Systemic therapists can sometimes find themselves corralled by the seemingly inflexible psychiatric and mental health diagnoses presented by their clients. A conviction by the person showing the symptom and equal commitment to those surrounding them can result in a stilted and impoverished exchange that significantly reduces the information qualities of the system and possibility for new solutions to emerge. Carmen Garcia Perez De Leon (2025) has authored a paper ‘around our relationship with certain nomenclatures, diverting from the accepted definitions and providing an opportunity ‘to exercise our imagination’. She is not proposing that this approach is a better understanding than those of DSM-5 or the ICD-11 ‘but rather as a possible way to engage with the behavioural patterns that these descriptions are based upon’.
What is the Value?
Systemic therapists focus on the patterns which connect problems and symptoms to the wider family, social, community and political context in which they present. This would appear to be contradictory to traditional psychiatric diagnoses which traditionally locate symptoms inside the person who experiences them and view the world around them in terms of the impact of behaviour on the sufferer’s functioning. Family therapists have addressed this issue by expanding the frame to consider processes and relationships that form around the diagnosis and how these may contribute to exacerbating the difficulties. Exploring different perspectives of diagnoses may allow ‘systemic therapists to divert from oppressive or pathologizing uses of diagnoses, without negating its presence in the life of people attending therapy, at multiple contextual levels.’
Shedding a New Light on Diagnoses
The authors demonstrate their divergent thinking through the lenses of Tourette’s Syndrome, ADHD and ASD, Psychosis, Depression and OCD. For example, ADHD can be conceptualised futuristically as an indicator of changed physiognomies that are adaptive to a world of computers where capacity to ‘attend to several stimuli at once or to displace quickly one’s attention from one thing to another’ may be better suited to processing and responding to rapid information distributed on a screen than a world where information is presented more slowly.
Depression can be understood as protest and impotence in the face of a world that requires ‘overactivity and active desire for ever progressing improvement,’ while OCD provides the illusion of control in an uncertain world.
In Conclusion
While charming, interesting, and worthy of consideration, the paper fails to address a central issue for those working with clients experiencing major mental health issues who are engaged in the mental health system. Examples given by the author are disconnected from the rhetoric and understanding of treating professionals and the client leaving them at risk for finding themselves torn between two quite different understandings of their situation. Even if the practitioner does not explicitly articulate their ’divergent’ conceptualisation, it will inevitably inform their practice and there is a risk the client may feel forced to choose. Adding this layer of confusion to a person whose experiences are already different from others may add to their distress. Despite this, the authors musings are a rich vein for teachers and practitioners eager to explore more expansive and socially connected ways of thinking about mental health diagnoses that move beyond the individual and into the socio-political domain. The challenge is how to incorporate them safely and usefully into the therapeutic dialogue with our clients and others who are treating them.
Carmen Garcia Perez De Leon: Diversions-or a More Imaginative than Rigorous Take on Some Psychiatric Diagnoses Australian and New Zealand Journal of Family Therapy, 2025; 46: e70027 https://doi.org/10.1002/anzf.70027
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