A Colleague’s Take on “Stop Pathologizing Ordinary Life”

If you haven’t seen Clay Routledge’s July 26 op-ed in the New York Times yet, chances are a partner in your practice will forward it to you soon — probably someone tired of documenting adjustment disorder for what used to just be called a rough year. The piece has been circulating widely among physicians since it ran, and it deserves a direct clinical read rather than a reflexive “kids these days” dismissal, because the argument touches something most of us in primary care and behavioral health encounter weekly: a patient arriving with a self-assigned diagnosis, pulled from a fifteen-second video, applied to a feeling that a generation ago would have simply been called stress, grief, or a hard stretch of life.

Routledge’s central claim is that the country’s growing public attention to mental health has coincided with worsening self-reported mental health, and that this isn’t merely a coincidence — some meaningful share of it is a byproduct of the attention itself. He builds this around “concept creep,” a term coined by psychologist Nick Haslam and developed further in a 2026 paper in Social Issues and Policy Review, describing the well-documented pattern in which the boundaries of what counts as harm, trauma, or disorder keep expanding over time. As Haslam’s own research on the topic argues, rising cultural attention to harm, combined with the pervasive influence of the mental health industry itself, promotes the adoption of diagnostic identities and a general tendency to over-pathologize ordinary experience and behavior. Grief, burnout, and everyday anxiety increasingly get described in clinical language, and once that language becomes culturally available and normalized, people reach for it — often before they’ve talked to anyone with the training to apply it accurately.

Routledge cites survey data suggesting roughly a third of American adults, and closer to half of Gen Z adults, have self-diagnosed a mental illness based on content they encountered on social media, along with separate research indicating that people who rely on social media as their primary source of mental health information tend to hold measurably less accurate beliefs about the conditions they’re describing than people who don’t. Those numbers track with what most of us are already seeing anecdotally in visit after visit, but the survey data gives it a scale that’s easy to underestimate from inside a single practice.

The part of the argument that should matter most to practicing clinicians isn’t the concept-creep framing on its own — most of us have watched that unfold in real time over the past decade of visits — it’s the self-reinforcing mechanism that follows from it. Experimental research on “harm inflation,” including work published in journals covering trauma psychology, has found that encouraging people to adopt a broader definition of trauma measurably increases how distressing they rate an unpleasant experience afterward, and increases how likely they are to label that experience as personally traumatic. A parallel dynamic shows up with anxiety: a normal, adaptive level of vigilance, once internally relabeled as a disorder, can push someone toward avoidance behavior — and avoidance is itself a known risk factor for developing a genuine, functionally impairing anxiety disorder over time. In other words, the label is not a neutral description sitting on top of a fixed underlying experience. Applying it can actively shape the course of the thing it claims to be naming, a point that researchers in this area, including scholars writing on psychiatrization more broadly, have been making with increasing consistency in recent years.

That has a direct clinical corollary for anyone doing intake or a first behavioral health visit. A patient who arrives already convinced they have generalized anxiety disorder, ADHD, or “trauma” because a short video matched a feeling they had is not approaching the visit as an open diagnostic question — they’re approaching it as a confirmation request. That shifts the therapeutic alliance before a single history question gets asked, and it puts the clinician in a genuinely uncomfortable position: either validate a label that may not actually fit the clinical picture, or spend scarce visit time gently talking a patient out of a self-diagnosis they may already be emotionally invested in, which is often a harder conversation than making an accurate diagnosis from scratch would have been.

To be clear, this is not an argument against taking mental health seriously, and Routledge is explicit that he isn’t making that case either — he credits the reduced stigma and improved access to care that the broader public conversation has produced, and none of us should want to return to an era when real, disabling disorders went unnamed and untreated. But the piece is a useful prompt for reconsidering how we respond, in real time, when a patient’s presenting complaint arrives already packaged as a diagnosis rather than as a symptom. Where the underlying distress is real, we can validate it without necessarily adopting the label the patient walked in with; where the evidence points elsewhere, it’s worth saying so directly, if gently, rather than defaulting to whatever term brought them into the office. A related literature on de-diagnosis in general medicine — the deliberate scaling back of diagnostic language for conditions that don’t meaningfully benefit from a formal label — offers a useful frame for thinking through when naming something helps a patient and when it just adds a chronic identity to a temporary experience.

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