I can see I'm just going to have to work my way through reading your entire stack, Michael, with the slowness and purpose it deserves. You've distilled down and presented what I believe to be the truth of the psychology-science illusion, a pretending at absolute truth. I'm a psychotherapist and psych assessor, with a particular interest in neurodiversity and some experience in research (though not in the neurodiversity field). If am keen to contribute where I can. For now, I will simply say that your critique of the field (and your acknowledgement of where current diagnostic frameworks are useful, albeit limited and blunt) appears pretty sound to me.
As an aside, I much prefer using the PDM (Psychodynamic Diagnostic Manual) to the DSM for my assessment work, because it includes (where possible) internal experience as more or less the core defining feature of a given diagnosis. There are also plenty of 'UNKNOWN' entries where the internal experience or contributing maturational patterns are not well understood. I shall have to remind myself what it has to say about autism when I am next in my office ... probably not a lot, but I still find an honest admission of "we don't really know that yet" more compelling than a behavioural label.
Thank you so much for this, Skye. Your comment genuinely means more than I can properly express—especially coming from someone actively working in assessment and therapy. The fact that you not only resonated with this but also brought in your own experience with the PDM (which I have a lot of respect for) really affirms the kind of structural shift I’m hoping to help make space for.
I couldn’t agree more about the value of acknowledging what we don’t yet understand—especially in contrast to the false certainty of behavioral labels. That humility, to me, is the beginning of real alignment with those we’re trying to understand, not a limitation.
If you ever feel compelled to share more—especially around how you use the PDM or how you’ve approached assessment with neurodivergent clients—I’d love to hear it. There’s a lot of room for this conversation to grow.
Thanks again for taking the time—and for the kindness in your words.
I'm always happy to share my experience, one of the real challenges in getting at a useful understanding of different ways of experiencing the world is the way in which each field tends to have a particular framework and agenda and they don't tend to really "talk" to one another. Which brings me to diagnosis in my line of work. The PDM is written mainly for psychotherapists and psychoanalysts, who (speaking really generally) are most interested in making links between past and present and how someone has learned to manage their suffering. So it's got a heavy focus on this, and I can't imagine there's much that's really detailed around ASD in there because it's not something we are really entrusted to be thought leaders around.
There are a few scenarios in my line of work (I primarily see people who have experienced serious trauma) where I am required to "refer up" for diagnosis to a psychiatrist. So if I begin working with someone with ASD, the diagnosis part of the process happens elsewhere (though I am lucky enough to work with some very good and open-minded psychiatrists, so I get some useful insight and input into the process).
The way in which I practice generally involves as little assumption as possible that I understand anything about what it is like to be in this person's mind and I find this really useful in working with different neurotypes. My own neurodiversity means I have never taken it for granted that I think or feel the same as others, so that's a bonus!
The framework of diagnosis gives a useful guide about possibilities, and what might be helpful, but I am of the mind that the more we lean on it the more is lost of that particular individual's experience. It's a tricky tension to hold (with the added complexity that we need to do the diagnostic bit for insurance/funding purposes).
I am looking forward to when I can next visit the university library to try and access more research on the internal experience of autism (I'm very interested in the papers you refer to). It strikes me that it's very difficult to capture not only because of the deficit lens but because (1) it's so impossible for someone to explain what it's like to be them, because it's all they know, how does a fish explain what water is, and (2) the entire way in which research is collected, collated, presented and understood is a neurotypical framework.
I really appreciate how openly you’re thinking through all of this—and especially how intentionally you’re holding that tension between diagnostic necessity and individual experience. That’s such a delicate balance, and the way you describe your practice speaks volumes about your integrity and attunement.
Your fish analogy is spot on, of course. It’s such a powerful way to frame the limits of internal explanation. And it’s had me thinking—clients absolutely shouldn’t be expected to explain the “water” they live in, especially when language itself often falls short. But I keep coming back to how much more effective therapy could be—especially for neurodivergent clients—if we had a framework that wasn’t just trying to decode behavior but genuinely bridge communication mismatch. One that broadens the lens not just diagnostically, but empathically and cognitively.
Not as a list of shoulds—but as a shared possibility. A way to expand how we relate to each other.
And at risk of sounding like an infomercial for my model—that’s really what I’m trying to do here. To share more of our (ND) perspectives with the world, to move away from deficit-based pathology and reframe our experiences in a way that positions us on equal cognitive footing. That actually demonstrates why the field is getting this wrong, and how much harm that misalignment continues to cause.
The irony here, of course, is that your practice—deeply attuned, humble, and person-centered—ends up treated as secondary to formal diagnostics, when in reality it’s far more validating for actual people. And that’s exactly the kind of shift I want to help support.
Thanks again for your honesty, curiosity, and presence in this conversation—it genuinely means a lot.
It’s statistics as proof, but the nuances of human behavior can’t be explained by numbers. We aren’t cells on a spreadsheet.
Statistics as proof is perhaps a little generous. But agreed.
