When Human Suffering Became a Medical Code

We’ve medicalized sadness. Pathologized grief. Turned burnout into a billable code.

At the same time, business leaders are held more and more accountable for creating psychological safety and being emotionally intelligent in the workplace. It’s a confusing assignment when the general public thinks all suffering should be relegated to “treatment” in the therapy room.

Mental illness is real. And diagnosis can be life-changing. But not all distress is illness. Much of it is simply the human experience.

In “Leadership Is the New Mental Health Frontline”, I wrote about how work became the front line for emotional distress. This post explores how that shift happened — and why leaders are now caught in the middle.

How We Got Here

Back in the day, people turned to their support systems for help navigating life’s emotional terrain. Family, neighbors, and churches provided the salve for human suffering. But over the past 70 years, that support system has quietly eroded.

Extended families became more dispersed. Religious affiliation declined. Community networks thinned. Where could people go to get support or guidance for life’s trials and tribulations?

Until the 1970s, insurance plans didn’t cover any mental health treatment. When they finally did, it was narrowly restricted to inpatient psychiatric care for serious diagnosable illnesses like schizophrenia or bipolar disorder.

By the 1980s and '90s, outpatient psychotherapy had become more common — but insurance coverage still depended on one critical medical requirement — a diagnosis. Without a billable code, there was no reimbursement. Client demand for emotional support continued to rise as their support systems weakened, but their ability to pay for professional counseling services was greatly limited.

So therapists and clients had to get creative. If someone came in with burnout, grief, or general distress, clinicians learned to use diagnoses like Adjustment Disorder or Dysthymia. These weren’t inaccurate, but they weren’t always about illness, either. They were about pain. And helping people afford support.

It became its own economy and industry. More and more people became licensed to provide emotional support services that were more and more in demand. Health insurance companies could make more money if they provided more benefits. The mechanism had been set.

The release of DSM-III in 1980 marked a pivotal expansion in diagnosable categories — broadening access to treatment, but also softening the boundaries between medical illness and normal emotional pain.

Starting with DSM-III in 1980 and accelerating with DSM-IV (1994) and DSM-5 (2013), the number of diagnoses grew to accommodate a broader range of human distress — and in doing so, unlocked insurance coverage for more conditions, more providers, and more treatment. New subtypes. More nuance. And more people walking away with a label.

This wasn’t a scam. It was an effort to make care accessible.

But over time, the workaround became the standard. Now, anything we suffer through might be called a disorder. And employees, without strong community support systems, expect robust insurance benefits that cover counseling.

This is how we got here.

A well-meaning system, stretched to its limits.

What Happens When Everything Hurts — and Everything’s Medicalized

As we blur the lines between illness and struggle, something subtle but significant happens in the workplace:

Emotional strain becomes something leaders may recognize in their staff, but feel unqualified to handle.

They want to help — but now that we are confused, believing every struggle is a diagnosable disorder, leaders freeze or avoid when things get heavy. Worried they’ll say the wrong thing, they may say nothing at all. Which leaves people feeling unseen — or worse, alone.

Therapy becomes the only recognized language for relief.

And when someone doesn’t want therapy — or can't access it — they quietly hope their manager will offer the safety, validation, or direction they need.

When everything is framed as a disorder, the only tools offered are referral or accommodation — even when what’s needed is thoughtful leadership.

And without well-developed leaders on the ground, HR becomes the de facto therapist, mediator, and fixer for problems that should’ve been addressed — or defused — upstream.

This isn’t a failure of empathy. It’s a failure of infrastructure. And infrastructure starts with leadership.

Until we give leaders a way to meet human struggle without pathologizing it, we’ll stay stuck between avoidance and overwhelm.

Reclaiming the Space Between “Suffering” and “Sick”

We need our language back.

Because there’s a wide terrain between human suffering and mental illness:

• Grief that doesn’t need treatment — just time and grace
  

• Shame that eases when someone listens well and offers understanding and support
  

• Anger that softens when a pattern is named or accountability is taken
  

• Disconnection that lifts with meaningful feedback given and requested
  

If we treat all emotional struggle as pathology, we rob people of the very thing that often helps most.

Connection. Reflection. And leadership that actually sees them.

Your Next Step

If your leaders are being asked to support emotional complexity — but only given clinical tools or compliance checklists — it’s no wonder they feel overwhelmed. The answer isn’t more diagnosis. It’s better development.

Work with 360° Coaching to equip your leaders with the insight, language, and capacity to meet the emotional realities of today’s workplace.