Making the Madness Sane Again
This article dismantles mental health labels, urging a rethink towards nuanced, human-centred understanding over rigid diagnoses.
Right, settle in, because this is serious. You know those labels, don't you? The ones that get flung around like confetti at a particularly joyless wedding – "narcissist," "psychopath," "borderline personality disorder," "control freak." They're slapped onto people, neat little tags designed to package up all the messy, contradictory, utterly human bits of us and file them away. And honestly? I’ve had enough of it!
These terms, these supposedly objective scientific determinations, often feel less like understanding and more like judgment. They feel like blinkered pronouncements from a so-called expert, designed to constrain, to restrain, to control. They leave precious little room for the glorious, bewildering, heart-breaking nuance of being alive. And for anyone who’s ever felt misunderstood, who’s ever been told their way of being isn’t "normal" enough, or "neurotypical" enough, well, this radical idea might just feel like a breath of fresh air.
It’s time we stopped saying, "What's wrong with you?" with a frown and a sneer, and started asking, kindly and compassionately, "What happened to you?" Maybe with a friendly tilt of the head.
This isn’t about denying pain or ignoring genuinely harmful behaviours. It’s about challenging the framework through which we view them, the language we use, and the power structures that underpin it all. It’s about reclaiming our stories from the neatly ordered shelves of the diagnostic manual and embracing the sprawling, wild landscape of actual human experience.
The Holy Book
For decades, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been presented as the definitive guide to the human psyche, a scientific arbiter of what constitutes "normal" and what's "disordered." But it's not a science textbook. There's no blood test for depression, no gene test for bipolar, no brain scan that definitively declares someone a "psychopath."
It's opinion. Lists of symptoms, defined by committees, voted upon, and influenced by a dizzying array of factors – market forces, pharmaceutical interests, prevailing cultural norms, and yes, even just the personal biases of the experts in the room.
As Allen Frances, who was the chair of the task force that revised the DSM-IV, has openly admitted, psychiatric diagnosis still relies exclusively on "fallible subjective judgments rather than objective biological tests." Every new version of the DSM, he warns, lowers diagnostic thresholds, turning what used to be ordinary human experiences – grief, shyness, adolescent angst – into treatable, diagnosable "disorders" overnight. We haven’t found new illnesses; we've simply lowered the bar, pathologising everyday life.
Your profound sadness after a loss isn't just grief; it might be "Major Depressive Disorder." Your restless energy and quick mind in childhood aren't just personality traits; they become "Attention Deficit Hyperactivity Disorder." This isn't ground-breaking scientific discovery; it's a social design, a set of rules collectively agreed upon, and then, bafflingly, treated as incontrovertible fact.
It’s like deciding that anyone who laughs for more than three seconds in a quiet room has "Compulsive Giggles Syndrome." It’s quite a thought, isn't it?
I understand the practical dilemma here. Researchers need some framework to study treatment effectiveness, clinicians need shared language, and insurance, welfare or benefits systems require diagnostic codes. The goal isn't to burn it all down tomorrow, but to evolve toward more nuanced systems like Hierarchical Taxonomy of Psychopathology (HiTOP) while maintaining these practical functions. Many clinicians already work this way, striving for person-centred care within existing frameworks.
Follow the Money to the Control
Why does this matter so much? Because these labels aren't benign. They come with immense power, and that power is often wielded by those who benefit most from the system. Follow the money, and you'll often find a trail leading straight to the pharmaceutical industry. Every new diagnosis, every broadened category, means more potential patients, more prescriptions, more profit.
When ADHD was added to the DSM and its diagnostic criteria were expanded, diagnoses surged. Suddenly, schools were pressured to label children, not just to understand them, but often because funding models rewarded it, and pharmaceutical companies were there, ready to sell stimulants. It’s a perfect ecosystem of what historian and critic of psychiatry, Joanna Moncrieff, refers to as the "drug-centred model" of care, where drugs become the primary intervention, and the diagnosis simply a gateway to that treatment. It’s a conversion factory: human distress gets funnelled into a label, which then points directly to a prescription. This isn't about care; it's about control, conformity, and cash.
This isn't some wild conspiracy theory; it's pattern recognition.
