Non-Diagnostic Therapy: Diagnosis As An Offering For Exploration
A common misunderstanding about our non-diagnostic therapy practice is that non-diagnostic means “no diagnosis” or “diagnosis = bad.” I’m not against diagnosis and not just because of insurance companies. There is a hugely significant body of work that has produced a few hundred diagnoses and an entire underlying framework for understanding human emotional suffering. Why would we throw that out?
My critique of diagnosis is that it is related to as a higher order of science, and as more significant than many other ways of understanding human suffering and emotionality. However, there are other ways to relate to diagnosis, specifically as an offering for exploration rather than an absolute authority.
There Are Many Ways Of Understanding Emotional Struggles: Diagnosis Is Just One
In a manner of speaking, diagnosis is a mode of understanding that may or may not be useful. But, who decides? The elevation of a certain type of science that underlies diagnosis is intense. It is represented as more important than other forms of understanding. I am deeply resistant to the idea that somehow diagnosis is some special, magical truth. There are so many ways of understanding emotional struggles, and seeing diagnosis as a sometimes useful one can help people see new possibilities of how to get better.
How Can We Debunk The DSM’s Authority?
My biggest objection (of many) of the relation to diagnosis as more significant is that the individual being diagnosed isn’t involved. To be clear, I’m not saying a therapist should open the DSM with a patient and pick a diagnosis. What I mean is that we have to find ways to debunking its authority.
Sometimes this means making fun of the DSM or the ways in which it’s taken so seriously. I like to acknowledge that sometimes it is really useful and was created by some really bright people, but that it was nonetheless created. I also like to make reference to the many, many other ways people make sense of suffering, whether religious, cultural or spiritual.
Seeing Diagnosis As One Mode Of Understanding Opens Up New Possibilities Of How To Get Better
We have a whole set of social guidelines and norms around how we relate to disease–the idea of suffering, symptoms, the question of whether there is a cure or not, etc. Whether we’re aware of it or not, when we talk about emotional suffering using this language borrowed from medicine, it limits possibilities for how to get better.
For example, people talk about “living with depression” or “coping with anxiety” in language similar to discussing diabetes or Crohn’s disease, with terms like symptom management or side effects. Depression is understood as something that can be cured or not cured in varying degrees. But, what if we stepped off that axis of understanding? What if we didn’t relate to depression as a discrete phenomenon, understandable in a similar manner as a blood test? What if we looked at it as a complicated response that might include, among other things, grief, alienation, historical and contemporary adaptations to trauma and yes, perhaps, a very understandable emotional state in response to an unhappy set of conditions?
Seeing depression as a disease can be a helpful part of this mix, but it can also be limiting. By relating to diagnosis, instead, as one mode of understanding, we can examine parts of our lives that we wouldn’t perhaps look at in an exam room, whether our relationship, our losses, our social location, the stability of our job and the lack of social safety net, or poor social supports we provide to new moms.