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Can a diagnosis ever be true: the difference between description and explanation

Posted Feb 16 2013 1:36am

A mental health diagnosis may or may not be useful.  It can never be true.

A diagnosis is a description.  It is a way of classifying something in comparison to something else.  It is a way of identifying some pattern of behavior, thought, emotion, social functioning and saying “this is like that.”  This pattern resembles that pattern.  It is useful when in identifying the pattern it helps you to come up with a response that is helpful. 

All of us are classified everyday in untold ways.  We constantly are classifying each other.  We use these classifications to guide how we interact with someone.  They are maps to guide what we do.  But like all maps they are only as good as they work.  Sometimes they lead us no where.  Sometimes they lead to places ultimately harmful.  Sometimes they are simply irrelevant to the reality they try to describe.  Sometimes they just dont take you where they say they do.

Maps are only useful or not useful.  They are not the territory they describe.  No matter how hard you look at a map to my house, no matter how hard you think about it, no matter how much you describe it, no matter what you do with it– you will not be at my house.  The X on the map is not my house.  Diagnoses are guides, maps to me.  They are not, can not be, and are never me.  And sometimes despite what they promise they will not take you to me.   In the hands of many mental health diagnoses are used to passionately try to convince that I am the X on the map.  And too often people get so entranced with the map they forget to see where it leads and find out if I really am there.

I remember a friend who had 5 different diagnoses.  She asked me how in the world she could have so many mental illnesses.  I told her she didnt that it was just 5 different ways to get to her.  Each one of them might or not be useful or accurate but none of them was her and she was not the collection of all the ways people tried to make sense of her.

One of the enduring cognitive distortions of the human species is the idea that anything is explained by the name it is called.  It is the foundation seemingly of much of our political reality.  It is everywhere in our culture.  So much of what we do seems to be about dividing up and taking sides.  We lose the importance of who we are or who others are and think “where they belong” is the same thing. 

Classifications tend to the question “this is like that.”  Explanations attend to the question “this is that.”  When diagnoses are treated as identity the result is always tragic.  When you are reduced…. whatever you are reduced to… no matter how much sense you think it makes…… you are still reduced.

And this confusion is the basis for why so many people feel so victimized by a system which claims it wants to help so bad.



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