I have a mixed bag of feelings and thoughts around mental health diagnoses.

I detest almost all of them for many reasons, which are probably too

much for this podcast episode alone.

Like how utterly subjective they are and how pretty much anyone can

fit into some kind of diagnosis.

These are major problems.

But in this episode, I'll focus on how a diagnosis, whether from a licensed

expert or a self-diagnosis may be part of the problem that a therapy client

is seeking help for in the first place.

Hi, I am Justin Sunseri, and this is Stuck Not Broken.

I'm really glad you're here with me.

Welcome.

This is not therapy or life advice, by the way.

Oh, and I, I am a therapist and, and a coach.

Um, so I'm bringing a lot of my own, um, personal experience when it comes

to working with clients to this.

Uh, we'll, we'll do a thought experiment though, and we'll,

we will imagine two clients.

The first client, Penny, comes to therapy because she's feeling heavy, not finding

enjoyment in things she used to enjoy.

She lacks energy.

She has thoughts of self-harm, and she spends a lot of time alone.

The second client, Milton, comes to therapy for the exact same reasons,

feeling heavy, not finding enjoyment in things he used to enjoy, lacking

energy has thoughts of self harm and spends a lot of time alone.

Penny and Milton are both desperate for change.

They are both serious about therapy and they both think that

something's wrong with them.

They keep thinking, I wish I were normal.

They long to be like other people who seem to have everything together.

And they both assume that they're going to receive a diagnosis

and finally get an answer to why they are the way that they are.

The difference between Milton and Penny lies in who they see for therapy, in

the diagnosis that they receive, and what they can do with that information.

It's a big difference.

Penny's therapist hears Penny's presenting problems and history and labels Penny

with the words major depressive disorder.

Penny's Therapist believes she has a mental disorder and Penny

believes her therapist because after all, the therapist is the expert.

Penny's therapist tells her she's going to need to manage this mental health disorder

probably for the rest of her life.

She should probably get on medication soon and they review a list of coping

skills, uh, that anyone could probably find on the internet with a simple search.

Penny asks, "How did I get this way?" And the therapist mutters something about

brain chemicals, or some people are just, uh, simply born this way for some reason.

Milton's therapist hears Milton's presenting problems and history

and does not label Milton.

Milton is shocked.

He protests to his therapist, "But I feel heavy.

I don't en, I don't find enjoyment in things I used to enjoy.

I lack energy.

I have thoughts of self-harm and I spend a lot of time alone."

Milton's therapist responds.

"Right, that that's all true.

Those are a list of some of your experiences.

We could acknowledge those and we can normalize them.

They make sense based on your life context, the events, the

people, the things in your life.

Would you agree with that?

If somebody else had your life and lived through what you've lived

through and we're still dealing with the things that you're dealing

with, they would also likely live with the heaviness and the lack of

enjoyment and, and whatnot, right?"

And so Milton says, "If someone else had my life?

Yeah, probably.

Um, but what diagnosis do I have?

What's my problem?

My, my what's my mental illness?"

Milton's therapist smiles.

I understand what you're asking.

And if you want me to give you a label, I'm sure we could find a

couple of labels, but, but then what?

What do you do with that label?"

Milton says, "Well, then I would have an answer for why I am the way that I am."

"Would you though?" This therapist responds.

"What would that tell you?"

"That I'm depressed! That there's something wrong with me."

Milton's therapist explains that a diagnosis is a label for a

set of behaviors and thoughts that often occur together.

These labels are contained in a book called the DSM.

The labels in the DSM book were created by a committee that voted on what

should or should not be included.

Labels come and or can come and go and have come and gone,

uh, based on cultural tides.

And there's no explanation within this book of why someone would

have the collection of behaviors and thoughts and feelings.

The book only says that they do have them and then gives them a label.

The DSM collects these things and gives them a name, a label.

That's really it.

The therapist says, "If I gave you a diagnosis, it's not like I'm extracting

your brain chemicals or blood and doing a test and then diagnosing you.

I'm not doing x-rays or anything.

No MRIs, no CT scans.

There's no like test in that way.

It's, you know, it's just me giving you a label based on what you're telling me.

And if you went to another therapist, they would also just give you a label.

