Why a diagnosis is (probably) not what you really need

In my practice, I do not give any diagnosis - neither officially nor in my head - while I evaluate the challenges you are going through. The reason for this is that I think it can be quickly misused. Let me explain.

For most people, a diagnosis is not what they need, and in some cases, it is completely counterproductive, misleading, and disconnecting from themselves and reality. In some cases, it is also quite helpful, but it depends very much on the intention behind wanting one. So if you find yourself wanting a diagnosis, ask yourself first:

What is my intention in wanting to know in which box I and my symptoms belong?

Why is it unhelpful to most?

Being different from the rest can be deeply disconnecting. A diagnosis, while meant to provide an explanation for why you are the way you are, can also create further isolation by placing you into a specific box or role. This categorization takes away the flexibility to react in ways that might not align with the diagnosis, limiting the possibility of change. It can block the process of forming new patterns and neural connections by restricting the freedom to respond differently in situations where you might otherwise follow your usual behavior.

Because a diagnosis implicitly or explicitly suggests how a person with that label is expected to think, feel, or act- and since we are all, to some extent, influenced by such expectations - it can make it harder to break out of old patterns, adapt, and move forward. It's like Martin Seligman’s experiment on learned helplessness, where dogs, after being repeatedly subjected to inescapable shocks, stopped trying to escape even when the cage door was open.

If we step outside the category we’ve been placed in: what are we then? A diagnosis is often intended to provide stability, safety, grounding, and understanding for both the psychologist and the client. But in reality, it can have the opposite effect. It creates a false sense of security. We end up identifying with a label that is as fluid and subjective as the psychologist who assigns it. It places us within a predefined box, imposing limits and defining us before we even have a chance to define ourselves. And that - more than anything else - is the most powerful bias and suggestion at play.

Why we do this to ourselves

Most of us, in one way or another, have felt unseen as we are, not good enough, not special enough, or as if we don’t belong. Often, the reaction to this is to hide even more from the world because we think we do not deserve or are not worthy of receiving this attention or having these needs met. But in other cases, it is the opposite: We want to be even more special - because then we will be seen, then we will belong, right?

Unfortunately, that is far from the truth. In our efforts to be special or seen, we do exactly what makes us disconnect even further from our real selves and from the world. Maybe the thought is that we must have a reason to get attention- something serious enough so that we finally deserve to be understood. Maybe, in the past or in childhood, our simple bids for attention or our displayed needs were not seen or responded to properly. And now we look for what might be different or wrong in us to justify why we need extra attention and care.

So often, we do not take ourselves seriously if no one around us did- if no one was compassionate or sensitive enough to see what we needed and show us how to get it. We do not learn how to give this to ourselves and start thinking that maybe there is something wrong with even wanting and needing what we want and need.

Or maybe we are wrong somehow if our caregivers did not want to help us. And so, shame blocks the process of fulfilling our needs and wants later on. Instead of thinking about how to get our needs met and asking for what we want, our shame absorbs all the energy, and we try to hide. Often, the shame - the feeling that something must be wrong with us or with our needs - leads us to look for wrong explanations. Why do I want and need so much? How do others not need as much? Why can’t I just be happy with what XY is giving me? Is there something wrong with me? Is this a disorder? We think something is wrong with us for not being seen, and so we search for the answer. And that is where, for many people, a diagnosis finds its place.

For some, it’s surely a relief. Finally, I know what is wrong with me. That’s why I can’t accept myself...because it’s actually not me; it’s not my fault. The shame disappears. Because now, it’s the diagnosis, not us. The diagnosis can now be carried like a shield in front of us, to protect us from blame, shame, self-acceptance, self-love, and, most importantly, taking responsibility for what truly matters. We can blame the diagnosis. We can further invalidate ourselves. We can further ignore our needs because that is easier and less painful than recognizing them and grieving their lack of fulfillment in the past. We can try to be like the rest and stop asking for so much, because this voice in us is not to be taken seriously; it’s just the diagnosis speaking.

And in the long run, the trade-off is often a deeper disconnection from ourselves - through ignoring our most primal, vulnerable desires and needs...all for the sake of fitting and belonging in some box (the diagnosis) due to shame. So it is a true paradox: wanting a diagnosis because we feel disconnected, only to eventually disconnect even more, as we now neglect our needs with even more conviction, believing they do not belong to us but to the diagnosis. The focus shifts to treating the disorder rather than recognizing and addressing our reaction to our unmet needs.

Because most of all - a diagnosed disorder is not just a condition; it is a reaction & response from our psyche to not having been truly getting what was needed in the first place.

What to do now

The greatest gift is to listen to yourself. To take yourself seriously. You cannot change your needs, your wants, or how much and what you need to be happy. That’s you- your emotions- and they are important because they show you who you are.

So before chasing a diagnosis, ask yourself: Why do I want one? What is the need behind it? Would that really be helpful? What are my conscious and subconscious expectation towards being classified or getting a diagnosis? There are certainly good reasons to have one- to find better interventions, creating connection or understanding, perhaps. But there are also many bad reasons. A diagnosis can make you feel like you are losing ownership of yourself or justify why you must feel helpless right now. It can feel like a shield that protects your ego from truly seeing yourself as you are. 

And that, my dears, is- long story short- why I do not give a diagnosis.