Skip to main content

Verified by Psychology Today

The Human Cost of Diagnosis

What if client and mental health provider co-created a diagnosis?

Many mental health professionals are speaking out about their fears and doubts related to the proposed revisions to the DSM. The following is an invited piece by Lois Holzman on the subject. I think you'll find it interesting and eye-opening.

The Human Cost of Diagnosis

By Lois Holzman, Ph.D.

As Eric Maisel has chronicled in recent posts, the serious pushback we've seen in recent weeks over proposed revisions to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) is not going away. Mental health professionals are voicing their concerns with DSM-5, concerns over the decision-making process, as well as the impact on client services and their own reimbursement that are likely to occur as a result of proposed changes.

While I'm thrilled to see the outcry, I would argue as a methodologist that the critique of DSM needs to be broadened to challenge the diagnostic paradigm as a whole and the medical model's pseudo-scientific approach to human emotionality.

Many in the critical and postmodern psychology camp have for decades challenged not simply over-diagnosis, but the diagnostic paradigm as a whole. In particular, we reject conceptions and methods at the heart of DSM that rely upon a dualistic separation between subjective-objective, mind-body, mental-physical, biological-cultural, and that then privilege the biological.

What assumptions must the profession be making: about persons; about therapy and the therapeutic relationship; about illness, cure and treatment; about emotions and cognition; and about mind, body and brain, in order to be convinced that human experiences and relationships can be mediated by a manual?

In Unscientific Psychology: A Cultural-Performatory Approach to Understanding Human Life, my colleague Fred Newman and I research the history of how psychology carved out its expertise in mental health, casting itself in the image of the medical model, while ignoring philosophy's methodological challenges to this very model (including those of Ludwig Wittgenstein, John Searle and others). Far from being anti-science, we objected to science's misappropriation by psychology.

In 1995, social psychologist Ken Gergen and Newman presented a paper at the American Psychological Association conference entitled, "Diagnosis: The Human Cost of the Rage to Order". It argues against psychological dualism, explores the philosophical assumptions that underlie DSM and, among other things, calls for a democratization of diagnosis. They suggest that perhaps the way to practically challenge the authoritarianism of diagnosis is to create a therapeutic practice in which people can perform the activity of figuring out a "diagnosis" together, something that Newman developed in his social therapeutic approach to emotional pain. Thousands have been helped with their "mental illness" through this and other approaches that relate to human beings with integrity and to mental health/illness as an issue of emotional and relational growth -- that don't depend on an "objective assessment" of a person's "illness" by an "expert" who consults a manual that was made up by other "experts."

Effective, non-diagnostic therapeutic practices that do not rely on DSM and psychology's methodological premises offer a practical critique of DSM. What is to be our approach to a person who doesn't get out of bed? Or to a boy who doesn't sit still? Or to a 14 year-old girl who pulls her hair out? Their behavior, their emotional and relational lives, their pain and distress are social, cultural activities. Relating to them as anything other is a scientific and moral violation.

Lois Holzman, Ph.D., is the director of the East Side Institute for Group and Short Term Psychotherapy and the author of Unscientific Psychology: A Cultural-Performatory Approach to Understanding Human Life (with Fred Newman); Vygotsky at Work and Play; The End of Knowing: A New Developmental Way of Learning (with Fred Newman); and other books

Thank you, Lois!

If you are interested in this subject and have a post you want to share with my readers, please let me know and let's chat.


Eric Maisel, Ph.D., is a psychotherapist, bestselling author of 40 books, and widely regarded as America's foremost creativity coach. His latest book is Rethinking Depression: How to Shed Mental Health Labels and Create Personal Meaning (New World Library, February, 2012) and is available here. Dr. Maisel is the founder of noimetic psychology, the new psychology of meaning. Please visit Dr. Maisel at or contact him at You can learn more about noimetic psychology at