By Anna Moochoon, LCPC
When people receive a diagnosis, it is easy to assume that an explanation has been found.
But diagnosis and explanation are not necessarily the same thing.
Consider this example.
Someone struggles with sadness, low energy, hopelessness, and difficulty concentrating.
A clinician may diagnose depression.
Now imagine asking:
"Why is this person experiencing these problems?"
The answer often becomes:
"Because they have depression."
But how do we know they have depression?
"Because they experience sadness, low energy, hopelessness, and difficulty concentrating."
Notice what has happened.
The diagnosis is being used to explain the very symptoms that were used to establish the diagnosis.
This is one example of what philosophers call circular reasoning.
The diagnosis accurately describes a pattern of experiences, but it does not necessarily explain why that pattern developed.
A label can tell us what is happening without fully telling us why it is happening.
Consider another example.
Someone frequently seeks admiration, becomes defensive when criticized, and struggles to empathize with others.
A person might ask:
"Why does he behave that way?"
And the answer may be:
"Because he's narcissistic."
But how do we know he is narcissistic?
"Because he seeks admiration, becomes defensive when criticized, and struggles to empathize with others."
Again, the label is describing the pattern.
By itself, it does not explain why the pattern developed.
Did the person grow up feeling unseen?
Were they excessively praised or harshly criticized?
Did they learn to protect themselves from shame through grandiosity?
Do they struggle with fears of rejection or inadequacy?
The label alone cannot answer these questions.
It identifies the pattern.
Understanding the person requires a deeper exploration of their history and experience.
This observation has led a number of influential thinkers to question what diagnoses can and cannot tell us about human beings.
Psychiatrist Thomas Szasz argued that many psychiatric diagnoses function primarily as descriptions rather than explanations. In his view, naming a pattern is not the same as identifying its cause.
R. D. Laing believed that emotional distress often becomes more understandable when viewed within the context of relationships, family systems, and life circumstances. Rather than asking what is wrong with a person, he encouraged people to ask what has happened to them.
The philosopher Michel Foucault explored how societies create categories of normality and abnormality. He suggested that diagnostic systems are influenced not only by scientific observation, but also by cultural and historical assumptions about human behavior.
Carl Rogers expressed concern that people can disappear behind labels. He believed that genuine understanding emerges through empathy and curiosity rather than classification alone.
Existential psychiatrist Irvin Yalom has often reminded therapists that they do not treat diagnoses. They work with people facing questions of meaning, loss, uncertainty, freedom, isolation, and relationship.
Despite their differences, these thinkers shared a common concern: understanding a person requires more than assigning a category.
At the same time, diagnosis serves important purposes.
Diagnoses help clinicians communicate with one another. They guide research. They can help identify treatment approaches that are likely to be helpful. They also provide access to services and insurance reimbursement.
In this sense, diagnosis can be a useful clinical tool.
The problem arises when the diagnosis is mistaken for a complete explanation.
Something interesting often happens when a label is applied.
Curiosity begins to fade.
"He acts that way because he's narcissistic."
"She struggles because she has depression."
"He avoids people because he has social anxiety."
The explanation feels complete, even though many important questions remain unanswered.
The label can create an illusion of understanding.
The conversation stops where it should perhaps begin.
Many therapeutic approaches attempt to move beyond description toward understanding.
Rather than asking only:
"What diagnosis does this person have?"
they may also ask:
"What happened to this person?"
"What problem is this behavior trying to solve?"
"How did this pattern develop?"
"What purpose might it be serving?"
Transactional Analysis offers a useful example of this perspective.
Eric Berne, the founder of Transactional Analysis, was deeply interested in how people communicate, relate, and make sense of their lives. His work focused on ego states, transactions, relationship patterns, and life scripts.
From a Transactional Analysis perspective, two people with the same diagnosis may arrive there through entirely different life experiences. Understanding those experiences may be just as important as identifying the diagnosis itself.
This does not mean abandoning diagnosis.
It means recognizing its limits.
A diagnosis can describe a pattern.
Research may help us understand some of the processes associated with that pattern.
A person's history can help explain how it developed.
Their relationships can reveal how it is maintained.
Their values can illuminate where they wish to go.
The diagnosis is part of the picture.
It is not the whole picture.
A diagnosis may provide a map reference.
The story helps us understand the journey.
And while labels can be useful, people are often best understood not only through the categories they fit into, but through the experiences, relationships, meanings, and choices that have shaped their lives.
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