Who gets pathologised? Often, it’s behaviour that challenges the status quo, behaviour that society finds inconvenient, uncomfortable, or uncontrollable. Rebellion, dissent, individuality that pushes against the boundaries of "acceptable" often find themselves neatly packaged and dismissed under a diagnostic label. It silences critics. It discredits difference. It’s psychiatry, sometimes, wielded as a conformity tool, and it leaves no room for genuine nuance or empathy.
Dimensions, Not Dungeons
The DSM, with its checklists and criteria, expects you to be either "in" a diagnostic box or "out" of it. You're either depressed or you're not. You're either a "psychopath" or you're not. This black-and-white thinking is not how human experience works. Real science, increasingly, says no.
A paradigm shift that’s been brewing in the academic world.
HiTOP argues that mental traits lie on a spectrum, a vast, interconnected landscape of human experience, rather than discrete, isolated categories. Your anxiety isn’t an on/off switch; it’s a dial, ranging from a slight nervousness before a big presentation to a full-blown panic attack. Your social withdrawal isn't a fixed state, it’s a tendency that might mean you simply lean towards introversion rather than extroversion, and only in extreme cases does it become debilitating detachment. The lines are fuzzy, complex, and influenced by countless factors – and that, crucially, is what real life looks like.
HiTOP builds on decades of research showing that symptom clusters often co-occur. Someone diagnosed with social anxiety might also experience depressive tendencies or obsessive thoughts. These aren’t separate diseases but interconnected patterns across broad dimensions like "internalising" (anxiety, depression), "externalising" (aggression, impulsivity), "thought disorder," "detachment," and a general "p-factor" representing overall psychological distress. This isn't woolly thinking; it’s evidence-driven realism. Your psychology is a dynamic landscape, not a static prison cell. It's time to stop locking people into categories and accept that human experience is fluid, not forensic.
It's also worth acknowledging that many legitimate researchers and scientists within the field of psychiatry are actively pushing for these very same dimensional, trauma-informed, and context-aware approaches. This isn't anti-science, it's science correcting itself.
Researchers within psychiatry are leading this dimensional shift precisely because the evidence supports it. The scientific method, at its best, encourages rigorous self-critique and evolution. So, while we might critique aspects of the rigid system, it's important to recognise that the seeds of its own transformation are often sown by dedicated minds inside it, engaged in legitimate scientific debate that aims for a more accurate and humane understanding of the mind.
Our challenge isn't against all science, but against dogma and inertia.
Furthermore, the increasing discovery of biological markers, such as genetic predispositions or neural network variations, supports dimensional thinking by showing how these markers contribute to a spectrum of traits rather than defining rigid disease categories.
Weaponising Psychopathy
Let's drag out the arch-villain of pop psychology shall we: the "psychopath." We're told they're these charming, unfeeling monsters, devoid of guilt and remorse, incapable of genuine human connection. Sounds like something straight out of a chilling true-crime documentary or a Hannibal Lecter movie, doesn't it?
But, the truth is, most psychiatrists don't actually believe in "soul-level evil." They look at brain geography, neural pathways, developmental trajectories – not moral damnation.
To be clear - I'm not critiquing trained clinicians using these tools carefully in clinical settings. I'm addressing the casual weaponising of these labels in everyday discourse, where 'psychopath' gets thrown around to dismiss anyone who doesn't express emotions as expected.
The Hare Psychopathy Checklist-Revised (PCL-R), often used to assess psychopathy, isn’t a black-and-white determinant. It measures a cluster of traits: fearlessness, detachment, impulsivity, grandiosity, and manipulativeness. But even within this, researchers distinguish between "primary" psychopathy (characterised by a cold, fearless detachment) and "secondary" psychopathy (which is more impulsive, reactive, and often accompanied by anxiety or other forms of distress). These are two radically different profiles, yet both might be captured under the same umbrella.
And here’s where it gets really interesting: empathy isn’t a binary switch. There's affective empathy (the ability to feel another person's emotions) and cognitive empathy (the ability to understand another person's emotions, even if you don't feel them yourself). People with psychopathic traits often lack affective empathy, yes, but their cognitive empathy can be intact or even enhanced. They can "read" a room, understand what makes people tick, and predict emotional responses – precisely what makes them effective manipulators, if that's their chosen path.
This isn't a deficit of understanding; it's a difference in emotional wiring.
