11/20/2025
I wouldn't argue that diagnosis is completely insignificant, but I agree with the idea that the diagnostic manual would be "a very thin volume" if we had a deeper understanding of the relationship between individuals' nervous system functioning and their environment. Interpersonal neurobiology is a core component of my approach, which I developed an interest in after the first years of my career revealed that traditional methods were limited. I wasn't helping people as much as I could because those methods miss this mark. This author captures why quite eloquently:
https://www.facebook.com/share/p/17Xmkgswym/
"The DSM Misses the Mark: IPNB Offers a Humane and Scientific Understanding of Mental Health"
Some trauma experts have said that if the psychiatric Diagnostic and Statistical Manual of Mental Disorders (DSM) acknowledged trauma, it would be a very thin volume because virtually everything else would fall beneath it. But from an Interpersonal Neurobiology (IPNB) perspective, the DSM is irrelevant. A categorical, symptom-based system, it separates people into boxes and treats distress as pathology. IPNB sees humans as relational, neurophysiological systems shaped by context, connection, and experience. What looks like âdisorderâ is often a survival adaptation to overwhelming environments, chronic stress, or disrupted relationships.
If IPNB principles were the foundation, there wouldnât be a manual of fixed categories. Instead, the focus would be on mapping how a personâs nervous system is functioning, how their relationships and communities support or sabotage regulation, and where overload or chronic threat is causing symptoms. Instead of labeling people, diagnosis would be about understanding context, connection, and neurophysiological patterns.
Dynamic, relational assessments of the health of internal and external systems would replace the DSM. Everything the DSM tries to name as âillnessâ would instead be seen as a signal that a system is under chronic strain. An IPNB-informed alternative to the DSM might look like:
No Static Categories, Only Relational Patterns
Instead of labeling people with fixed disorders, it would map patterns of nervous system response across different contextsâthreat detection, connection, regulation, and recovery. A âdiagnosisâ wouldnât be a label on a person; it would describe how their system is managing stress, connection, and homeostasis.
Distress As A Signal, Not A Pathology
Every symptomâanxiety, depression, pain, insomnia, dissociationâwould be seen as information about the nervous system and relational environment. These are adaptive responses to chronic stress, trauma, neglect, or abusive hierarchies, not evidence of âbrokenness.â
Emphasis on Developmental and Ongoing Trauma
Instead of isolating traumatic events, it would recognize cumulative relational stress across the lifespan. The system would map how early experiences, caregiving environments, and ongoing societal pressures shape nervous system patterns. Most âdisordersâ would simply fall under this umbrella.
Systems-Level Assessment
The focus would include family, community, culture, and institutions. How connected is the person? How much support do they actually receive? How safe are their environments? These factors would be central because they directly shape nervous system regulation.
Dynamic, Context-Sensitive Framework
Assessments would be fluid, constantly updated with ongoing observations of physiological state, relational interactions, and environmental demands. It would account for recovery, regression, and adaptation over time, rather than treating symptoms as static.
Intervention Targets
Rather than prescribing medication or therapy based on a label, interventions would aim to:
Reduce chronic threat load
Repair and strengthen relationships and community
Enhance nervous system regulation capacity
Address environmental and structural sources of stress
Education and Prevention as Key
Instead of a manual for diagnosing pathology, it would be a framework for understanding human adaptation, preventing overload, and fostering connection. Everyoneâs nervous system could be âmappedâ and supported before distress becomes severe.
Several notable organizations have expressed significant opposition to the DSM-5, the current edition: the British Psychological Society, American Counseling Association, Society for Humanistic Psychology (APA Division 32),
Society for Community Research and Action: Division of Community Psychology (APA Division 27), Society for Group Psychology & Psychotherapy (APA Division 49), UK Council for Psychotherapy, the Association for Women in Psychology, Constructivist Psychology Network, and the Society of Indian Psychologists. Reasons for opposition include lack of scientific basis (not based on objective biological markers but on clinical consensus), clinical unusefulness (does not accurately reflect clinical reality and that some diagnoses are overly broad or poorly defined) and its focus on symptoms vs. underlying causes.
The DSM under IPNB wouldnât exist because its foundation--categorical labeling of people based on symptom clusters--is fundamentally misaligned with how humans function. We would have a relational, neurophysiological map of adaptation and stress, not a book that labels pathologizes them. In my view, given its irrelevance, coupled with its history of driving deep and widespread harm, the DSM should be banished now.
