When we hear the word diagnosis, it’s hard not to think of the DSM. The dreaded DSM. But hating this particular book is nothing new: over the years, therapists have called it pathologizing, stigmatizing, reductive, invalid, culturally insensitive, and vague. The Networker even ran a feature in 2014, just after the DSM-5 was released, called “The Book We Love to Hate.”
Clinicians have long tried to find an alternate way of understanding and categorizing mental states: one that encompasses the whole person—their strengths and challenges—while taking the influence of culture and environment into account. So far, nothing has come close to eclipsing the forces of the DSM.
What’s new about this? Well, as disdain for the DSM’s diagnostic constructs continues to spread among clinicians, something interesting is happening in the wider culture: increasing numbers of clients are wanting a DSM diagnosis. They’re asking for labels that not so long ago might’ve been viewed as pathologizing, stigmatizing, or reductive. With the proliferation of mental health information on TikTok and other social media platforms, people who once felt alone in their suffering are finding communities of likeminded souls who validate their experiences, normalize their struggles, and fulfill their desire to belong. For some, a diagnosis has become a vital and valued part of their identity.
But what does this cultural shift mean for the many therapists who are critical of the DSM—some of whom rarely even use it and instead routinely type “adjustment disorder” on insurance forms? In this issue, we explore the growing disconnect between clinicians’ emphasis on strengths-based approaches and the trend among clients to embrace pathology.
First, senior editor Chris Lyford takes us on a high-energy, fantastical journey through the tangled landscape of mental-disorder classification, from the earliest iterations of the DSM to recently proposed alternatives that drop the “disorders” construct entirely. Then, several clinicians dive into key elements of the diagnosis conundrum, including what’s led to the current clamor for the autism diagnosis; why the ODD diagnosis needs to be permanently retired; what makes moral injury distinct from PTSD; and how to work productively with clients clinging to self-diagnoses that limit or even hurt them. Plus, we hear from Matthias Barker, therapist and TikTok sensation, on how he leverages the much-maligned fad of “therapy-speak” to benefit his clients and online followers. Whew!
Whether you’re in the for, against, or undecided camp of traditional diagnostic systems, it’s clear that the ways in which people identify and talk about suffering are shifting—possibly seismically. The question is: will this shift guide more people toward genuine healing?
Livia Kent
Livia Kent, MFA, is the editor in chief of Psychotherapy Networker. She worked for 10 years with Rich Simon as managing editor of Psychotherapy Networker, and has collaborated with some of the most influential names in the mental health field on stories that have become widely read articles and bestselling books. She taught writing at American University as well as for various programs around the country. As a bibliotherapist, she’s facilitated therapy groups in Washington, DC-area schools and in the DC prison system. In 2020, she was named one of Folio Magazine’s Top Women in Media “Change-Makers.” She’s the recipient of Roux Magazine‘s Editor’s Choice Award, The Ledge Magazine‘s National Fiction Award, and American University’s Myra Sklarew Award for Original Novel.
