Am I anti-pathology?

I’ve found myself sitting with this question more over the last year, particularly through my work with clients who arrive describing anxiety, panic, overwhelm, burnout, or what they often refer to as “not coping”. Not because I don’t believe mental health difficulties exist. I do. Nor because I think therapy or clinical intervention lack value. They absolutely have their place.

What I’ve become more cautious about is how quickly we move to interpret human distress through a pathological lens, often before we’ve fully understood the context in which that distress has emerged.

A recent coaching engagement sharpened this for me. A client came into the work in a state of what would likely be described clinically as significant anxiety. Sleep had deteriorated, appetite had reduced, and their thinking had become repetitive, catastrophic, and exhausting. Medical support was already in place and therapy was next. And yet, as we slowed the conversation down and widened the lens slightly, their response began to make a different kind of sense.

Over a relatively short period of time, they had experienced sustained pressure across almost every area of life. Financial strain. Relationship stress. Repeated loss. Responsibility without pause. A growing sense that they had to keep functioning regardless of what was happening internally. What initially presented as “symptoms” became increasingly understandable within the context of what they had been carrying.

That distinction feels important to me.

Because I sometimes wonder whether we’ve become so psychologically literate as a society that we’ve also become increasingly quick to identify ourselves as disordered. Distress is immediately categorised. Anxiety becomes an identity. Burnout becomes evidence of personal inadequacy. Emotional struggle becomes something to eliminate as quickly as possible rather than understand. Of course, there are situations where pathology is absolutely the appropriate lens. Severe depression, psychosis, significant risk, profound dysfunction. I’m not talking about those situations lightly, nor suggesting that coaching should replace clinical care.

But there’s a large middle ground that I think deserves more thoughtful consideration. The "worried well" as a Senior Clinician once offered as a label for my clients. A space occupied by people who are overwhelmed, emotionally flooded, exhausted, disconnected from themselves, and operating under enormous internal and external pressure, but who still retain insight, agency, and the capacity to engage reflectively with their experience.

Should I be concerned that I'm not concerned by those clients?

In fact, I often feel an immediate sense of ease with them, partly because their responses feel recognisable and human rather than abnormal. When someone tells me they’re anxious, overwhelmed, unable to switch off, or mentally consumed by life, my instinct is rarely to think “what’s wrong with this person?” More often, I find myself wondering how long they’ve been carrying all of this without enough support, perspective, or permission to slow down.

I suspect part of this comes from my own lived experience, both personally and professionally. There’s not much people can say about being human that shocks me anymore. Most of us, at some point, experience periods where our thoughts become louder than our perspective, where fear narrows our world, or where life simply exceeds our current psychological resources.

What interests me is not just the distress itself, but the relationship people have to it.

This is one of the reasons I find approaches grounded in Psychological Flexibility so compelling. The work isn’t necessarily about removing difficult thoughts or emotions, but about helping people develop a different relationship with them (Hayes et al., 2006). In many cases, the shift isn’t that life becomes easier, but that the individual becomes less fused with the idea that they’re broken, failing, or incapable of coping.

I also think we underestimate how deeply modern life shapes psychological distress. Many people are living within systems that reward over-functioning, productivity, emotional suppression, and constant self-monitoring. We’re told we have freedom and individuality, whilst simultaneously being shaped by powerful social expectations around success, relationships, work, identity, parenting, masculinity, femininity, and achievement. People absorb these rules so thoroughly that they often stop recognising them as rules at all.

Then, when the strain of trying to maintain all of it becomes too much, the individual is framed as the problem.

That feels worth questioning.

Not because personal responsibility disappears, but because context matters. Human beings don’t exist separately from the systems they’re trying to survive within.

This is where I think coaching psychology occupies an interesting and sometimes uncomfortable space. Ethical practice rightly requires us to recognise the limits of coaching and the importance of appropriate referral. The literature is increasingly clear that the boundary between coaching and therapy is nuanced and requires careful judgement rather than rigid categorisation (MacDougall, 2024; Hepworth et al., 2025).

For me personally, the distinction often comes down to capacity. Can the person reflect? Can they engage? Can they tolerate exploration without becoming destabilised? Are they looking to understand themselves and move forward, or are they seeking rescue, certainty, or someone else to take responsibility for change? Those questions matter more to me than whether someone uses the word “anxiety”.

I don’t think we help people by pathologising every difficult human experience. Equally, I don’t think we help by pretending suffering can simply be coached away. The challenge, perhaps, is learning how to hold distress with enough nuance that we neither medicalise it too quickly nor minimise it carelessly.

I’m still thinking this through myself, and I suspect I will be for a long time. But I do know that the way we frame people’s experiences shapes what they believe is possible, and I’m increasingly cautious about frames that strip people of context, agency, and trust in their own adaptability.

I'm really curious how others working within coaching, psychology, therapy, or mental health are thinking about this tension at the moment. What are your thoughts?

References:

Hayes, S. C., Luoma, J. B., Bond, F. W., et al. (2006). Acceptance and commitment therapy: Model, processes and outcomes.

MacDougall, L. (2024). Walking the line: The boundaries between coaching and therapy. Hepworth, C., Day, F., & Poate-Joyner, A. (2025). Ethical practice with clients experiencing mental health concerns.