A Diagnosis Is a Form of a Hypothesis

[DISCLAIMER]

Among the relatively many reasons I prefer to practice Rational Emotive Behavior Therapy (REBT) in my personal and professional life is because it serves as a transdiagnostic approach to care for mental, emotional, and behavioral health (collectively “mental health”).

Not all psychotherapeutic models are similar to REBT. Sometimes referred to as a “disease model,” pathological consideration of abnormal cognitive, emotive, and behavioral functioning generally requires diagnosis—the art or act of identifying a disease from its signs and symptoms.

Per the American Psychological Association (APA), the definition of diagnosis further relates to “the classification of individuals on the basis of a disease, disorder, abnormality, or set of characteristics.” Thus, unlike REBT, many psychotherapy models assess for illness or disorder.

This method of addressing mental health needs relates to what the APA defines as pathology, “any departure from what is considered healthy or adaptive.” Thus, the disease model focuses on identifying what’s wrong with people, in order to remedy or supposedly fix them.

One noted shortcoming with diagnosis is, as one source accurately states, “Mental disorders are largely clinical diagnoses that seldom have specific objective findings that can be detected through laboratory testing, physical examination or imaging.” It isn’t like diagnosing cancer.

Moreover, qualified mental health professionals aren’t the only individuals who can diagnose people with mental disorders. This can lead to misdiagnosis (an incorrect, inaccurate, or incomplete identification of a disease or disorder). Regarding this matter, one study found:

Of the 840 primary care patients assessed, 27.2%, 11.4%, 12.6%, 31.2%, and 16.5% of patients met criteria for major depressive disorder, bipolar disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder, respectively.

Misdiagnosis rates reached 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder.

Aside from primary care physicians misdiagnosing people with mental disorders, there’s a noted pattern of individuals self-diagnosing in regard to information received from the Internet or social media. For instance, one source states:

It is worth noting that media surveys have observed that Generation Z is particularly prone to self-diagnosing mental health issues, with 30% having done so in one such survey. Out of these, anxiety (48%) and depression (37%) were the most common.

The same survey revealed generational differences in the preferred platform for self-diagnosis, with Generation Z favoring TikTok, in contrast to older generations showing a preference for Facebook.

A separate source reports that 15% of Baby Boomers, 20% of Generation X, 26% of Millennials, and 30% of Generation Z have self-diagnosed regarding online content. Regarding this matter, I stated in a blogpost entitled Diagnoses Feel Empowering:

I was recently reminded of the clients X and Y of the world when listening to episode 215 of the DarkHorse podcast with Bret Weinstein and Heather Heying. This remembrance stemmed from the following interaction:

Heying: Diagnoses feel empowering.

Weinstein: Diagnoses feel empowering. They also free us from responsibility for our errors.

Heying: Yeah, it’s simultaneously empowering and freeing, and disempowering, honestly. It takes away agency and it gives, like, a directionality to, like, “Oh, all I have to do is correct the chemical imbalance.”

It’s worth noting that I disagree with colloquial use of the word “feel,” as expressed by Heying and Weinstein. Nevertheless, I understand that in common parlance, “feel” is used synonymously with “think,” “believe,” or “hunch.”

Therefore, stating, “Diagnoses feel empowering” is understood to represent proper use of the expression, “Diagnoses are believed to be empowering.” Minor quibble aside, I agree with the critique offered by Heying and Weinstein.

In that post, I laid a foundation for personal responsibility and accountability (collectively “ownership”) for one’s own outcomes – regardless of whether or not one has an actual mental health diagnosis. This is in accordance with a transdiagnostic approach to mental health.

Irrespective of actual or perceived diagnosis, with noted exceptions (e.g., an individual with a clinical diagnosis of schizophrenia and who actively experiences psychosis), I use REBT techniques regarding the ABC model and unconditional acceptance (UA).

Whereas the ABC model is a scientific approach to wellness, UA serves as a philosophical method for reducing self-disturbance which is caused by one’s own irrational beliefs. I view the former as an abortive approach to disturbance and the latter as a preventative method.

