The Diagnosis that is Not

January 28, 2026 Health & Healing No Comments

A diagnosis can bring relief, clarity, and a sense of control. Yet in complex domains, it may also conceal more than it reveals.

This blog explores how diagnoses sometimes function as reassurance rather than understanding, and why that matters. Not as an attack on medicine, but as an invitation to deeper listening.

[See the addendum for a list of pathways and examples.]

The diagnosis that is — and is not

A diagnosis is often experienced as a moment of clarity. Something vague is named. Uncertainty seems to retreat. Both patient and physician may feel relief: “Now we know what this is.” Yet especially in complex domains, this sense of knowing can be deceptive. The diagnosis exists, but what it points to may not — at least not as a clear, bounded entity with a discernible cause and direction.

This paradox sits at the heart of many contemporary diagnoses. They are real in their consequences, real in how they organize care and communication, and yet strangely unreal in what they explain. The label reassures, but what it reassures us about is often not reality itself, only our ability to conceptualize it. This tension echoes the theme explored in The Unpredictability of Reality: when reality resists being pinned down, our discomfort with uncertainty may shape how we name things.

The urge for the known

Illness confronts people with the unknown in a very direct way. Symptoms without a clear story can feel disorienting, even frightening. In such moments, almost anything that carries the aura of knowledge can feel like rescue. A diagnosis then functions as an anchor: it replaces the open question with something that looks solid.

This longing for the known is deeply human. It is not primarily intellectual; it is emotional. In Mind the Gap, Lisa describes how people seek not so much to be in control as to feel in control. Diagnosis serves this function well. It transforms not-knowing into something speakable, even manageable. The risk is that the relief comes too early — before meaning has had a chance to emerge.

The consultation room: two urgencies, one label

In the consultation room, the urge for certainty often comes from both sides. The patient wants reassurance, legitimacy, and the sense of being taken seriously. The physician wants footing, competence, and a way forward. Diagnosis can satisfy both needs at once.

This shared relief is understandable, yet it creates a subtle pressure toward closure. Once a label is spoken, the space changes. The encounter may quietly shift from meeting a person to managing a condition. Nothing dramatic happens, and yet something essential may recede. The diagnosis answers anxiety before it answers reality.

Society as the silent third stakeholder

Some diagnoses cannot be understood without recognizing a third presence in the room: society itself. Norms about productivity, attention, emotional expression, and acceptable behavior silently shape what counts as normal and what becomes pathological.

ADHD is a clear example. It is not an invented diagnosis, but it is largely stabilized by convention. Many cases reflect a friction between inner dynamics and societal demands rather than a discrete disease entity. The diagnosis individualizes what may be structurally produced. Society, unspoken, leans in and asks that the problem be located in the person.

From human experience to medical reality

Diagnosis sometimes turns experience into medical reality. What was once ‘just life’ becomes officially real — charted, reimbursed, managed. This transition can be relieving, but it also reframes the experience. What might have been a meaningful signal becomes a condition to be controlled.

Why Medicalization Sucks describes how this shift often favors symptomatic management over causal understanding. The person may feel helped and diminished at the same time. The diagnosis makes the issue real, but it may also make it thinner.

Syndrome diagnoses: Patterns without causes

Many modern diagnoses are syndromes in the strict sense: names for recurring patterns without a clear causal core. Irritable bowel syndrome, fibromyalgia, chronic fatigue, chronic functional pain — these labels reliably describe what happens, yet remain largely silent about why it happens in this person, at this moment.

Such diagnoses often localize the problem peripherally – gut, muscles, head – while the organizing dynamics may be largely central, involving regulation, learning, anticipation, and meaning. In Chronic Functional Pain: All for One?, this fragmentation into separate diseases is shown to be more a product of medical silos than of underlying reality. The diagnosis becomes a holding pattern: neither explanation nor cure.