Furthermore, studies on the brain show that sometimes, the "absence" of empathetic or fear responses in individuals with psychopathic traits is actually a matter of attention. When their attention is specifically directed to cues of distress or fear, some individuals do show more typical physiological and brain responses. This suggests that the deficit isn't a permanent void, but perhaps an attentional bias – they're simply not processing those cues automatically. That changes everything about "treatment," doesn't it? It means emotional detachment isn't some incurable evil; it may be wiring, survival, pain, or trauma.
Treating it as a moral failure is ignorance, plain and simple.
And when everyday people, layperson, fling the word around, accuse and define others as psychopaths, they are merely showing their ignorance; their ignorance of the diagnosis, their ignorance of the diversity of life, their ignorance of the other person. They are demonstrating their lack of empathy…
Silence is Sincerity
We’re told that if someone doesn’t cry on cue, if their face doesn’t crumple just so, if they don't perform sorrow or regret or remorse in the expected way, then they don’t feel it. They can’t. They are defective. And, frankly, that’s ridiculous.
I’ve been told once or twice by one or two people that my sincerity isn’t. That my words are insincere. But let me tell you, every word I utter, every sentiment I convey, is drenched in sincerity. It’s not my fault if it doesn't align with the performative sincerity others have grown accustomed to, or the frame of reference they have for sincerity. It’s their interpretation, their rigid expectation of how remorse should look.
Are we really going to judge the genuine depth of someone’s feelings by how closely they mimic the displays we see in our family, our teachers, on EastEnders or in a Hollywood tear-jerker? People express themselves differently. We need to learn to listen, not dismiss just because it’s not delivered with tears and trembling hands.
If I am honest, I reckon most people mean what they say. Do you say things you don’t mean? A lot? Always? Mostly? Sometimes? Ever?….probably not. Or are you just speaking your honestly held beliefs your way. Almost certainly.
Emotional attunement depends on a myriad of factors: our upbringing, our past traumas, our individual wiring, even our current focus of attention. Yes, some people might appear more cold or detached, or overwhelmed and shut down. That’s context, not diagnosis. Your stoicism isn't detachment; it’s your way of coping, your internal processing that might not manifest in the expected outward display. To say someone "can't learn" from their mistakes, simply because they don't perform regret in a way we recognise, is deeply cynical and unhelpful.
We’ve all messed up, repeated patterns we regret. Does that make us monsters, or just, well, human?
And on the matter of guilt and remorse specifically, let's look at this a bit closer. The clinical narrative often paints a picture of individuals with certain labels as entirely lacking these fundamental human emotions. But how do we truly know what’s going on inside someone's head? Just because someone doesn’t express guilt or remorse in a way we expect (perhaps they don't vocalise it, or they don't show the 'typical' signs of distress) that doesn't mean it isn't there.
People process profound emotions in incredibly diverse ways. Someone might feel immense guilt but be utterly incapable of articulating it due to past trauma, a different neurodivergent processing style, or simply having never learned the social scripts for such expressions. To assume an absence of these feelings based solely on external presentation is a profound oversimplification.
Furthermore, there's a crucial distinction between regret (disappointment for self-related outcomes, like "I regret getting caught") and remorse (sorrow for the suffering one has caused another). While a truly manipulative person might only experience regret, it's dangerously quick to assume that anyone who doesn't present their sorrow in the 'right' way is incapable of the latter. This judging of emotional intent based on outward display is where true understanding so often misfires. It denies the rich internal world that might be struggling to find expression, and instead rushes to a condemning label. Many skilled clinicians are already attuned to these nuances, looking beyond superficial displays.
Seeing the Whole Bloody Picture
Then there's the whole "blaming the victim" accusation. In the diagnostic world, if someone, let’s say, suggests that in a breakdown, both parties might have had a role or something to learn, the label gets slapped on. "Oh, they're blaming the victim, how psychopathic!" But is it? Really?
I see it differently. I think some people are brave enough to see the messy, complex truth: that life is very very rarely a neatly packaged hero-and-villain narrative. They see the full depth of a situation, the intricate dance of cause and effect, the ways in which everyone contributes to a dynamic, good or bad. They're not denying pain; they're just refusing to simplify it. They’re saying, "Hang on, maybe we all have something to learn here."
They are seeking for all of us to grow together - a wonderful goal, not a blame or avoidance at all.
To suggest that only one person bears responsibility, that one person is purely a blameless victim and the other a pure perpetrator, now that feels like a blinkered, unnuanced view of the world. It’s disempowering, actually. It stops us from seeing our own agency, our own capacity to learn and grow, even from difficult situations.