Regarding a scientific approach, the APA defines science as “the systematic study of structure and behavior in the physical, natural, and social worlds, involving the generation, investigation, and testing of hypotheses, the accumulation of data, and the formulation of general laws and theories.”

Concerning the current blogpost, it’s worth adding that the APA defines a hypothesis as “an empirically testable proposition about some fact, behavior, relationship, or the like, usually based on theory, that states an expected outcome resulting from specific conditions or assumptions.”

Essentially, when using REBT as a scientific approach to mental health, I search for truth about reality. Here, “truth” means the body of real things, events, and facts: actuality. “Reality” means the quality or state of being real—having objective independent existence.

Depending on one’s reported symptoms (any deviation from normal functioning that is considered indicative of physical or mental pathology) – even in the absence of diagnosis and in the presence of irrational beliefs – people may lose their perception of reality.

Thus, when providing psychoeducational lessons on the ABC model, I often find it useful to discuss the scientific method. I thusly addressed this matter in a blogpost entitled The Morality-Reality Distinction:

One method of analyzing whether or not something is real relates to use of the scientific method.

This includes observation, questions, researching relevant information, forming a hypothesis, designing and conducting an experiment, data analysis, drawing conclusions, and communicating results. Of this tool, I stated in a blog entry entitled Challenging Disappointment:

Science neither proves nor disproves ideas. Rather, it accepts or rejects data based on supporting or refuting evidence and revises conclusions based on additional evidence.

Given this consideration, determination of what’s considered true, untrue, real, or unreal is an ongoing and rigorous process of examination.

To recapitulate, REBT is a transdiagnostic approach to mental health that addresses personal ownership for one’s own self-disturbed outcomes. While other psychotherapeutic models use diagnosis to inform an approach to mental health care, there remains an issue of misdiagnosis.

Not only are non-psychotherapeutic entities able to diagnose people with mental disorders, there’s a somewhat significant trend of people self-diagnosing (and perhaps misdiagnosing) with information found online. Perhaps the latter occurs, because diagnoses may seem empowering.

Also, irrespective of what diagnosis a person actually or presumably has, the scientific method serves as a tool that affords one the ability to determine truth about reality concerning self-disturbance. This is all important, as I stated in a blogpost entitled Treatment vs. Management:

The bottom line is that management reduces symptoms enough for an individual to moderate self-disturbance [i.e., feeling better] while treatment increases overall functioning. Regarding the latter, I promote the improved ability to employ healthy strategies (function) and improve overall quality of life (i.e., getting better).

When managing or treating presenting problems, I realize that a diagnosis is a form of hypothesis. Noteworthy, while listening to an episode of Joe Rogan’s podcast, Chris Masterjohn stated of this matter:

A medical diagnosis is a hypothesis that the patient will respond to the treatment that they’re given. And you test that hypothesis by giving the patient that treatment, and then you see if they get better. And if they don’t get better, then you take them off the treatment.

In support of this perspective, a separate source states, “The method of diagnosis is essentially similar to the scientific method in which a cause is suspected from clues in a situation and formulated as a hypothesis that is proven correct by the observation of its consequences.”

The only quibble I have with this postulation is that, as previously stated, science neither proves nor disproves ideas. In any event, I’ve had clients referred to me by other mental health care professionals. Often, these clients come to REBT services with prior diagnoses.

Rather than disregarding these classifications, I view them as mere hypotheses which may be accepted or rejected based on supporting or refuting evidence, as conclusions are revised based on additional evidence. Even in cases regarding which I diagnose clients, I use this approach.

So, how does all this tie together? I’ve learned of an unfortunate circumstance which reportedly involved a minor-aged individual apparently having completed suicide when discovering her diagnosis and reviewing the characterization online. About this matter, one source states:

A 17-year-old high school student [Maya Cassady] died by suicide just hours after reading the contents of her mental health records. […]

Maya searched, ‘Is persistent depressive disorder lifelong?’ and googled specific mental illnesses that were listed on her chart, including bipolar II.

