Diagnoses as Maps, Not Territories

Diagnoses are not static and discrete categories. They are subjective and to some extent arbitrary. Even as we improve our knowledge and understanding of mental health and mental dysfunction this is still the case. 

Diagnostic categorization serves multiple purposes. It gives therapists a shared language we can use to converse with one another. It nurtures our need for intellectual stimulation. It gives a name to a common cause that we can call take up, but, at the risk of sounding cynical, it can also give us a common enemy we can direct our ire towards. This also happens. 

To give someone a diagnostic label is to make a loud and declarative statement about them. You’re identifying a particular issue as the root cause of someone’s problems. Maybe even the sole cause. 

The truth is that human beings are too complex for us to ever be so certain. The same diagnostic label can manifest in countless ways depending on the person and their context. Therapists who recognize this fact shift their focus away from labeling and towards learning how to be with uncertainty. The phrase be with uncertainty is used intentionally in order to make a distinction between being with and merely tolerating uncertainty. Being with uncertainty implies embracing it to the greatest extent possible. 

Diagnoses could be thought of as maps of the territory rather than the territory itself. This allows space to make necessary updates and revisions to the map as things become more clear and the territory reveals more of its secrets.