Why do we have to be sick to go to therapy? Part 1

The utility (or lack thereof) of diagnostic labels

I’ve been thinking a lot recently about the value of diagnostic labels. Many people feel validated and normalized by diagnoses: they feel that, if a description of their experiences appears in so many people that it deserves its own label, then they are not alone. And, if you can define a problem, then oftentimes you can define its solution: diagnostic labels can provide roadmaps to effective treatments. I’m also really pleased that mental health has been so de-stigmatized that we are no longer afraid of diagnostic labels, and scientific literacy has improved so that we know a lot more about various conditions.

But have we become too quick to label and to pathologize unpleasant yet normal human experiences? It sometimes seems like everyone who struggles to pay attention has ADHD, everyone who feels socially awkward has Autism, and everyone who feels anxious has Anxiety with a capital A. We separate the people who are assigned those labels from those who aren’t, describing them as clearly different, and implying that their problems are fixed and immutable. And, unless you qualify for one of those labels, your suffering is invalid and unworthy of attention. Of course some people struggle more than others, but all people benefit from mental health interventions to help manage the stress in their lives. So sometimes I fail to see how our current framework of pathology–which dichotomizes illness and wellness–is productive.

When I was finishing up graduate school, there seemed to be momentum in the field away from diagnostic categories and toward dimensional descriptions of functioning. People seemed eager to describe multiple behavioral and emotional domains on continuum, ranging from normal to abnormal, that cut across traditional DSM diagnoses. In fact, the National Institute for Mental Health proposed a new initiative called the Research Domain Criteria project, which intended to develop new frameworks for conducting research on psychopathology that were dimensional rather than categorical in nature. 

I’m bummed that the momentum hasn’t yet changed practice in our field. I hope one day it does. I wish that therapy was seen as something you do to maintain general wellness rather than as an intervention to fix something wrong: more like healthy eating and exercise and less like Ozempic. And I think that sort of paradigm shift would require us to think of individuals—describing their uniqueness and complexity—rather than reduce people to diagnostic labels.

(Before you mention it, I know that therapy is expensive, and you need diagnoses for insurance. In my ideal world, everyone—diagnosis or not—has access to affordable therapy.)

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You’re either going to think this is super adorable or super annoying. I love it. Especially Jane Krakowski. Enjoy!