Diagnosis: What it means, why it matters, and when it helps
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I'm recording this while driving to work because I'm a busy mom. Today I want to talk about diagnosis—what it means, why we do it, and what my particular take on it is. As a clinical psychologist, I was trained in the medical model alongside psychiatrists. We learned the DSM, the diagnostic manual that classifies psychiatric conditions into discrete categories like depression, anxiety, schizophrenia, bipolar. It's useful because it creates a common language for clinicians and allows us to study treatments and measure whether symptoms are reducing.
But the DSM has pitfalls. It's inherently biased—mostly based on Western, predominantly American research and samples. In South Africa, for example, hearing voices might indicate psychosis according to the DSM, but for some cultural groups it's a sign someone is a sangoma, a traditional healer. We have to use the framework for what's useful and leave the rest. So why diagnose at all? For many people, especially women who've been told they're too sensitive or too emotional their whole lives, hearing "you're depressed" or "you have anxiety" is deeply validating. It's not you being difficult—it's a real condition that deserves treatment.
I stay away from binaries like "is this real depression or just normal life stress?" If someone is struggling and their quality of life is reduced, they deserve help whether it's a temporary hormonal thing, lack of support, or a diagnosable disorder. The question is: does the diagnosis resonate with someone's lived experience? Adult ADHD diagnosis in women is a perfect example. Women weren't diagnosed as kids because they internalized symptoms, while boys bounced off walls physically. Now women are getting diagnosed in their 30s and 40s and feeling massive relief—finally someone understands what's happening inside their minds. That's when diagnosis is most useful: when it leads to self-compassion, not pathologizing, when it helps us scaffold support systems and treatment plans, not just slap on a label.
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But the DSM has pitfalls. It's inherently biased—mostly based on Western, predominantly American research and samples. In South Africa, for example, hearing voices might indicate psychosis according to the DSM, but for some cultural groups it's a sign someone is a sangoma, a traditional healer. We have to use the framework for what's useful and leave the rest. So why diagnose at all? For many people, especially women who've been told they're too sensitive or too emotional their whole lives, hearing "you're depressed" or "you have anxiety" is deeply validating. It's not you being difficult—it's a real condition that deserves treatment.
I stay away from binaries like "is this real depression or just normal life stress?" If someone is struggling and their quality of life is reduced, they deserve help whether it's a temporary hormonal thing, lack of support, or a diagnosable disorder. The question is: does the diagnosis resonate with someone's lived experience? Adult ADHD diagnosis in women is a perfect example. Women weren't diagnosed as kids because they internalized symptoms, while boys bounced off walls physically. Now women are getting diagnosed in their 30s and 40s and feeling massive relief—finally someone understands what's happening inside their minds. That's when diagnosis is most useful: when it leads to self-compassion, not pathologizing, when it helps us scaffold support systems and treatment plans, not just slap on a label.
Follow Carly on:
Website: https://onthecouchwithcarly.com/
YouTube: https://www.youtube.com/channel/UCfBi56xQookfRGL3zvWVzCg
Instagram: https://www.instagram.com/onthecouchwithcarly/?hl=en
Facebook: https://www.facebook.com/onthecouchwithcarly/
TikTok: https://www.tiktok.com/@onthecouchwithcarly
Apple Podcasts: https://podcasts.apple.com/za/podcast/on-the-couch-with-carly/id1497585376
Spotify: https://open.spotify.com/show/3t7A2FMnISQ2fz9D5p0Xuw
Chapters
- 00:14 Recording while driving: talking about diagnosis today
- 01:11 Clinical psychologist training in the medical model
- 01:38 Difference between psychologist and psychiatrist
- 03:48 What is the DSM and why we use diagnostic manuals
- 04:37 How diagnosis creates common language and standardization
- 06:15 The pitfalls: classification systems are inherently biased
- 08:07 Cultural context: hearing voices as psychosis vs sangomas
- 09:21 Why diagnose? Validation for people told they're too sensitive
- 11:53 Grief vs depression: when does bereavement become a diagnosis?
- 13:24 Postpartum struggles: normal response or anxiety disorder?
- 14:58 Staying away from binaries: real diagnosis vs just life stress
- 15:16 Not all people benefit from diagnosis, especially children
- 17:33 Externalizing the problem: you have an illness, you're not broken
- 18:17 The history of equating psychology with morality
- 19:29 ADHD diagnosis everywhere on social media right now
- 20:24 Why boys were diagnosed more: physical vs internal symptoms
- 21:14 Does the diagnosis resonate with someone's lived experience?
- 22:33 The isolation of internal experiences no one else can see
- 23:42 Your brain is like other people's brains, mapped and understood
- 24:49 Diagnosis leading to self-compassion, not excuses
- 26:18 ADHD women aren't using it to be assholes
- 26:55 Using diagnosis to scaffold support and manage symptoms
- 27:49 Steering away from pathologizing: increase compassion and empathy