The real "blaming the victim" happens when someone consistently externalises all responsibility for their own actions, refusing any self-reflection on the pain they caused (whether intentionally or not). But seeing mutual contribution in a conflict? That’s emotional intelligence and maturity, not pathology.
Those who seek to define one party as good and the other as bad, it’s more likely that these are the immature and unfair ones. Not the ones who seek for us to come together and accept a mutual dynamic.
Neurotypical is the New Normal
And don’t even get me started on "neurotypical." Honestly, what even is that? It sounds like some sort of beige, perfectly functioning robot that only exists in a scientist’s wet dream. We’re constantly being compared to this mythical "neurotypical" standard, and if we deviate, if we dare to be our wonderfully diverse selves, then suddenly, we’re "disordered," "problematic," or worse, "psychopathic."
This is, quite frankly, a broad simplification. The world is bursting with billions of unique individuals, each with their own wiring, their own experiences, their own way of processing the universe. To suggest there's a singular "normal" or "neurotypical" way to exist is not just unhelpful; it’s entirely and demonstrably incorrect and as a result becomes a dangerous tool of control. It demands conformity, stifles individuality, and punishes difference.
It’s the ultimate "Square Peg, Round Hole" scenario, but instead of celebrating the square peg’s unique form, we’re told it’s broken.
And for those of us who grew up feeling like the quirky sidekick in a Britcom – perhaps a bit like Peep Show's Mark Corrigan, forever overthinking, or Super Hans, just living his best chaotic life – this idea of a "normal" brain feels utterly alien. We are all different, and that's not just okay, it's brilliant.
And these empathy experiments? You know the ones. "We showed them a picture of a kitten crying, and their amygdala didn't light up like a Christmas tree, therefore, psychopath!" While neuroimaging research is far more sophisticated than my simplified example suggests, the fundamental point remains - we're still interpreting complex internal states through necessarily limited experimental designs. The risk isn't in the science itself, but in overgeneralising findings to real-world human complexity.
Some people feel empathy for some things and not others. Some will melt for a stray dog but be stoic in a human crisis, perhaps because of their own trauma, or because they process it internally. Others are the opposite. Our frames of reference are unique, shaped by a lifetime of experiences.
Just because someone doesn’t react in the scientist’s pre-ordained "empathetic" way, doesn’t mean they’re devoid of it. It just means their empathy might be triggered differently, or expressed differently, or perhaps that particular scenario doesn't resonate with their specific life experiences. It’s a judgmental, black-and-white lens, and it misses the glorious, messy rainbow of human empathy.
And what of the methodological bias inherent in such scientific designs?
When a scientist has designed an experiment they think will elicit empathy, there's an inherent assumption that their chosen stimuli and expected responses are universally applicable. This fails to account for cultural variations in emotional expression, individual life experiences that shape how we relate to different scenarios, or even just transient states like fatigue or distraction. The very structure of these tests can predispose them to certain outcomes, often pathologising anyone whose internal world doesn't perfectly align with the researcher's 'norm.'
It's not just that the amygdala didn't light up like a Christmas tree; it's that the test might not be illuminating the complex tapestry of empathy in the first place, or it's measuring a very narrow slice of it. Many thoughtful researchers are already grappling with these complexities.
I Don’t Really Care
I once had a boss who told me it was very difficult to manage me because I didn’t care where I would be in five years. That was his problem, not mine. But let me tell you about my daughter.
She’s a brave, brilliant kid who’s navigated a tough start – cancer as a baby, then her mum and I splitting up. She struggles sometimes with knowing how her behaviour impacts others. She can seem, to the outside observer, "devoid of bother" in certain situations. Like me, she just simply doesn’t care about some things at all.
Now, according to the textbook, all that might raise a red flag, right? But she’s not a psychopath. She’s a child who is hurt, who finds processing emotions incredibly hard, who’s developing her understanding of the world. She's overloaded; she's coping.
Having said that, we venerate this mindset in other contexts, don’t we?
We call it "calm in the face of danger," or "chilled out," or "self-sufficient." The stoic hero of a spy thriller, perhaps a bit like James Bond, always composed, even when the world's exploding around him. Men in movies? Stoic heroes. Girls in real life? Warning signs.
Same brain activity. Radical double standard.
