Why I Don’t Diagnose Psychiatric Disorders in My Practice
Mental health struggles are real. People suffer from overwhelming sadness, fear, stress, and intrusive thoughts every day.
But here’s the question: Does labeling these struggles as “disorders” actually help?
In my practice, I choose not to diagnose psychiatric conditions using the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the book most mental health providers use to classify psychiatric conditions.
And before you jump to conclusions, let me be clear:
I’m not saying mental health challenges don’t exist.
I’m not saying people don’t suffer.
I’m not saying these experiences aren’t real.
What I am saying is that the DSM—and the labels it creates—don’t actually tell us what’s happening inside a person’s mind or body. And in many cases, the diagnosis itself doesn’t change how we approach treatment.
Why Don’t I Use the DSM?
Most people assume psychiatric diagnoses are like medical diagnoses—that if you “have” depression, it’s like having diabetes or pneumonia.
But that’s not how the DSM works.
Even the most recent version (DSM-5-TR, 2022) states:
“Since a complete description of the underlying pathological processes is not possible for most mental disorders, it is important to emphasize that the current diagnostic criteria are the best available description of how mental disorders are expressed and can be recognized by trained clinicians.”[1]
Translation?
We don’t actually know what causes most psychiatric conditions.
The DSM is just a collection of symptom checklists, not a guide to disease mechanisms.
Compare that to a medical diagnosis.
If someone comes in with shortness of breath, my job is to figure out whether they have:
A pulmonary embolism (life-threatening clot)
Pneumonia (infection)
Heart failure (fluid overload)
COPD or asthma (airway issues)
Or something else entirely
The diagnosis tells me what’s happening at a biological level, so I know exactly how to treat it.
But DSM diagnoses don’t do this.
If I say someone has Generalized Anxiety Disorder, what does that tell me?
It doesn’t tell me why they feel anxious.
It doesn’t tell me what’s happening in their brain or body.
It doesn’t tell me whether the cause is stress, trauma, lifestyle, or something else entirely.
It’s just a label—one that doesn’t explain the actual problem.
The DSM Was Designed for Billing, Not Better Treatment
Most people don’t realize that psychiatric diagnoses became standardized partly because of insurance billing [2].
In order for a provider to be reimbursed for mental health services, they need an ICD (International Classification of Disease) code. The DSM provides these codes so insurance companies will pay for treatment.
That’s fine if you bill insurance.
But I don’t.
I run a direct primary care practice, where my patients pay a monthly membership fee that covers all their visits. Since I don’t need diagnostic codes to get paid, I have no reason to rely on DSM classifications.
What About Research? Doesn’t That Prove These Are Real Diseases?
One of the most common arguments for DSM diagnoses is that scientific research shows brain changes in people with depression and anxiety.
Here’s the problem with that argument:
Most psychiatric research selects participants using DSM criteria.
That means any brain differences they find are already shaped by DSM definitions.
So when researchers say “We found brain changes in depression,” they really mean “We found changes in people who fit the DSM checklist for depression.”
And there’s another issue:
Most of these studies focus on functional brain imaging (fMRI, PET scans), which measure activity levels—not structural damage.
We already know that thought patterns, habits, and behaviors physically change the brain over time.
For example:
London taxi drivers have larger hippocampi due to years of memorizing complex routes [3].
Meditators show increased prefrontal cortex thickness because of mindfulness training [4].
Chronic worriers show heightened amygdala activity—but that doesn’t mean they have a brain disease [5].
So when studies show heightened amygdala activity in anxious people, is that proof of a disorder?
Or is it just the natural result of chronic stress and negative thought patterns?
The DSM doesn’t answer that question.
Psychiatric Diagnoses Depend on Culture, Not Biology
The DSM itself states that what we consider a disorder depends on cultural norms.
In its most recent edition, it says:
“The boundaries between normality and pathology vary across cultural contexts for specific types of behavior. The threshold of tolerance for specific symptoms or behaviors differs across cultural contexts, social settings, and families.” [1]
Think about what that means.
If you break your leg, it’s broken whether you’re in New York, Tokyo, or rural Kenya.
If you have diabetes, it exists regardless of your culture, social class, or upbringing.
But according to the DSM, whether or not you have a mental disorder depends on cultural expectations and social settings.
That doesn’t mean people don’t suffer.
That doesn’t mean their experiences aren’t real.
It just means that these diagnoses are human-made constructs, not fixed biological diseases.
So What Do I Do Instead?
I see patients every day who feel trapped in cycles of fear, stress, sadness, and self-doubt. Some are paralyzed by anxiety. Others feel numb and hopeless.
But instead of handing them a label and calling it a day, I focus on:
✔ Understanding their story—where they come from, what they value, and how they see the world.
✔ Identifying thought patterns, behaviors, and lifestyle factors that contribute to their distress.
✔ Helping them build strategies to change the way they interact with their emotions and environment.
Some people feel validated by a DSM diagnosis, and I respect that.
But I also believe that a diagnosis shouldn’t make you feel powerless.
Mental health struggles are not fixed diseases inside of you.
They are experiences—experiences that can change.
That’s why I don’t use DSM diagnoses.
Because I believe people are more than a label.
Final Thoughts
If you’re struggling with your mental health, you don’t need a label to validate your experience.
What you need is someone who will listen to your story, help you understand what’s happening, and guide you toward healing.
And you don’t HAVE depression.
You don’t HAVE anxiety.
You’re experiencing them.
And experiences can change 😊
Like This Perspective? Let’s Talk.
If this resonates with you and you want a different kind of healthcare experience, I invite you to learn more about my practice.
Fill out the contact form or text me directly at (910) 758-1769
Your mental health journey doesn’t have to start with a label. It starts with a conversation.