And there's a really good chance that it would be a different one than me,

or maybe they would give you the same one as me or a different one, and then

another label on top of it, like ADHD, which pretty much everyone who comes

into my office seems to have these days.

Okay, so fine.

Um, "What's wrong with me then?" Milton asks.

"What's wrong with you?" says the therapist.

"Nothing's wrong with you."

" I am not here for no reason," Milton says.

And the therapist says, "Of course not.

You're here because of heaviness and thoughts of death and lack of energy.

I, I get it, but nothing's wrong with you.

I think there are things you'd like to change.

Yeah, sure.

You're not happy with your life at all.

You don't want to have those thoughts and feelings.

I, I get it and I'm, I'm glad you're here and we can work on that.

But as we agreed before, the things that you're here for are a normal and expected

result of your life context, and, and anybody else would probably live with the

same experiences if they had your life.

Right?"

Milton says, yeah.

So when he's, he's, of course, he's unsure of what to do with that information.

"Well, since we know what you're going through and we know it makes

sense, you're going through it, let's, let's give you permission to

have these experiences. Let's not fight it. Let's pay attention to it."

" Pay attention to it?!

But then I'll spiral out of control and these things are, will get even worse."

"Yeah, probably if we did nothing different, your experiences would,

would get worse." The therapist agrees.

"So let's do things differently."

"Well, differently how?" asks Milton.

The therapist says, "If I asked you right now to pay attention to your

feelings, it would probably be too much,

so I won't do that.

But we know what your feelings are already and we know that they're

normal based on your life context.

You know, we agreed on that.

So let's give them permission to be there.

Let's not reject them."

Milton cautiously agrees.

"Now I'll take things in a different direction instead of rejecting your

emotions and your feelings and your thoughts, um, let's let him be there and

I'll ask you, how are you breathing?"

Milton and shrugs and says he's breathing normally.

The therapist asks, "Okay, but um, are you breathing into your chest or your

belly? Is it full or is it shallow? Is it tense or is it relaxed?" Milton

says he's breathing into his belly.

It's shallow with some tension.

The therapist leads Milton through a really simple practice, paying attention

to what he sees outside the window, what he hears in the immediate space in the

room, and checking his breath again.

After a few minutes of this really simple mindfulness practice, Milton notices

that his breath feels fuller and more relaxed, and it's still into his belly.

His belly is expanding.

He feels more grounded than he was before, and then he has in a long time.

" Do you remember when I said we need to give your feelings permission to be?

That we should pay attention to them instead of rejecting

them?" And Mil- Milton, uh, does indeed confirm he remembers that.

"Right now in this moment, as you feel this level of connection, are you

open to paying attention to your other feelings, the ones that bring you here?"

Milton says that, yeah, he is.

The therapist helps him identify where the heaviness lives in the body.

Milton says it feels heavy all over, like he's being pulled

down, just weighted down.

It's a very lonely existence, he says, like he's in a dark cave and, and no one

will bother even looking his direction.

The therapist leads Milton again through connecting with the world around him,

looking out the window, listening to the world around him in the, or at least in

the little room, checking his breath.

"So how's that heavy feeling now?"

Milton says it's still there, but less, and he has a puzzled look on his face.

This is different.

The therapist says, do you see how this works?

And Milton nods, he's kind of getting it.

"We don't reject how we feel. We don't try to banish or, or get

rid of it. We acknowledge our experiences and we balance them with

connecting to the present moment."

"I get it," says Milton.

"I think it's gonna take practice, but I, I get it. This is, this is different."

"Yeah, it, it definitely takes practice. We're never quite done

with it," the therapist says.

"There is some benefit to using simple skills like this to

reduce uncomfortable feelings.

Um, but there's a bigger benefit when you use these skills proactively on purpose,

like part of a daily ritual, maybe.

We can take this little practice that we did here and we can extend

it, we can deepen it, but we we'll hold, hold off on for say, let's go

back to the question of a diagnosis.

Yeah.

You probably meet the criteria to be diagnosed with Major Depressive Disorder.

So what?

What does that do?

Milton says, "I thought it would gimme an answer, but maybe not so

much. So I don't have a chemical imbalance of serotonin something

or other, a dopamine this or that?"

The therapist says, "I have no idea.

I can't tell you that.

But I can tell you that I meet with many, many people who come into this

very office, sit where you sit for the same reasons as you and other ones.