These are often the very same internal states, the very same outward expressions, but suddenly, when filtered through the lens of judgment, they become sinister. It’s hypocritical. It shows that the "problem" often lies not in the person, but in the rigid, un-empathetic perspective of the observer.
This apparent "emotional detachment" or struggle with knowing her behaviour's impact is not a sign of pathology in her.
When a child experiences immense stress, fear, or a sense of helplessness – like battling cancer at a tender age or navigating the upheaval of parental separation – their developing emotional regulation systems can be profoundly impacted.
The brain might learn to suppress overwhelming emotions as a survival mechanism, leading to what looks like a lack of emotional response, but is, in fact, a deeply ingrained coping strategy. It's a protective shield, not a deficiency of soul. Her brain isn't "broken"; it's adapted to an incredibly challenging environment.
We must shift our focus from "what's wrong with her" to "what happened to her," understanding that these behaviours are often echoes of past pain, demanding compassion and support, not a damning label.
Severe Mental Illness
For individuals with severe, persistent conditions like treatment-resistant schizophrenia or bipolar disorder, the 'what happened to you?' framework alone may be insufficient. These conditions likely involve complex interactions between neurobiological vulnerabilities, environmental triggers, and developmental factors. The dimensional approach doesn't deny biological reality, it simply places it within a richer context, aiming to expand good practice rather than simply overturning existing approaches. Many compassionate clinicians recognise this complexity.
You’re an Entitled Control Freak
Honestly, sometimes I wonder if the people who come up with these definitions – of psychopathy, narcissism, control freaks – if they are the ones with the problem, not the people they’re diagnosing.
What makes them want to define and categorise others, rather than accept them?
When someone is an absolute force for good, empowering others, setting them free, refusing to be constrained themselves. But then they encounter someone who, for their own sense of sanity, prefers orderly or controlled situations, some who thrives on consistency and stability for their own sense of safety. The person who resists that control, who stands up for their right to be free, just as they would for anyone else’s right to be free, can get branded a "control freak” or “entitled".”
Because their act of resistance to control in fact feels like an act of control. Because it stops the other person having what they want or need.
But who’s really trying to control whom in that scenario? It’s the person trying to impose their need for order who’s doing the controlling. It's projection, plain and simple. It’s a defence mechanism from those who fear losing their grip on a world they desperately need to manage.
Take any civil rights activists – Martin Luther King Jr., Rosa Parks, Susan B. Anthony, Cesar Chavez, Harvey Milk, Nelson Mandela, or any of the many other brave pioneers – back before they succeeded, it could have easily been said they felt "entitled" to special treatment. That they were breaking social norms. But they were standing up for what was fundamentally right, for the dignity of themselves and their community. Their "entitlement" was to equality, not superiority. The system that labelled their defiance as "deviance" was the one trying to control.
And how can we possibly "know" if emotions are "feigned"? Could they not simply be difficult for someone to express, so they come out awkwardly, differently? How do we "know" someone is lying, rather than genuinely struggling to recall an experience, making mistakes, and then changing their mind as new realisations dawn? How do we "know" someone is obfuscating, rather than simply not understanding, but trying their best to communicate anyway, resulting in vagueness? How do we "know" someone is "distorting facts," when they might simply have a profoundly different perspective and understanding?
The idea of "gaslighting" is fascinating. It’s when someone supposedly makes you doubt your own memory, perception, or sanity. But what if they simply have a different reality, a different experience, and they want you to understand that, alongside yours? What if they genuinely believe their version of events, and they're just trying to share it, expecting you to be capable of holding two differing realities side-by-side without one needing to erase the other? That’s not doubting your reality; that’s accepting reality is nuanced, subjective, and perspective driven. It's embracing complexity, not denying it. When someone's emotions are dismissed because they don't fit a predetermined mould, or their perspective is invalidated because it deviates from the "norm," it's often the observer who is rigid, not the person being observed.
This brings us to the crucial distinction between genuine communication and manipulative tactics. When someone says, "If you do X, I will feel Y," that is communication. It's a statement of personal boundaries and emotional truth. Not a manipulation. When they say, "When you did Z, it made me feel A," that's also communication – it's a reactive expression of impact. These are acts of vulnerability and assertion. They are not saying “If you don’t do B, I will shove C down your throat.”
With the first two examples, the problem arises when the listener resents the change they chose to make in response to the honest communication, then turns around and cries "manipulation!" That's often a refusal to take personal responsibility for their own choices, and an attempt to control the speaker's right to express their feelings honestly.
