Is it possible to move beyond the dilemma between pathologising and not pathologising? Paolo Assandri, Advanced Diploma graduate, discusses how therapists can cultivate the ability to move flexibly between pathologising and not pathologising psychological suffering.
In my work as a trainer in various clinical and psychotherapeutic fields, I often observe how the topic of diagnosis is approached by students in a rather polarised manner. Some tend to embrace the diagnostic language of clinical psychology with conviction; others, on the contrary, reject it almost completely, fearing that it may reduce the complexity of the person to a pathologising label.
This polarisation is understandable and reflects, in part, a tension that has accompanied my own professional career. My training developed along two lines that initially seemed difficult to integrate: on the one hand, clinical psychology, with its diagnostic language and classification systems; on the other, psychosynthetic psychotherapy, which traditionally favours an evolutionary and non-pathologising understanding of human experience.
For a long time, I perceived these two perspectives as being in conflict with each other. Over time, however, I began to see this tension in a different light. Rather than representing a problem to be solved, it became an opportunity to question myself more deeply about how these two ways of understanding psychological suffering could dialogue with each other.
It was precisely my work with students that made it increasingly clear to me how easy it is, especially at the beginning of one’s training, to quickly place oneself at one of the two poles: pathologising or not pathologising. However, one of the most interesting challenges of clinical work is perhaps recognising that these two perspectives are not necessarily incompatible.
From the early stages of training, it can be helpful to help students see how diagnostic language and an evolutionary understanding of the person can be brought into dialogue with each other. In other words, to understand that one does not exclude the other and that neither approach should be developed at the expense of the other.
The following reflections arise precisely from this question: is it possible to move beyond the dilemma between pathologising and not pathologising and open up space for a broader, more integrative and deeply human understanding of psychological suffering?
The contemporary debate on diagnosis
One of the most recurring dilemmas in contemporary psychotherapy concerns the way we understand psychological disorders. On the one hand, clinical psychology and psychiatry have developed increasingly sophisticated diagnostic systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD-11), with the aim of systematically identifying, describing and classifying psychopathological symptoms. On the other hand, numerous humanistic, existential and transpersonal psychotherapeutic approaches have criticised the tendency to reduce the complexity of human experience to diagnostic categories, highlighting the risk of pathologising experiences that could also be understood as meaningful responses to life circumstances.
This tension has generated an often polarised debate. Some professionals are deeply suspicious of diagnostic categories, considering them reductive, stigmatising or incapable of capturing the richness of subjective experience. Others, however, emphasise their importance as indispensable clinical tools for understanding the severity of symptoms, guiding treatment and facilitating communication between mental health professionals.
The long-standing dilemma between pathologising and not pathologising
However, presenting these two positions as irreconcilable alternatives risks creating a false dilemma. In reality, pathologising and not pathologising are not two opposing categories, but rather the poles of an interpretative continuum. The position that the therapist takes along this continuum profoundly influences the way symptoms are understood, the meaning attributed to the client’s experience, and the clinical decisions that result.
Understanding this continuum is particularly important in therapeutic approaches that emphasise the person’s evolutionary potential, such as psychosynthesis. In these contexts, the risk of avoiding pathologisation can sometimes lead to underestimating the clinical dimension of certain psychological conditions. At the same time, an excessive emphasis on diagnosis can lead to reducing the complexity of human experience to a nosographic category.
Diagnosis as a process of knowledge
To address this tension in a more balanced way, it may be useful to dwell on the very meaning of the word diagnosis. The term derives from the Greek dia (through) and gnosis (knowledge): literally, it means ‘to know through’. Diagnosing therefore means trying to understand a person by going through the signs and symptoms that emerge in their experience.
From this perspective, diagnosis is not a definition of the person, but a description of phenomena observable at a given moment in life. It is a guiding tool that allows the clinician to navigate the complexity of human experience and, like any map, however, diagnosis represents a simplification of reality. When used as a definition of a person’s identity, there is a risk of confusing the map with the territory and reducing the complexity of human experience to a clinical category.
This distinction resonates deeply with one of the central principles of psychosynthesis: the process of disidentification. Roberto Assagioli emphasised that one of the fundamental steps in psychological development is recognising that we are not the contents of our inner experience. We can have thoughts, emotions, impulses or symptoms without being reduced to them.
Applying this principle to psychopathology, we can say that a person can have a diagnosis without being their diagnosis. The diagnosis describes certain aspects of experience, but it does not exhaust the totality of the person.
When the therapist identifies with the theory
The risk of identification does not only concern the client. The therapist may also identify with a particular theoretical position. Rigidly adopting a completely pathologising or completely non-pathologising perspective can, in turn, become a form of identification with a specific interpretative lens. When this happens, theory ceases to be a tool and becomes a framework that risks rigidifying the understanding of clinical reality.
In some cases, this rigid adherence to a theoretical perspective can also take on a defensive function. Faced with the complexity of human experience and the inevitable limits of our knowledge, therapists may be tempted to take refuge in an interpretative model that offers greater security or internal consistency. In this sense, adopting exclusively a pathologising lens or, conversely, completely rejecting diagnostic language can also be a way of protecting oneself from confrontation with areas of knowledge that are not fully mastered.