And I can give them the same diagnosis.

When these clients begin to pay attention to the present moment,

though, and to their emotions, even the uncomfortable ones, things tend to change.

To get better.

Of course, I, I can't guarantee that.

And if you really want to talk with a psychiatrist about it, I'm happy to

connect you with someone that, that I think acts very ethically and isn't

quick to just, dispense medication after talking with you for 15 minutes."

Okay, dear listener, we'll stop our little story here.

Obviously, I'm giving you two very different examples on purpose.

I'm trying to illustrate something.

Penny's example leans much more toward like a negative experience, right?

And to you might be, well that's extreme.

That's obviously just concocted, but it's really not.

This is a very, Penny's is a very, very realistic expectation

or reflection of therapy in 2026.

I hear it from clients all the time.

Milton's example is a very realistic reflection of very common

dialogues between clients and me.

I had the same conversation with someone just a couple days ago.

Of course, there's a huge gray area and there are tons of therapists

out there who can label and still provide great treatment.

I hope you have one, or I hope that you are one.

But, um, let's focus on the differences be between Penny and Milton, and try to focus

on especially the diagnosis part of it.

A diagnosis is a shorthand way of expressing a cluster of

behaviors or thoughts or emotions.

It's professional quasi medical terminology intended for professionals

to use amongst themselves.

That's really it, even though diagnosis and our understanding of it has ballooned

into something else entirely, especially in, uh, non-professional settings.

But essentially since the first DSM in 1952, its purpose has been to create

a shared language among professionals.

For example, imagine I had to talk to a colleague without having

a label, a diagnostic label.

I would say, "Hey, therapeutic colleague.

I need to consult about a client who has excessive anxiety and worry about

a- a variety of topics, events, or activities that occurs more often,

not than not for at least six months, and is clearly excessive and the worry

is experienced as very challenging to control, and the anxiety and worry

are accompanied by edginess, tiring easily, and impaired concentration."

Huh?

That is a lot to say, right?

So instead of saying all that, I would just say, "Hey, therapeutic colleague.

I need to consult about a client who meets the criteria for generalized

anxiety disorder." Much simpler, right?

I wouldn't say with a client who has generalized anxiety disorder, I would

say they meet the criteria for it.

So diagnosis is a label, a naming device for professionals, not an explanation.

Diagnoses carry.

Almost no explanatory power.

PTSD might be the exception, at least the one that comes to mind right now.

They focus on the presenting concerns that commonly occur together and

then group them under a label.

That's a diagnosis.

Diagnoses also lack foresight.

They can't tell what's gonna happen next.

For example, in Penny's case, uh, she would be labeled as

depressed, major depressive disorder probably, and that's kind of it.

But in Milton's case, the therapist is looking through a much different lens.

That therapist does not see Milton as having a mental illness or

mental virus, or an affliction or a disorder of any kind.

He sees Milton first off as.

A result of his life context, but also in the present moment, he sees

Milton through a lens of the nervous system and he can anticipate Milton's

current needs and what will come next.

As somebody in Milton's state recovers, which is probably a

collapsed shutdown state, they will likely experience increased mobility.

So that therapist will be able to work with Milton to monitor any increased

mobilization to normalize it and even encourage it in productive ways.

Milton's therapist will recognize when mobilization shows up in a

regulated and unregulated way, and then adjust the homework and the

treatment plan along with Milton.

Milton's therapist will recognize irritation, for example, as a positive

sign and will know that Milton needs to focus probably a little bit more

on safety practices to, or those present moment practices to balance the

irritation and also work with Milton on an avenue for his irritation, like more

physical movements or creative outlets.

But all, all of what's happening within Milton is understood and expected.

Penny's therapists will look at the irritation and think

things are maybe getting worse.

They will encourage Penny to cope through distraction as a way to get their mind

off of irritating things, or maybe encourage Penny to think more positively

or do a gratitude journal or something.

Penny's therapist can't anticipate what the next phase

of change is gonna look like.

That therapist will only add friction to the process of recovery 'cause

they only see Penny as the diagnosis.

Another issue regarding and, and a non temporary diagnosis.

But another issue regarding diagnosis is its impact on the client.

Penny got her answer, and that's kind of it.