Cassady, for her part, found that the last search on her daughter’s phone concluded that her symptoms were ‘untreatable.’

‘She had given up hope when she felt that her diagnosis was untreatable — that was the response when she Google searched some of the terminology in the report,’ Cassady told CTV.

I have no firsthand knowledge of this case. As a matter of conjecture, it appears as though the decedent learned of what the APA defines as treatment resistance, “failure of a disease or disorder to respond positively or significantly to treatment, as in treatment-resistant depression.”

Unfavorably, it appears as though she didn’t understand that a diagnosis is a form of hypothesis to be tested. Because an individual in a similar situation may self-disturb to a significant degree whereby suicide is deemed a viable option, I’ve decided to draft the current blogpost.

Even if you have a diagnosis that is “untreatable” (or perhaps unmanageable), I encourage you to take in stride the disease model of mental health. Rather than self-disturbing about the matter, I invite you to practice the ABC model and UA.

As a matter of personal disclosure, I, too, use REBT to treat and manage my clinically diagnosed mental disorders. Thus, I test the hypotheses which were assigned to me. You can do this, as well. If you’d like to know more about how this is done, then I look forward to hearing from you.

If you’re looking for a provider who tries to work to help understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.

As a psychotherapist, I’m pleased to try to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.

At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply trying to help you to feel better, I want to try to help you get better!

Deric Hollings, LPC, LCSW

Photo credit, fair use

References:

Ahuja, J. and Fichadia, P. A. (2024, March 21). Concerns regarding the glorification of mental illness on social media. Cureus. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC11032084/#:~:text=It%20is%20worth%20noting%20that%20media%20surveys,older%20generations%20showing%20a%20preference%20for%20Facebook.

APA Dictionary of Psychology. (2023, November 15). Diagnosis (Dx). American Psychological Association. Retrieved from https://dictionary.apa.org/diagnosis

APA Dictionary of Psychology. (2018, April 19). Hypothesis. American Psychological Association. Retrieved from https://dictionary.apa.org/hypothesis

APA Dictionary of Psychology. (2018, April 19). Mental disorder. American Psychological Association. Retrieved from https://dictionary.apa.org/mental-disorder

APA Dictionary of Psychology. (2018, April 19). Misdiagnosis. American Psychological Association. Retrieved from https://dictionary.apa.org/misdiagnosis

APA Dictionary of Psychology. (2018, April 19). Pathology. American Psychological Association. Retrieved from https://dictionary.apa.org/pathology

APA Dictionary of Psychology. (2018, April 19). Psychosis. American Psychological Association. Retrieved from https://dictionary.apa.org/psychosis

APA Dictionary of Psychology. (2018, April 19). Science. American Psychological Association. Retrieved from https://dictionary.apa.org/science

APA Dictionary of Psychology. (2018, April 19). Symptom. American Psychological Association. Retrieved from https://dictionary.apa.org/symptom

APA Dictionary of Psychology. (2018, April 19). Treatment resistance. American Psychological Association. Retrieved from https://dictionary.apa.org/treatment-resistance

Bird, J. (2025, November 26). Schoolgirl, 17, killed herself after accessing doctor’s secret records about her mental health conditions. Daily Mail. Retrieved from https://www.dailymail.co.uk/news/article-15329289/vancouver-teenager-suicide-medical-record.html

Bradford, A., Meyer, A. N. D., Khan, S., Giardina, T. D., and Singh, H. (2024). Diagnostic error in mental health: A review. BMJ Quality & Safety. Retrieved from https://qualitysafety.bmj.com/content/33/10/663

Heying, H. (n.d.). Heather Heying [Official website]. Retrieved from https://www.heatherheying.com/

Hollings, D. (2024, May 22). A philosophical approach to mental health. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/a-philosophical-approach-to-mental-health