Socioeconomic Factors
We often talk about mental distress as if it's purely an individual failing or a flaw in someone's personal wiring. But to ignore the colossal impact of our environment – the very fabric of society – is to miss a huge part of the picture. Socioeconomic factors are not just background noise; they are often the drumbeat of suffering that leads to what we then label as "disorder."
Think about it: how much "anxiety" is simply the crushing weight of poverty, the precariousness of unstable housing, or the constant threat of discrimination? How much "depression" is a rational response to systemic inequality, lack of opportunity, or the exhaustion of fighting for basic dignity? When a community is steeped in intergenerational trauma due to historical oppression, how can we simply label the resulting distress as individual "mental illness" without addressing the root cause?
These factors – poverty, lack of access to healthcare, systemic racism, sexism, ableism, food insecurity, insufficient social support – are massive contributors to mental distress. They create chronic stress, erode hope, and limit agency. Yet, our diagnostic frameworks often individualise these problems, suggesting that the person experiencing the distress is the one with the "disorder," rather than acknowledging the sickness in the system around them.
Real solutions here aren't found in a pill bottle alone; they require societal, political, and economic interventions – robust social safety nets, equitable opportunities, dismantling discriminatory structures. We need to demand that our understanding of mental well-being stretches beyond the individual brain and into the collective human experience shaped by our world. Many forward-thinking clinicians and public health experts already embrace this broader perspective.
Accountability Requires no Label
While this whole piece argues passionately against the misuse and overreach of psychiatric labels, it's crucial to acknowledge that genuinely predatory, exploitative, and harmful behaviours do exist. There are individuals whose actions cause profound suffering to others, and we cannot simply dismiss this by saying "they're just different" or "they're struggling." This isn't about excusing cruelty or enabling abuse.
The challenge is to hold individuals accountable for their actions and the impact of those actions, without resorting to labels. Instead of asking, "Is this person a psychopath?" we could instead ask:
"What is the impact of their behaviour on others?"
“Are their actions causing genuine harm or exploitation?"
"Are they taking responsibility for that harm, or consistently deflecting blame?"
"What mechanisms exist to protect victims and ensure accountability for harmful actions, regardless of a diagnosis?"
This shifts the focus from an internal, often unprovable "pathology" to the observable, measurable consequences of behaviour. It's about ensuring safety and justice for victims, while still advocating for a nuanced understanding of the perpetrator's history, development, and potential for change (however challenging that might be).
We can uphold strong boundaries, protect the vulnerable, and demand accountability for actions, all without needing to slap on a "psychopath" label that might obscure deeper truths or hinder genuinely effective interventions. It means acknowledging the very real and devastating effects of certain behaviours, without resorting to the easy, but ultimately unhelpful, dehumanisation of a diagnosis.
We must also acknowledge that diagnostic labels, however flawed, currently serve as gatekeepers to essential resources - disability benefits, workplace accommodations, insurance coverage. Any critique of the system must grapple with this reality and advocate for alternative pathways to support, not just tear down existing ones without replacement. This is about expanding good practice to ensure equitable access to support, rather than simply dismantling existing structures.
Labels Do (Sometimes) Help
Now, I’ve given the psychiatric labelling system a good old kicking here, haven’t I? But it's important to be fair and acknowledge that for many, a diagnostic label, as imperfect as it is, has been a lifeline. It's not all bad; for some, it's been genuinely helpful, and we cannot ignore that reality.
I value knowing that I have long term Chronic Anxiety and long term Depression. But I value it as a means for me to communicate my needs and inabilities, as a starting point.
And, similarly, many individuals report immense relief and validation from receiving a diagnosis. Imagine struggling for years, feeling fundamentally "wrong" or "broken" without understanding why. Then, a label like ADHD, autism spectrum condition, or bipolar disorder comes along, and suddenly, there's a framework, a name for their experience. This can be profoundly validating. It can provide a sense of belonging, connecting individuals to communities of others with shared experiences, which can be incredibly empowering. It offers a language to explain their internal world, not just to themselves, but to family, friends, and colleagues. For some, it finally unlocks access to accommodations, specific treatments, and support services that significantly improve their quality of life – whether that's medication, therapy tailored to their needs, or adjustments in academic or work environments. To deny this positive impact for many would be disingenuous.