They'll do some coping and management skills and talk

about the week over and over.

Uh, maybe they'll discuss childhood and family issues, but Penny and her

therapist will forever look at this as an affliction that Penny has.

Something to manage, something affecting Penny.

Milton and his therapist have a different view.

They see Milton's presenting problems as temporary instead of merely coping

and managing, this therapist who is again looking through a a nervous

system lens, is gonna address Milton's underlying baseline state and help

him shift it through proactive skills.

There's much more hope in Milton's scenario.

Penny believes something's wrong with her.

She'll leave therapy with the belief that she's inherently depressed.

She will feel the heaviness and sadness and isolate herself, and she'll

say, this is my depression again.

She'll reject those experiences.

She'll wish for them to go away.

She'll shame herself for not getting better, not being normal,

and maybe forever be stuck.

In her state.

I know this sounds like the extreme, but it's not.

You might be living with this today.

Milton believes he's temporarily in this state.

He'll leave therapy with a new way of understanding himself and with

more hope that things can change.

When he feels the heaviness and the sadness and when he

wants to isolate himself.

He still won't like it, but he's more likely to be curious about it.

And not reject it.

He's more likely to balance these experiences with present moment

mindfulness and other skills He'll learn through therapy.

He's less likely to reject his experiences, more likely to

embrace them and balance them out.

And as he does, he'll begin to make changes at a deep nervous

system level and he, and he and his therapist will know what comes next.

Milton and his therapist will find ways that Milton can proactively

improve his presenting problems.

Not only reactively manage them.

But they could do that too.

So look, I don't know you, dear listener, and I don't know your diagnosis.

They're not all equal.

Things like depression and anxiety.

ADHD, OCD, panic, PTSD, these are very treatable.

Because the underlying nervous system states is very changeable.

Someone who's diagnosed with, uh, ADHD for example, can eventually

get to a place where that diagnosis is no longer relevant.

It doesn't have to be a lifelong label.

Same with depression, same with anxiety and on, and.

I'm not telling you to disregard your diagnosis.

It plays a role, but it's, it's not limiting.

I hope you don't view it that way.

It's, it's just a label.

The word, I mean, the word is a label.

The experiences you have are real.

It's okay to acknowledge that and to treat it with respect.

And your current experiences probably make sense in light

of present and past context.

It's okay to acknowledge and to respect that as well.

But change is possible.

And it starts maybe with a curiosity, being a little bit more curious,

not a, not with a label, not an answer, that someone else gives you.

Curiosity about your own experience and what your nervous system

might be trying to tell you.

But look like discard the nervous system framework.

You don't even need that.

Your emotions that you're struggling with aren't just things in your brain, right?

You feel them.

You feel them in your body or at at least if you're paying attention enough, you do.

A lot of times we're unaware of what's happening from the neck down.

So if you can try and be a bit more curious about what's

happening in your body.

Where are your emotions showing up?

Where's the tension held?

Where do you feel heaviness?

What does your body need?

Does it need quiet or does it need lowered lights?

Does it need sunlight and space, maybe?

A diagnosis, labels where you are.

It was never meant to tell you who you are or what your

potential is now or in the future.

I'm inviting you to rethink what a diagnosis is in the role

that it plays in your life.

And if you're a provider, someone who has the power to label.

I invite you to rethink how you're thinking about diagnosing and how

that affects what you think your client's potential for change is.

I'm not making this stuff up.

This is exactly what I do for a living with my clients in therapy.

They come in and yeah, they easily meet the criteria for this

and that and the other thing.

Some want a diagno- a diagnosis, some don't.

Uh, regardless, uh, change is possible.

And we don't lose sight of that.

There are many, many ways to spend more time on this stuff at all.

Price points from the free, Mindful Moment get togethers that I host virtually to

my books, to working with me one-on-one.

Every option that I have to deepen your learning and your practice is

listed stucknotbroken.com/start.

Stucknotbroken.com/start.

Thank you so much for joining me in this episode.

Bye.

This, another content I create is not therapy, not intended to be therapy

or be a replacement for therapy.

Nothing in this creates or indicates a therapeutic relationship.

Please consult with your therapist or speak for one in your area if you're

experiencing mental health symptoms.

Nothing should be construed to be specific life advice.

It is for educational and entertainment purposes only.