Gnosis and Diagnosis
Many of my patients have been given a psychiatric diagnosis of ADHD; by that I mean that a psychiatrist gave them this label, I did not, and do not give out diagnoses. Some treat this diagnosis as if it were an accomplishment, even as a kind of conversion experience: whereas life before diagnosis was chaotic and confusing, full of emotional outburst, life after diagnosis is explicable and known, bounded by the identity of the diagnosis, plus now with the steady drip of pharma. The diagnosis organizes their world in a way that is highly useful, if not downright revelatory; the diagnosis is an epiphany and a container; + Adderall.
The recent popular term neurodivergent is regularly used as a blanket diagnosis covering ADHD, PTSD, anxiety disorder and autism spectrum. One of my ADHD patients has referred to this neurodivergent group, of which he counts himself a member, as spicybrains. This is a term of endearment. In the popular imagination spicybrains get things done. Here we can see how even a playful diagnosis can resolve behavior, that once may have been termed a disability or a pathology, into a special-ability and a gift. See for example the engaging and highly weird podcast The Telepathy Tapes regarding the telepathic powers of autistic persons.
As with any container the diagnosis likewise functions as a defense. When confronted by their own inscrutable behavior, the patient can relay blame to the diagnosis. “Oh don’t mind me, that’s just my spicybrains.” Much of the diagnostic container, as we know it today, is built from the cognitive behavioral idea that one’s abnormal behavior is determined in advance by abnormal neurology—all those spicy neurons. The symptoms do not have an emotional cause, but a chemical one, maybe even a genetic cause: “oh that’s not me, that’s just my biological destiny.” Naturally, if it has a chemical cause, then it must have a chemical fix—for which big-pharma can charge a premium.
And yet it is the occult nature of the psyche to outpace diagnosis. That’s why the DSM periodically requires new editions. Certain diagnoses go in and out of fashion: every generation requires a new name for life after war, whether war-neuroses, shell-shock, or PTSD.
On the one hand, we can see how the power of diagnosis to contain emotional distress is without question. And on the other hand the desire for diagnosis is itself symptomatic of our mania for knowledge. The diagnosis is the tool-end of a hegemonic system of discourse complete with a metaphysics, symptomatology, insurance codes, membership and belonging, political-economy, treatment regimens and pharmaceutical solutions.
Following the position of my school I remain indifferent to my patient’s diagnoses, I neither confirm nor deny them; they are points of departure for discussion. As I’ve written about before on this channel, I think that the DSM V has more in common with a Dungeon Master’s guide to Dungeons and Dragons, than to any kind of hard-science document. In other words: the diagnosis of mental phenomena always includes a certain amount of fantasy. In the last analysis there may be something more true in the designation spicybrains than ADHD.
I am struck just now by how the word Diagnosis has the word Gnosis tucked away secretly inside of it. I say secretly because I only noticed this right now while writing this essay. Gnosis means knowledge, but it is also an ancient and esoteric means of transcending to higher worlds. If I were to offer a working definition of gnosis, in its gnostic (and diagnostic) register, it would be: knowledge that changes your life. According to the gnostic imagination, gnosis is the triumph of mind over matter; reality is determined by knowledge and not, as science would have it, the other way around. As you can well imagine such a claim has rather far-reaching psychological implications that demand further exploration. But suffice to say that, like the gnostic recognition of your own divinity, the diagnosis of spicybrains, for better or worse, offers an entire platform for living.