It's also worth acknowledging the genuine dilemma facing clinicians working within these imperfect systems. Many are deeply committed to human-centred care while navigating insurance requirements, legal frameworks, and the practical need for shared professional language. The problem isn't individual clinicians but the constraints of the systems they work within. Many already practice with a high degree of nuance and person-centred focus, striving to expand good practice.
Crisis Intervention
In acute crisis situations - psychotic episodes, imminent suicide risk, severe catatonia - rapid intervention trumps philosophical nuance. Diagnostic frameworks, however imperfect, can be literally life-saving tools for immediate decision-making. The goal isn't to eliminate these emergency protocols but to ensure they don't become the default lens for understanding all human distress. This is about ensuring safety and well-being in critical moments, complementing a broader, more nuanced approach to mental health.
This also relates strongly to neurodevelopmental perspectives. While I've critiqued the homogenising effect of "neurotypical," for many within the autism spectrum, ADHD, or other neurodivergent communities, labels have actually been empowering. These aren't necessarily trauma-based conditions but represent genuine, innate neurological differences in how brains process information, social cues, or sensory input. For many, a diagnosis provides not only validation ("Ah, so it's not a moral failing, it's just how my brain works!") but also a gateway to understanding themselves, connecting with a neurodivergent community, and advocating for necessary accommodations. It allows them to say, "This is who I am," rather than constantly striving to fit into a neurotypical mould that doesn't serve them. The problem, then, is not always the label itself, but the way society and the medical system apply, interpret, and stigmatise it.
Reclaiming Humanity
We’ve created these elaborate diagnostic frameworks, these neat little boxes, often for reasons of convenience, or perhaps a desperate human need to categorise the frighteningly unpredictable. But they’ve become shackles. They limit our empathy. They shut down understanding. They stifle individuality.
It’s time for a radical shift. It’s time we stopped judging people by how closely they adhere to or how far they are from some imaginary "normal" or "neurotypical" standard. It’s time we ceased to equate difference with disorder. It’s time we put down the labels and actually, truly, deeply listen to one another. This is about expanding good practice within mental health, not simply overturning it.
This is a call to:
Dimensional diagnoses: Stop locking people into yes/no boxes. See where someone sits on a spectrum of human experience, not if they're in or out of an arbitrary category.
Contextual interpretation: Swap "What's wrong with you?" for "What happened to you?" Ditch the moralising; start contextualising. Understand their history, their wiring, their environment.
Narrative over numbers: A life story speaks deeper, truer, and more helpfully than a checklist score. Value the richness of individual experience.
Empathy for complexity: Accept that emotional wiring varies wildly. Some feel things briefly, some deeply, some internally, some externally. All are valid. Remove the shame from silence, the absence of tears, or atypical expressions of emotion.
Stigma dismantling: A diagnosis shouldn't follow you like a scarlet letter, restricting your life, your work, your relationships. Labels should clarify, not condemn.
Nourish diversity: Stop punishing difference; start nourishing it. The richness of humanity lies in its infinite variations, not in its conformity to a prescribed ideal.
This shift requires practical changes: research funding for dimensional studies, insurance codes that reflect spectrums rather than categories, clinical training that emphasises individual narratives alongside symptom patterns, and public education about the complexity of human psychology. This is about evolving the system towards better, more humane practices.
Every single one of us is a complex, multi-layered being, a work in progress, often trying our very best to navigate a world that sometimes makes no sense. We all have our struggles, our hidden pains, our unique ways of expressing joy and sorrow. To reduce that infinite complexity to a dehumanising label – "psychopath," "narcissist" – isn't understanding. It's a failure of imagination. It's a failure of empathy. It's an act of control.
You’re not “toxic.” You’re a 3D being in a world that often only sees 2D. That’s not illness. That’s truth.
Let’s reclaim our narratives. Let the labels die. Let the stories live. Because when psychiatric labels fall, real humanity rises.
This isn't a one-size-fits-all solution. Some will find relief in traditional diagnoses, others in dimensional understanding, others in purely social or trauma frameworks. The goal is expanding options and reducing the harm of rigid categorisation, while maintaining the scaffolding that helps people access care and support.
And….this is also about making it clear that those out there who do use these labels, these definitions, these words without care, without understanding, to undermine, demean and disable, they are the ones making things worse for everyone (except, maybe, for themselves, of course….)