Hollings, D. (2025, August 26). A preventative approach to self-disturbance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/a-preventative-approach-to-self-disturbance

Hollings, D. (2024, May 24). A scientific approach to mental health. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/a-scientific-approach-to-mental-health

Hollings, D. (2024, April 20). A transdiagnostic approach. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/a-transdiagnostic-approach

Hollings, D. (2025, August 26). An abortive approach to self-disturbance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/an-abortive-approach-to-self-disturbance

Hollings, D. (2025, September 24). Animalistic instinct: Just because it seems right doesn’t mean it is. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/animalistic-instinct-just-because-it-seems-right-doesn-t-mean-it-is

Hollings, D. (2024, November 15). Assumptions. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/assumptions

Hollings, D. (2024, September 15). Challenging disappointment. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/challenging-disappointment

Hollings, D. (2024, October 29). Cognitive continuum. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/cognitive-continuum

Hollings, D. (2024, March 19). Consequences. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/consequences

Hollings, D. (2024, October 27). Correlation does not imply causation. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/correlation-does-not-imply-causation

Hollings, D. (2024, March 15). Diagnoses feel empowering. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/diagnoses-feel-empowering

Hollings, D. (2022, March 15). Disclaimer. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/disclaimer

Hollings, D. (2024, March 6). Emotional responsibility. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/emotional-responsibility

Hollings, D. (2024, July 10). Empirical should beliefs. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/empirical-should-beliefs

Hollings, D. (2024, December 30). Empowerment. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/empowerment

Hollings, D. (2025, March 9). Factual and counterfactual beliefs. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/factual-and-counterfactual-beliefs

Hollings, D. (2023, September 8). Fair use. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/fair-use

Hollings, D. (2025, June 9). “Feeling better” doesn’t help you understand or change behaviors. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/feeling-better-doesn-t-help-you-understand-or-change-behaviors

Hollings, D. (2024, May 17). Feeling better vs. getting better. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/feeling-better-vs-getting-better-1

Hollings, D. (2025, March 5). Five major characteristics of four major irrational beliefs. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/five-major-characteristics-of-four-major-irrational-beliefs

Hollings, D. (2023, October 12). Get better. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/get-better

Hollings, D. (2023, July 13). Holes in the proposal. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/holes-in-the-proposal

Hollings, D. (n.d.). Hollings Therapy, LLC [Official website]. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/

Hollings, D. (2024, February 20). I have a theory about that. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/i-have-a-theory-about-that

Hollings, D. (2025, October 13). Knowledge, wisdom, understanding. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/knowledge-wisdom-understanding

Hollings, D. (2025, January 14). Level of functioning and quality of life. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/level-of-functioning-and-quality-of-life

Hollings, D. (2023, September 19). Life coaching. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/life-coaching

Hollings, D. (2025, November 25). Logos and natural order. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/logos-and-natural-order

Hollings, D. (2024, March 4). Mental, emotional, and behavioral health. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/mental-emotional-and-behavioral-health

Hollings, D. (2025, November 16). Mental health, mental illness, and mental disorder. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/mental-health-mental-illness-and-mental-disorder

Hollings, D. (2023, September 3). On feelings. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/on-feelings

Hollings, D. (2023, April 24). On truth. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/on-truth

Hollings, D. (2025, April 9). Perception, action, and will. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/perception-action-and-will

Hollings, D. (2024, February 24). Personal agency. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/personal-agency

Hollings, D. (2022, November 7). Personal ownership. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/personal-ownership

Hollings, D. (2025, September 9). Personal responsibility and accountability. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/personal-responsibility-and-accountability

Hollings, D. (2023, November 23). Problems. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/problems

Hollings, D. (2024, January 1). Psychoeducation. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/psychoeducation

Hollings, D. (2023, September 15). Psychotherapeutic modalities. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/psychotherapeutic-modalities

Hollings, D. (2024, May 5). Psychotherapist. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/psychotherapist