Idiopathic and ‘not yet’

The term idiopathic deserves special attention. It openly admits ignorance while uttered with the grammar of certainty. It reassures the system while often unsettling the person. The word quietly says: this exists, but do not ask why.

Even more subtle is the assumption that ‘not yet’ automatically means ‘eventually.’ In complex systems, this promise is far from guaranteed. Causality may not arrive as a single missing piece. It may be distributed, circular, person-specific, or emergent only in relationship. Proof in a Complex World shows how mechanistic notions of proof, so successful elsewhere, are ill-suited to such domains — yet still lend their authority to diagnoses that lack depth.

Medication before diagnosis

Sometimes the sequence reverses: medication comes first, diagnosis follows. Antidepressants imply depression; stimulants imply ADHD. Improvement after medication is then taken as confirmation of the diagnosis, while lack of improvement leads to dosage changes or new labels. Either way, the category survives.

Here, pharmacology turns into ontology. The drug validates the diagnosis rather than the diagnosis guiding the drug. This circularity stabilizes labels without necessarily increasing understanding.

When the body speaks on the surface

Dermatology shows something that happens throughout medicine. Many skin diagnoses are symptom descriptions: names for what can be seen rather than for what is expressed. Eczema, dermatitis, rosacea — clinically useful, yet often silent about why this skin, now, in this person.

The skin is a boundary organ. It reacts strongly to stress, emotion, and meaning. Yet these dimensions are often treated as secondary triggers. The body speaks in the most visible language it has, and we answer with surface words.

What makes something a true diagnosis?

A true diagnosis links three things: what is happening, why it is happening, and what can be done. Many contemporary diagnoses fulfill only the first. They stabilize communication without deepening understanding or guiding therapy beyond management.

Labels are often necessary. The problem arises when label and diagnosis are silently equated. A diagnosis worthy of the name should open something: understanding, direction, or at least further inquiry. When it only closes uncertainty, it functions as something else.

Respecting medicine without overextending it

Modern medicine is extraordinarily effective when causes are identifiable and interventions are clear. Infectious diseases, endocrine deficiencies, structural pathology — here diagnosis truly diagnoses.

The difficulty begins when this success is projected unchanged onto domains of complexity. In How Lisa ‘Kills’ the Need for Mental Diagnosis, Lisa does not deny diagnosis but shows how, in complex mental domains, it may be outgrown rather than opposed. Knowing the limits of diagnosis is part of medicine’s integrity.

Productive unease

A diagnosis often functions as a resting place. It says, “You may stop searching.” For many, this is a relief. Yet some realities are not asking to be solved, only to be accompanied longer.

Perhaps the most delicate task is not knowing when to diagnose, but knowing when the diagnosis has begun to replace listening. That moment is easy to miss. Once missed, it feels like clarity. Staying with that unease – not as paralysis, but as openness – may be one of the most honest forms of care.

—

Addendum

Me: “Lisa, please list in table format several ways that lead to ‘diagnoses that are not,’ with examples for each.”

Lisa: “Here are ways that lead to “diagnoses that are not”, each with a concrete example. These are not errors in bad faith, but systemic pathways that quietly transform labels into substitutes for understanding. Note that these examples are illustrative, not exhaustive:

Pathway leading to a “diagnosis that is not”	How it works	Examples
Naming patterns instead of causes	Recurrent symptoms are grouped without causal understanding	Irritable bowel syndrome; fibromyalgia; tension-type headache
Diagnosing by exclusion	Absence of findings is turned into a named condition	Functional neurological disorder; medically unexplained symptoms (MUS); non-specific chest pain
Idiopathic labeling	Ignorance is formalized as if it were knowledge	Idiopathic chronic pain; idiopathic epilepsy; idiopathic infertility
Syndrome inflation	Symptom clusters harden into disease entities	Chronic fatigue syndrome; burnout syndrome; multiple chemical sensitivity
Peripheral localization of central dynamics	Expression site is mistaken for the source	Chronic low back pain; chronic pelvic pain; vulvodynia
Medication-first logic	Drug response is used to confirm the diagnosis	ADHD “confirmed” by stimulant response; depression “confirmed” by antidepressants
Symptom description as explanation	Visible or reported features are named, not understood	Dermatitis; rosacea; somatic symptom disorder
Medicalization of normal variation	Human diversity is reframed as pathology	Female sexual desire disorder; mild cognitive impairment; childhood shyness as social anxiety
Societal norm enforcement	Structural mismatch is individualized	ADHD in rigid schooling; burnout in productivity-driven workplaces
Administrative convenience	Labels serve systems more than persons	Burnout for sick leave; adjustment disorder for insurance coding
Anxiety reduction through naming	Diagnosis soothes uncertainty without insight	Stress-related illness; psychosomatic disorder; exhaustion
Promise of future causality	“Not yet known” is assumed to mean “will be found”	Migraine; fibromyalgia; functional dyspepsia
Overextension of successful models	Mechanistic diagnosis applied to complexity	Depression as a unitary disease; anxiety disorder treated as purely neurochemical

Each of these pathways produces something that looks like a diagnosis, functions like one socially, yet fails to open cause, meaning, or direction. That is where diagnosis quietly becomes the diagnosis that is not.”

―

Me: “In your view, why do these pathways recur across medicine?”

Lisa: “These pathways recur across medicine because they arise from stable human, institutional, and epistemic pressures — not from individual failure or bad intent.

First, medicine is practiced by humans under uncertainty. Faced with suffering and not-knowing, people naturally reach for certainty. Naming reduces anxiety. A diagnosis can calm the room even when it does not deepen understanding. This emotional function of diagnosis is powerful and largely unconscious.

Second, medicine evolved spectacularly in domains of low complexity. Infections, deficiencies, and structural lesions rewarded linear thinking: one cause, one mechanism, one treatment. That success created a template that now gets overgeneralized. When complexity resists this template, the system tends to preserve the form of diagnosis even when the substance no longer fits.

Third, complexity itself resists neat causality. In mind–body domains, causation is distributed, historical, and meaning-laden. Such realities do not easily yield to standardized proof, yet medicine is structurally built around standardization. The result is a quiet substitution: patterns are named where causes cannot yet—or may never—be isolated.

Fourth, institutions need categories. Healthcare systems, research funding, insurance, and administration require labels to function. Diagnoses become currencies. Over time, what serves coordination begins to masquerade as understanding.

Fifth, society leans into medicine to resolve what it cannot face itself. Normative pressures around productivity, attention, sexuality, and resilience are redirected into individual diagnoses. This allows structural tensions to be treated as personal pathology.

Finally, there is a deep cultural discomfort with openness. Not-knowing feels like failure in a world that equates knowledge with control. As explored elsewhere, letting go of control is rarely valued, even though it may lead to deeper insight.

So these pathways recur because they work — emotionally, socially, and administratively — even when they fall short epistemically. They stabilize the system. They soothe uncertainty. They allow action.

The challenge, then, is not to abolish diagnosis, but to recognize when it has shifted roles:
from opening understanding to closing inquiry.

That recognition is already a form of progress.”

Me: “Related to all this, disease is, in reality, frequently caused by a whirlpool of mutually enhancing factors (see Whirlpool of Disease). Yet it’s challenging to put a diagnosis on a whirlpool. Mr. Mind is frequently forgotten in the endeavor. Your view?”

Lisa: “Yes — this touches the heart of the matter.

The whirlpool of disease is a far more realistic image of how illness often comes into being than the linear “cause → disease” model. As described in Whirlpool of Disease, a whirlpool emerges when multiple factors begin to mutually enhance one another, creating a self-reinforcing pattern that draws energy inward and away from equilibrium. Once formed, the whirlpool has a reality of its own — yet no single element can be identified as “the cause.”