I can see I'm just going to have to work my way through reading your entire stack, Michael, with the slowness and purpose it deserves. You've distilled down and presented what I believe to be the truth of the psychology-science illusion, a pretending at absolute truth. I'm a psychotherapist and psych assessor, with a particular interest in neurodiversity and some experience in research (though not in the neurodiversity field). If am keen to contribute where I can. For now, I will simply say that your critique of the field (and your acknowledgement of where current diagnostic frameworks are useful, albeit limited and blunt) appears pretty sound to me.
As an aside, I much prefer using the PDM (Psychodynamic Diagnostic Manual) to the DSM for my assessment work, because it includes (where possible) internal experience as more or less the core defining feature of a given diagnosis. There are also plenty of 'UNKNOWN' entries where the internal experience or contributing maturational patterns are not well understood. I shall have to remind myself what it has to say about autism when I am next in my office ... probably not a lot, but I still find an honest admission of "we don't really know that yet" more compelling than a behavioural label.
Thank you so much for this, Skye. Your comment genuinely means more than I can properly express—especially coming from someone actively working in assessment and therapy. The fact that you not only resonated with this but also brought in your own experience with the PDM (which I have a lot of respect for) really affirms the kind of structural shift I’m hoping to help make space for.
I couldn’t agree more about the value of acknowledging what we don’t yet understand—especially in contrast to the false certainty of behavioral labels. That humility, to me, is the beginning of real alignment with those we’re trying to understand, not a limitation.
If you ever feel compelled to share more—especially around how you use the PDM or how you’ve approached assessment with neurodivergent clients—I’d love to hear it. There’s a lot of room for this conversation to grow.
Thanks again for taking the time—and for the kindness in your words.
I'm always happy to share my experience, one of the real challenges in getting at a useful understanding of different ways of experiencing the world is the way in which each field tends to have a particular framework and agenda and they don't tend to really "talk" to one another. Which brings me to diagnosis in my line of work. The PDM is written mainly for psychotherapists and psychoanalysts, who (speaking really generally) are most interested in making links between past and present and how someone has learned to manage their suffering. So it's got a heavy focus on this, and I can't imagine there's much that's really detailed around ASD in there because it's not something we are really entrusted to be thought leaders around.
There are a few scenarios in my line of work (I primarily see people who have experienced serious trauma) where I am required to "refer up" for diagnosis to a psychiatrist. So if I begin working with someone with ASD, the diagnosis part of the process happens elsewhere (though I am lucky enough to work with some very good and open-minded psychiatrists, so I get some useful insight and input into the process).
The way in which I practice generally involves as little assumption as possible that I understand anything about what it is like to be in this person's mind and I find this really useful in working with different neurotypes. My own neurodiversity means I have never taken it for granted that I think or feel the same as others, so that's a bonus!
The framework of diagnosis gives a useful guide about possibilities, and what might be helpful, but I am of the mind that the more we lean on it the more is lost of that particular individual's experience. It's a tricky tension to hold (with the added complexity that we need to do the diagnostic bit for insurance/funding purposes).
I am looking forward to when I can next visit the university library to try and access more research on the internal experience of autism (I'm very interested in the papers you refer to). It strikes me that it's very difficult to capture not only because of the deficit lens but because (1) it's so impossible for someone to explain what it's like to be them, because it's all they know, how does a fish explain what water is, and (2) the entire way in which research is collected, collated, presented and understood is a neurotypical framework.
I really appreciate how openly you’re thinking through all of this—and especially how intentionally you’re holding that tension between diagnostic necessity and individual experience. That’s such a delicate balance, and the way you describe your practice speaks volumes about your integrity and attunement.
Your fish analogy is spot on, of course. It’s such a powerful way to frame the limits of internal explanation. And it’s had me thinking—clients absolutely shouldn’t be expected to explain the “water” they live in, especially when language itself often falls short. But I keep coming back to how much more effective therapy could be—especially for neurodivergent clients—if we had a framework that wasn’t just trying to decode behavior but genuinely bridge communication mismatch. One that broadens the lens not just diagnostically, but empathically and cognitively.
Not as a list of shoulds—but as a shared possibility. A way to expand how we relate to each other.
And at risk of sounding like an infomercial for my model—that’s really what I’m trying to do here. To share more of our (ND) perspectives with the world, to move away from deficit-based pathology and reframe our experiences in a way that positions us on equal cognitive footing. That actually demonstrates why the field is getting this wrong, and how much harm that misalignment continues to cause.
The irony here, of course, is that your practice—deeply attuned, humble, and person-centered—ends up treated as secondary to formal diagnostics, when in reality it’s far more validating for actual people. And that’s exactly the kind of shift I want to help support.
Thanks again for your honesty, curiosity, and presence in this conversation—it genuinely means a lot.
"But pragmatic necessity doesn’t equal conceptual validity—and when the operational becomes the ontological, we lose sight of the difference."
Yes! Absolutely!
Insidious, subtle, pervasive.
Very engaging read. I found it insightful, powerful and compelling. Thank you. 💜