Hollings, D. (2022, March 24). Rational emotive behavior therapy (REBT). Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rational-emotive-behavior-therapy-rebt

Hollings, D. (2024, December 5). Reasoning. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/reasoning

Hollings, D. (2024, March 14). REBT and emotions. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rebt-and-emotions

Hollings, D. (2024, January 4). Rigid vs. rigorous. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rigid-vs-rigorous

Hollings, D. (2022, November 1). Self-disturbance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/self-disturbance

Hollings, D. (2024, March 24). Smartphone and social media addiction. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/smartphone-and-social-media-addiction

Hollings, D. (2025, October 27). Suicide and suicide attempts: Jumping out the window. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/suicide-and-suicide-attempts-jumping-out-the-window

Hollings, D. (2024, October 4). The morality-reality distinction. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-morality-reality-distinction

Hollings, D. (2023, August 6). The science. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-science

Hollings, D. (2025, February 28). To try is my goal. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/to-try-is-my-goal

Hollings, D. (2025, January 9). Traditional ABC model. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/traditional-abc-model

Hollings, D. (2024, June 19). Treatment vs. management. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/treatment-vs-management

Hollings, D. (2024, October 20). Unconditional acceptance redux. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/unconditional-acceptance-redux

Hollings, D. (2024, September 29). Well, well, well. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/well-well-well

Hollings, D. (2025, April 12). What’s the big idea? Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/what-s-the-big-idea

Hollings, D. (2022, September 16). Wild out. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/wild-out

Jain, B. (2017, March 1). The scientific nature of diagnosis. Diagnosis (Berlin, Germany). Retrieved from https://pubmed.ncbi.nlm.nih.gov/29536906/

Lens Whisper Tales. (n.d.). A frustrated female patient sits on the couch with a psychologist and talks about […] [Image]. Freepik. Retrieved from https://www.freepik.com/premium-ai-image/frustrated-female-patient-sits-couch-with-psychologist-talks-about-problems_406658303.htm#fromView=search&page=4&position=34&uuid=e31fc76a-c9ab-4e59-9d2d-aad5158bb71f&query=psychologist

Masterjohn, C. (n.d.). Chris Masterjohn, PhD [Official website]. Retrieved from https://www.chrismasterjohn-phd.com/

PowerfulJRE. (2025, November 29). Joe Rogan Experience #2420 - Chris Masterjohn [Video]. YouTube. Retrieved from https://youtu.be/QBn54YNnKD0?si=neT6a0VUZbU6cVNE

Redshaw, L. (2023, August 2). Is self-diagnosis on social media helping or hurting people’s health? The Intake. Retrieved from https://www.tebra.com/theintake/medical-deep-dives/tips-and-trends/is-self-diagnosis-on-social-media-helping-or-hurting-peoples-health

Seligman, M. E. P. (2000). Positive psychology, positive prevention, and positive therapy, University of Pennsylvania. International Organization for Migration. Retrieved from https://www.iom.int/sites/g/files/tmzbdl486/files/staff-welfare/positive_psychology.pdf

Vermani, M., Marcus, M., and Katzman, M. A. (2011). Rates of detection of mood and anxiety disorders in primary care: A descriptive, cross-sectional study. Primary Care Companion for CNS Disorders. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3184591/

Weinstein, B. (n.d.). Bret Weinstein [@DarkHorsePod]. YouTube. Retrieved from https://www.youtube.com/@DarkHorsePod

Weinstein, B. (n.d.). Bret Weinstein [Official website]. Retrieved from https://www.bretweinstein.net/

Weinstein, B. (2024, March 6). Contested development: The 215th evolutionary lens with Bret Weinstein and Heather Heying [Video – starting at approximately minute 1:30:37]. YouTube. Retrieved from https://www.youtube.com/live/zD_7FMib2vQ?si=XRMY4Y9a8BXN1jYu

Wikipedia. (n.d.). Joe Rogan. Retrieved from https://en.wikipedia.org/wiki/Joe_Rogan