The Failure of Categories

Names have power. People who are sick tend to feel a kind of relief when their illness is named – ah, I have lupus; even though it’s a terrible diagnosis, there is relief in knowing. Having a name for the illness means others know what it is, perhaps how to treat it, and it means it’s “real,” in some way. It’s not uncommon for individuals to go from one doctor to another, to another, to another, in an effort to get a diagnosis for troubling symptoms.

Most psychologists and psychiatrists rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose emotional suffering. The DSM undergoes revision every few years, and those revisions reveal an important flaw in the concept of categorical labeling of emotional suffering. For example, homosexuality was categorized as a mental disorder in the DSM until 1986; political and cultural views clearly have an influence on the DSM categories.

psychotherapy catagoriesMore importantly, though, experience does not neatly fit into a category. If you tell me that you have been diagnosed with bipolar disorder, that communicates a list of potential criteria – mood swings, cycling, etc., but it does not tell me anything at all about your experience. I often hear therapists or counselors refer to people simply by a DSM category designation: “She’s an Axis II” (borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, etc.), or “He is a cluster B” (dramatic, emotional, or erratic) without any other description of the person as a human being.  Perhaps worse, I have heard people refer to themselves that way.

This diagnostic approach to understanding people has profound implications for treatment. Most broadly, it does not involve the therapist in really getting to know you. It interferes with understanding you as a whole person, ignoring the larger context of your life and experience. When someone focuses exclusively on diagnostic criteria – your ‘symptoms’ – you become nothing more than a pathological entity. You are not merely a bundle of symptoms. These diagnostic categories serve the pharmaceutical industry and the insurance industry, not you.

Therapists who take a humanistic approach, on the other hand, try to understand the patient’s reality, rather than trying to force the patient into their own reality. Humanistic therapy is more a process of discovery, in which the patient and therapist seek to understand the person as a whole, and to understand what works and what doesn’t work. No effort is made to necessarily fit you into the ‘norm,’ which can suppress radical and creative points of view; instead, the goal is for you to understand who you are, and to find your own way of being in the world that works well for you.

Article Name
The Failure of Categories
Diagnostic categories serve drug and insurance companies, but they fail to capture you as a person. Humanistic therapy addresses you as a whole individual, rather than a list of symptoms.

About Marc Handelman, PhD

I am a licensed clinical psychologist practicing in New York City. My office is located on the Upper West Side of Manhattan, near Columbia University. I work with adults from college age and up who want help addressing problems ranging from depression, anxiety, and relationship issues to addiction, co-dependency, and the effects of early trauma. I believe psychotherapy should provide a sense of comfort and support as the starting point for addressing emotional problems. I have more than 30 years' experience as a psychotherapist, and have been affiliated with The Hazelden Foundation since 1997. Please see my professional website for more information:
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