For every hour I spend in the diagnosis of psychopathology I spend fifty hours talking my clients out of the diagnoses that they already have. Don’t get me wrong, I am a dedicated scientist and I recognize the research, communication, and treatment value of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which is the official catalog of mental disorders. The very serious problem is that the abstractions of the DSM are often mistaken for the legitimate description of individual human beings, as though they were medical diagnoses. This is a particular problem when those individual human beings accept their diagnosis as an absolute and permanent description of themselves, which is where I must intervene.

   Medical diagnosis is essential to the treatment of medical problems. Beyond umbilical clamping and circumcision, any pediatrician who proposes to perform surgery on my infant grandchildren had better have a really solid diagnosis. There are undoubtedly a number of legitimate medical (psychiatric) conditions in the DSM, like schizophrenia and Alzheimer’s dementia, which require medical treatment not available from clinical psychologists, but there are also a large number of social stereotypes and personal insults like Narcissistic Personality Disorder, which describes jerks, and Oppositional Defiant Disorder, which describes uncooperative kids. DSM-III included homosexuality as an official psychopathology until 1974, when it was finally removed from the official list of mental disorders. No further comment is required here, I hope.

   Between schizophrenia and homosexuality lies a whole range of diagnostic terms that have been more or less abused in their translation to folk-English; including ADHD, Bipolar, Asperger’s, Dependent Personality, Borderline Personality, and Obsessive-Compulsive Personality disorders. This is not to say that these things don’t actually exist, but the terms are vastly overused and they often pose the first and most formidable obstacle to progress when they are adopted by the people who are accused of them by their family, by their friends, and by licensed professionals. Even ordinary mood and chemical dependency diagnoses have their complications as well as their uses. You are not your diagnosis and I probably won’t give you one unless you need it for insurance purposes, in which case I am sure you will meet the criteria for something.