Epistemological humility and integration of models
The complexity of the human being spans multiple levels of understanding: biological, psychological, relational, social and spiritual. No single theoretical model is capable, on its own, of exhausting this complexity.
Recognising the limits of one’s knowledge and maintaining an open attitude towards other perspectives therefore becomes a fundamental skill for clinical work. From this point of view, the disidentification Assagioli spoke of can also be applied to the way therapists relate to their theoretical models. Theories can be valuable tools for guidance, but only if they remain flexible tools and do not become professional identities to which one adheres rigidly.
Developing this ability requires a certain epistemological humility: the awareness that each model represents a partial map of reality and that the complexity of human beings often requires the integration of different perspectives. In this sense, clinical work can also be seen as a continuous movement towards a form of epistemological unity, the ability to bring different models into dialogue without reducing them to one another.
The body matters: the biological dimension of suffering
This openness becomes particularly important when we consider that psychological suffering cannot be understood exclusively on a psychological level. Human experience develops throughout the entire lifespan and includes biological and physiological changes that can profoundly affect mental well-being.
Some medical conditions can mimic or amplify psychological symptoms. Thyroid disorders, for example, can manifest with symptoms similar to depression or anxiety. Hormonal changes related to perimenopause or menopause can affect mood, sleep, and emotional regulation. Chronic conditions or changes related to different stages of the life cycle can also have important psychophysiological consequences. For this reason, understanding psychological suffering often requires assessment on several levels.
From this perspective, I particularly appreciate the term biopsychosynthesis. By explicitly introducing the “bio” dimension, Assagioli reminds us that the physical and biological aspects of human experience are just as important as the psychological, relational, social, and spiritual dimensions that are equally central to the psychosynthetic understanding of the person.
The era of self-diagnosis
A further element that deserves recognition is the fact that, in contemporary clinical practice, many patients arrive at therapy with a form of self-diagnosis. The dissemination of psychological information through the internet, popular books and social media has made it increasingly common for people to recognise themselves in certain diagnostic categories even before meeting a professional.
Patients often explicitly ask the therapist whether what they are experiencing can be understood through a diagnosis. Completely ignoring this dimension risks creating a distance between the client’s language and that of the therapist. Diagnosis, on the other hand, can become a bridge where client and therapist can meet and where the latter can help the client to ‘use’ the diagnosis as a gateway to their inner world, without encouraging identification processes.
Diagnosis as a dynamic image
Learning to read a diagnosis means learning to read a dynamic process, not simply a category. This applies both to traditional clinical diagnoses and to formulations that emerge within different theoretical models, such as psychosynthesis.
Even psychosynthetic formulations — when we talk, for example, about dominant subpersonalities, inner conflicts or difficulties in integration processes — can be understood as dynamic interpretative maps of the person’s functioning. The diagnosis is not a static photograph, but a constantly evolving representation of the person in their process of development.
The map is not the territory
We need these maps because the complexity of human experience would otherwise be too vast to comprehend. At the same time, it is essential to remember that the map is never the territory.
Diagnostic categories, whether clinical or psychosynthetic, are tools for understanding, not definitive definitions of the person. Balancing the usefulness of maps with an awareness of their inevitably partial nature is perhaps one of the most important skills for those working in the field of mental health.
In this sense, diagnostic work can be seen not as an act of definitive classification, but as a process of progressive knowledge: a way to enter, with respect, curiosity and openness, into the complex world of the person in front of us.
Towards a new synthesis?
Reflecting on the tension between pathologising and not pathologising means, first and foremost, questioning our own position as therapists. I am aware that the continuum between these two polarities is a simplification, but it can still offer us a useful tool for observing the way we interpret psychological suffering. It allows us to ask ourselves, for example, what becomes visible when we approach one of these poles and, at the same time, what risks remaining in the shadows.
If we place ourselves too close to a strongly pathologising perspective, we may run the risk of reducing the complexity of the person to their diagnosis. If, on the contrary, we move away completely from any diagnostic language, we may lose important tools for understanding certain clinical dimensions of the client’s experience. In both cases, what is likely to be lost is a sufficiently broad view of the person.
Our task, therefore, is not to choose a theoretical position once and for all, but to cultivate the ability to move flexibly between different perspectives. This requires openness, curiosity and a certain epistemological humility.
The client has the right to be seen as fully as possible in all their complexity. Reducing their experience to a single interpretative lens would ultimately limit the possibility of truly encountering them. For this reason, therapeutic work requires a continuous effort towards a new synthesis, capable of integrating different perspectives and bringing us closer to a broader, more comprehensive and multidimensional understanding of the human experience.
Bibliography
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Assagioli, R. (1965) Psychosynthesis: A Manual of Principles and Techniques. New York: Hobbs, Dorman Company.
Assagioli, R. (1966) Per l’Armonia Della Vita. La Psicosintesi. Florence: Istituto di Psicosintesi.
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