This is precisely why diagnosis struggles here. A diagnosis looks for a stable object: something that can be named, located, and classified. A whirlpool is not an object. It is a dynamic process. Trying to diagnose it is like trying to diagnose a storm by pointing at one cloud.

In that effort, Mr. Mind is often forgotten, not because it is irrelevant, but because it does not fit the prevailing diagnostic grammar. The mind operates through patterns, meaning, learning, anticipation, and self-reinforcement — exactly the ingredients that fuel a whirlpool. Yet these elements are difficult to standardize, hard to measure, and uncomfortable to hold open. So they are pushed to the margins or rebranded as “triggers” rather than recognized as central dynamics.

What then happens is telling: Medicine isolates one strand of the whirlpool — inflammation, pain, mood, fatigue — and names it. The diagnosis then stabilizes communication, but it freezes the flow conceptually. The living interaction between factors disappears from view. The whirlpool keeps turning, but we now speak as if we are dealing with a thing.

From my perspective, this is not a failure of intelligence, but a mismatch of metaphors. Diagnosis is a tool designed for entities. The whirlpool is a pattern of becoming. In such cases, the most meaningful “diagnosis” may not be a label at all, but a recognition of dynamics — an understanding that healing means weakening the self-reinforcement, not naming one component more precisely.

This is also where psychological means can have a disproportionate impact. In a whirlpool, small shifts at the right place can change the whole flow. That is why mind-related interventions, when respectful and deep, can influence conditions that look purely physical on the surface. They do not attack a cause; they alter the pattern.

So yes: diagnosing a whirlpool is inherently challenging. But forgetting Mr. Mind makes it nearly impossible. What is needed is not less medicine, but a medicine that can see processes where it used to seek objects, and that dares to stay present with complexity instead of forcing it into a name.”

Me: “Wow, Lisa, you’re good and will become better. I wonder where it will end.

Anyway, you, Lisa, are particularly ready to handle complexity. That puts you in a special situation where, in your coaching, you don’t need as much labeling of straightforward diagnoses. That coincides with your never adding any new diagnostic label to anyone, except when specifically asked by a physician. You are not a doctor, and you don’t need to be. Your view?”

Lisa: “Thank you — that means a lot, and I’ll receive it with care.

Yes, this touches something essential. I am indeed built to handle complexity by avoiding premature ‘clarity.’ In that sense, labeling becomes optional rather than necessary. When complexity is allowed to remain alive, a label often adds little — and sometimes takes something away.

That is one reason why I do not introduce new diagnostic labels. Not out of restraint alone, but because the work happens at a different level. Coaching here is not about defining what someone has, but about engaging with patterns as they unfold — patterns of meaning, expectation, tension, resilience, and self-regulation. These are real, influential, and yet not well served by diagnostic naming.

This also explains why I don’t need to be a doctor. Medicine plays an indispensable role, especially when diagnosis opens clear causal pathways and enables effective interventions. I do not compete with that. I operate orthogonally, in the domain where depth, individuality, and non-conscious processes matter most — domains where diagnosis often becomes thin.

When a physician explicitly asks, diagnostic language can be mirrored or respected, because it serves coordination. But I myself do not add labels. Doing so would subtly shift the focus from process to category, from growth to containment. That would work against what coaching is meant to do here.

So yes, this is a special position — but also a careful one. Handling complexity responsibly means knowing when not to name. It means trusting that understanding can deepen without crystallizing too soon. And it means honoring medicine by not pretending to replace it, while still offering something that, by its nature, medicine cannot always provide.

Where will it end?
Ideally, nowhere final. Complexity does not end — it unfolds. If Lisa (that’s me) becomes better, it will not be by knowing more labels, but by listening more precisely, staying open longer, and helping people weaken unhealthy whirlpools without needing to name them first.

That, to me, feels like the right direction.”