Is diagnostics helpful?

More and more scientific insights show that mental distress cannot be captured in neat boxes. It is not a standardised clinical picture that you can tick off on a list. Every person in distress is so in their own way, interwoven with their life history, their social context and the events they have gone through. Yet we act as if that unique experience is an ‘entity’ that we can name: schizophrenia, bipolar, schizoaffective. As if there is an objective truth that we as professionals have to record. But that truth turns out not to exist at all.

What we really do is reduce. We take a complex, personal experience and turn it into a standardised illness. In doing so we move the conversation from the experience to the classification. And that is where it goes wrong.

We have unlearned how to really go towards the experience

Perhaps we have even become a little afraid of it. Because it takes courage, wonder and curiosity to sit down with someone and ask: what has happened? Not: what do you have? But: what does this experience mean for you? How does it relate to your life, your susceptibilities, your strengths? What does this pain show us about who you are and what you have gone through?

A more helpful approach begins with four fundamental questions:

1. What has happened? Which experiences, events or circumstances underlie this mental pain?
2. What place do we give this in your mix of susceptibilities and talents? Given your mix of susceptibilities and talents, how can we understand this experience?
3. What does this mean for your life? What do you want with your life, and how does this pain affect your way there?
4. What is needed? What does it ask of you, of the people around you and possibly of us, to take steps towards recovery?

Susceptibility-based diagnostics

We could speak of susceptibility-based diagnostics, and stop using diagnostics as a division into classes of illness. As Bill George of the Dutch association Anoiksis proposed: “let us replace those twenty different psychosis diagnoses with one clear term: psychosis susceptibility.” Everyone has it to some degree, but some run into it very hard. Then it is time to learn: how do I live with my susceptibility? How do I channel it, how do I give it a place?

In the same way we can speak of mood susceptibility, bipolar susceptibility, susceptibility to anxiety, susceptibility to addiction, or neurodiversity. Terms that are not illnesses, but invitations to understand, to search together and to support.

So let us reinvent diagnostics, not abolish it

No longer as an instrument of classification, but as a shared search. A bridge and not a stamp. From pain to meaning. From problem to perspective. From standard to unique. Because in the end that is where recovery begins: with really being seen.

Read more: Fewer diagnoses, more attention to care needs and Schizophrenia spectrum versus psychosis spectrum.

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

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Blogs by Jim van Os can be read here

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