Existential Topics: Diagnosis
Existential psychotherapists generally are quite skeptical of DSM diagnosis and other over-structured forms of diagnosis. This is not exclusively true, though. Dr. Stephen Diamond, who studied under Rollo May, is a strong advocate of appropriate usage of diagnosis. In his book Anger, Madness, and the Daimonic, he provides some good examples of existential approaches to diagnosis.
A primary concern is not that diagnosis exists, but rather how it is used. Certainly, few existential thinkers would be concerned about trying to construct a language to better communicate about suffering. The concern is more specifically with the DSM and its usage. This emerged from the medical model and retains many of its inherent biases. For example, there is a strong bias toward biological perspective first, and solution-focused therapies secondarily.
The DSM is often assumed to be absolute truth by those who use it and by the culture at large. Instead, existentialists would tend to view diagnosis in a much more flexible manner. These are clusters of symptoms that tend to emerge together. However, the specific patterns are very unique and always individualized to the person who experiences them. It would then be more appropriate to talk about a depressive pattern or a borderline process or tendency than speak of these as if they were biological disorders.
There are many problems with the popular usage of DSM diagnosis. This can promote an avoidance of responsibility, a sense of hopelessness, and a label which causes shame in many people seeking therapy. Therapists may begin treating their therapeuts like a diagnosis, fail to reconsider aspects of their therapeut’s condition, and write off some therapeuts as someone who won’t progress (for example, personality disorders and some psychotic disorders).
While it is not always possible for some practitioner’s to avoid using diagnosis, existential perspectives would warn to use them with caution. Clinicians shouldn’t diagnosis out of habit or just because of what they were told to do. Rather, they should make the determination on a case by case basis as to whether it would be beneficial to the client if a diagnosis was made.
All this does not mean that existential psychologists don’t believe there are biological causes of mental illness. There may be some disorders which are biologically determined. However, we must be cautious in writing off any condition as merely being biological. For example, if we are to believe that schizophrenia is a biological disorder and write off seeking a psychotherapy cure, we are taking a huge risk. If there is a therapeutic cure that is not being sought because of this assumption, then becomes a huge disservice to people suffering with this disorder and who will develop it in the future. In other words, we should always hold our conclusions about biological causes cautiously.
It is also possible that some disorders could develop from either biological or environmental causes. For example, many psychologists have believed for a long time that depression may be either biological or environmental in its etiology.
In summary, diagnosis is a dangerous tool. It is important for therapists to learn how to use this tool well in order to avoid using it harmfully. Learning to use diagnosis well does not mean that it should always be used. Rather therapists may be better off making this determination on an individual basis with each therapeut they work with.
Original Version added 2004. Updated December 2005