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Why I Use a "Non-Diagnostic" Approach

Before I begin, I want to recommend this article by Ayesha Khan, Ph.D. right off the bat. If you are interested in the intersection of decolonization, neurodivergence, mental health, and collectivism, read it. They write clearly and powerfully about the importance of questioning a diagnostic framework and I am so grateful to them for putting words to this complex topic.

For as long as I've been studying psychology (about 16 years now), I've hated the DSM. Sure, I hated memorizing the criteria for tests, but it was more than that. Partly, I find the whole thing so utterly boring. I just can't believe that a group of people choose to spend their time trying to categorize and label human behavior and then put it in a book and declare "this is how we know a human needs our help!". And that we've built a whole mental healthcare system around it?! Ugh. The presumption, the chutzpah, the gall! Not only is it arrogant, it's violent, and if I had ever bothered to buy a physical copy, I'd happily have ripped it to shreds by now.

As I've grown as a therapist and a human, I remain exasperated by the DSM and by diagnoses in general. I know that getting a diagnosis can feel like relief for a lot of people - it certainly did for me, when my therapist told me I had depression. It can feel like belonging, like a path towards deeper understanding of ourselves. Diagnoses help people connect to the resources they need, and it can be an important stepping stone towards expansion - as long as we treat it as one of many stages.

The danger in diagnoses (aside from the ways in which they have been used to sell pharmaceuticals, place the onus on individuals when the issues are systemic, and more) is that people will often over-identify with their diagnoses, which can cost them their capacity to change. When we wrap ourselves around an identity, when we understand ourselves through a label, we tend to cut out one of the keys to change: curiosity. We say "well this is who I am, this is how I understand myself" and we are less likely to question and seek nuance. We might seek relationships and communities that crystallize these identities, entangling us further into structures that will never be able to hold our complexity. We may also lose sight of our own choice and feel ultimately feel more disempowered and helpless.

Identity is powerful and egos seek stability. When we strongly identify with any "I am ___" statement, it can become very difficult to see ourselves any other way. To be clear, we shouldn't try to transcend or remove our egos - they make us human, they shape our personalities and how we show up in the world, But humans, like all of nature, are meant to be flexible, malleable, and fluid. When we are held with spaciousness and allowing, when we do not cling too desperately to structures that no longer serve us, we can radically shift. And - while there are many oppressive and destructive systems that might make us feel as though we don't - we actually do have some agency. This can get very sticky when we talk about diagnoses, and I am not implying that people are choosing to have depression or ADHD, or that we choose to suffer. But, as Dr. Khan aptly says, it is important to "be wary of biological essentialism that sounds like 'I was born like this, I've always been like this, this is just how my brain works'... People often frame neurodivergence as atypical brain wiring which is the same biological essentialism that gave us race science." We ought not hold onto a diagnosis any longer than it proves useful and expansive.

No, we are not choosing to suffer and struggle. Yes, we are suffering and struggling and living and loving, individually and collectively navigating a wide diversity of responses to the oppressive, exploitative, and lonely systems of capitalism and colonialism. We are not going to end our suffering by categorizing ourselves and others, by separating the neurodivergent from the neurotypical, the depressed from the anxious. We are not going to "cure" ourselves by taking medications, even if they do make it easier to survive within exploitative systems. Yes, find the tools that make life manageable. And remember that you are inseparable from the world around you, that your body is in constant communication and connection with your environment. You are much more than the words we've invented in our attempts to define, inspect, and separate ourselves.

Don’t separate your hurt. Don’t clean it up or try to locate and understand it. No. Get so soft and big around it that it can’t keep its shape and color. Get bigger. Wider. Wilder. - Sophie Strand

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