equates psychological difficulties with mental illness, treating both as explicable through biological conditions in the brain. Second, the diagnostic boundaries built on that framework can remain difficult to define and apply.
There is also a problem with the language surrounding those boundaries.
When words make asking for help harder
Terms such as “mental illness,” “psychopathology” and even “mental health problems” are often used with care and good intentions. They can convey that someone’s suffering is not a personal fault.
The criticism is that words such as “disorder,” “problem” and “pathology” also carry negative associations. Even when the intention is compassionate, the language can reinforce the impression that there is something shameful about psychological difficulty.
“They say what I’m experiencing is an illness, a disorder, something pathological.” For someone already struggling with self-worth, those words can become another burden.
That is what happens in Xiaoming’s story. The language of illness, disorders and symptoms stands between him and the counseling room.
Could recognizing how common these experiences are loosen that barrier? The proposal here is tentative: if people understood that most of us may encounter psychological difficulties at some point—fear, anxiety, sadness or substance addiction, for example—they might be less inclined to fear, disparage or stigmatize them.
But what makes these difficulties ordinary?
Ordinary does not mean unimportant
The book’s author argues that psychological difficulties are ordinary for two reasons: they emerge through normal biological and psychological processes, and they are far more widespread than we tend to assume.
Neither reason makes them trivial. Psychological difficulties can cause considerable suffering, seriously disrupt a life and sometimes lead to tragedy. Calling them ordinary is not permission to ignore them.
The first argument concerns how difficulties develop. The book’s author proposes understanding them as arising through normal biological and psychological processes, rather than as products of mental or brain disease.
Human lives share many features, but individual differences in behavior are everywhere. Ordinary variations in our brains and behavior interact with our experiences, producing different responses. Differences in psychological characteristics also affect how much shock, disruption or fear a person can withstand. Any of these experiences may give rise to psychological difficulties.
Circumstances matter too. Even two people with identical psychological characteristics could experience very different levels of suffering and impairment in response to the same event if their living environments differed.
From this perspective, psychological difficulties develop naturally, through processes related to those by which people adapt to change. Those processes operate in everyone. Their familiarity is part of the argument for treating psychological problems as ordinary human experiences.
The second argument concerns how many people experience them.
When viewed through diagnostic categories, psychological problems—called mental disorders within the medical model—can seem relatively rare. But reports indicate that a questionnaire study from the 1990s found far more people experiencing panic disorder, depression, alcoholism, hallucinations and other psychological difficulties than might have been expected.
When participants’ reports were assessed strictly against DSM criteria, approximately 25% met the criteria for at least one mental disorder during the study year. A particular disorder might be uncommon, while psychological difficulties considered together are widespread.
One year also captures only a slice of a person’s experience. To understand how difficulties accumulate across a lifetime, researchers need to follow the same people over many years. According to reported findings, longitudinal research tracking a group over 30 years found that 80% met DSM criteria for a mental disorder at least once during that period.
That 30-year figure concerns the people studied over that observation period. Its significance for the argument is the difference between looking at a single year and looking across decades. What is called “abnormal” behavior, the author emphasizes, is hardly confined to a small minority. Psychological difficulty is a common part of human life.
A more practical question about therapy
Given these concerns, the book’s author proposes a more practical way to understand psychological problems: patterns of behavior that cause suffering or impair functioning in important areas of life.
In this view, there is no absolute line dividing “having a problem” from “not having one.” The point at which a boundary becomes practically relevant is when you decide whether you need therapy.
That decision rests primarily with you. Are your thoughts, emotions or behaviors causing substantial suffering? Are they interfering with ordinary life? Has the difficulty reached a point where you need therapeutic help?
The position taken here is that you can seek therapy at any point along the continuum, provided the difficulty genuinely affects your life.
Now return to Xiaoming. Imagine that, after he confided in his friend, he had heard this instead:
“You’ve been feeling very sad lately, haven’t you? If this is affecting your life, then as your friend, I’d suggest speaking with a professional counselor. That recommendation doesn’t itself mean your psychological functioning is disordered. Everyone feels sad sometimes; what you’re feeling right now is especially intense.”
“Life is complicated. It won’t always turn out as perfectly as you imagined. Everyone has times when they struggle to adapt, when they feel a little allergic to the world. For now, these feelings have you caught. You need to reach a hand out of the swamp.”
We believe a response like this could help Xiaoming stop feeling trapped by words such as “unhealthy” and “disordered,” and speak to a counselor about his feelings without shame.
Perhaps he is facing something most people are bound to encounter at some point in their lives.
Frequently asked questions
Does calling psychological difficulties ordinary mean they can be ignored?
No. The article explicitly recognizes that psychological difficulties can cause considerable suffering, seriously disrupt life and sometimes lead to tragedy. Calling them ordinary is not permission to ignore them.
Does the article establish that Xiaoming has depression?
No. His friend raises depression as a possibility. The narrative describes a month of distress and disruption to his studies, work and everyday life, while leaving his diagnosis unresolved.
Does recommending counseling establish that someone has a disorder?
In the imagined supportive conversation, recommending counseling does not itself establish disordered psychological functioning. That reassurance does not rule out a disorder; Xiaoming’s diagnosis remains unresolved.
Does the reported 80% figure represent a universal lifetime rate?
No. The article reports that 80% of a studied group met DSM criteria at least once during a 30-year observation period. The figure concerns those participants and that period, rather than establishing a lifetime rate for every population.
