The Diagnosis Is Just to Get Insurance Paid

I find myself saying this over and over, sometimes to clients, sometimes to colleagues, sometimes to myself when I'm sitting across from someone whose pain is being reduced to checkboxes on a form. "The diagnosis is just to get the insurance paid.”

Please don't forget you are dealing with a human being.

Because here's what nobody tells you about mental health care in this country: the system is designed to pathologize first and understand second. Your grief over losing everything that mattered to you becomes major depressive disorder. Your body's natural response to being overworked and undervalued becomes generalized anxiety disorder. Your entirely reasonable reaction to living in broken systems gets labeled as a disorder that needs to be fixed, managed, medicated into some form of submission.

We're trained to reduce the complexity of human experience into neat categories that insurance companies can understand and billing departments can process. Not because it serves the person sitting in front of us, but because that's what gets reimbursed. Context doesn't have a billing code. Complexity doesn't fit into treatment manuals. The particular weight someone carries from navigating a world that treats them as disposable, that's not something you can capture in a diagnostic manual.

And still, I am having a hard time to rush toward pathology when what I'm witnessing might just be a completely rational response to irrational circumstances.

When Survival Gets Diagnosed as Sickness

The most heartbreaking part of this work is watching people internalize labels that were never meant to capture their truth, I too have fallen victim to that reality more times than I can count. I've sat across from women who survived things that would break most people, only to be told their hypervigilance is a symptom that needs to be eliminated. I've worked with people whose bodies learned to shut down as protection, then got pathologized for "avoidance" and "emotional numbing," when dissociation is the only way to get through the day to day.

But I am here to tell you that our nervous systems are working exactly as they should. The problem isn't our response, but what we’re responding to. The systems that continue claiming to people often feels remarkably similar to the systems that harmed them in the first place.

People who are struggling, are required to keep the system running, and people who are awake make institutions that benefit from that system uncomfortable.

The System Profits From Your Not-Quite-Healing

Mental health care as it exists now needs you to be unwell enough to keep coming back, but not so unwell that you can't function in the machine. It needs you regulated enough to show up to the job that's slowly killing you, but not regulated enough to recognize that the job itself might be the problem. It needs you medicated enough to stop asking inconvenient questions, but not so clear that you start demanding inconvenient changes.

Actual healing, the kind that helps people recognize their worth, set boundaries, leave situations that don't serve them, threatens this entire structure. Because healed people don't settle, they name harm when they see it. Healed people walk away from systems that demand that they stay silent as the price of admission. While not everyone can afford to walk away, those who can do, and will. At minimum, they will not be quiet.

This system cannot afford that kind of healing, who will make the rich rich if we are all well?

Staying Human in Dehumanizing Spaces

The cost of maintaining integrity in these spaces is real. You will feel like a foreigner. You will sit in staff meetings and wonder if everyone else has forgotten what we're actually supposed to be doing here. You will watch people's stories get flattened into treatment plans and wonder if you're the only one who remembers that we're dealing with human beings, not case files. You will be the Black sheep in a space where people expect you to assimilate, in order to do this work.

They will tell you that you care too much. That your expectations are unrealistic. That you need to be more "professional," which often means more detached, more willing to prioritize documentation over connection, more comfortable with systems that prioritize efficiency over humanity.

But I didn't become a therapist to protect institutions from the inconvenience of human complexity, especially when it directly causes harm. I came here because I believe people deserve to be met with genuine care. Not the performance of care that satisfies insurance requirements and keeps administrators happy, but the kind of presence that says that your pain makes sense, your reactions are understandable, and you are not the problem. What is a brightly colored, bold footed, “trauma informed care” & “person centered” statement if we aren’t actually being trauma informed and person-centered?

What Care Actually Looks Like

Real care doesn't start with pathology, it starts with curiosity. It asks what happened to you instead of what's wrong with you. It recognizes that most of what we label as mental illness is actually mental injury, and injury requires different treatment than illness. So Many of our problems could be resolved with resources and community, something that seems to be getting further and further away from us all. And our communities are not only spread thin, they too have started to lack the resources to truly support.

Real care acknowledges that most of us are carrying more than our individual pain. We're carrying the weight of systems that see us as expendable, communities that have been systematically harmed, families that never learned how to love themselves well enough to love us well. We are being mistreated by loved ones, partners, family members, friends, colleagues, bosses, institutions and more.

Real care doesn't rush toward solutions that require you to adapt to harmful circumstances and experiences. Instead, it helps you trust what you already know, which is that you deserve better than what you've been given, and that your body's refusal to accept unacceptable situations isn't pathology.

For Those of Us Who Refuse to Assimilate

If you're the one in team meetings asking uncomfortable questions about why we're doing things the way we're doing them, you're not the problem. If you're the clinician who feels sick watching colleagues treat people like diagnoses instead of humans, trust that feeling. If you're struggling to find your place in a field that seems designed to extract care from caregivers while offering very little in return, you're not alone. We are tired.

Some of us were never meant to blend into systems that cause the very harm they claim to heal, we were meant to be different. We are meant to feel more, question harder, have hard conversations, and create what doesn't exist yet.

And maybe these systems will never change, and for sure the insurance companies will always prioritize profit over people. Likely, the institutions will always choose efficiency over humanity.

But that doesn't mean we have to become complicit. That doesn't mean we have to sacrifice our integrity for institutional comfort. That doesn't mean we stop remembering what this work was supposed to be about, or that we get bullied, or punished into assimilation at the expense of the reason why we pursued this work. Most colleges are just academic mills built to push out people who won’t do critical thinking enough to disrupt the system.

I'm still here because I've seen what happens when people are met with truth instead of pretense. I’ve seen what happens, and am what happens, when your discomfort is alive and you refuse to internalize it. I've witnessed the moment when someone realizes that their pain makes perfect sense given what they've survived in their lifetime, and at this current moment. I know what it feels like to be truly seen, and I believe everyone deserves that experience.

I know what I came here to do, and it's not to uphold systems that profit from people's pain.

It's to remember what care should feel like. And to refuse to offer anything less.

Be well.