What Diagnosis Left Behind: Towards a Situated, Humane Psychology

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Neil Nallan Chakravartulla questions the shortcoming of diagnosis as it separates the person from their world and detaches their pain from their circumstances. He reflects on the troubling consequences of this in South Asia.

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During my internship at a mental health facility, a 15-year-old boy was brought in. The first few notes on his chart were stark and unsettling. He was being referred for what was described as homicidal ideation and psychopathic tendencies. His teachers feared him, his peers avoided him, and the psychiatric team seemed already poised to pathologize him. But something didn’t sit right with me.

Instead of starting with symptom checklists or personality inventories, I asked what felt like the most obvious question: Who is this boy when he goes home? What does his world look like outside these walls?

That’s when the story shifted. I learned that his father had a long history of substance use and erratic violence. His older brother had recently been incarcerated for gang involvement. His mother was caught in a cycle of trauma and addiction herself, barely present. He had grown up not with care, but with chaos. What looked like coldness or violence on the surface began to take on new meaning – an expression of chronic exposure to fear, instability, and abandonment.

This moment stayed with me. It reminded me how dangerously easy it is to isolate the individual from the web of relationships, histories, and systems that shape them.

In a field that so often looks inward, I had to ask: Why are we so quick to treat pathology as if it begins and ends inside a person? And what does it cost us to ignore everything else?

The Individual as an Island: A Modern Myth

The tendency to isolate the individual from their social context is not new, but it has been exacerbated by modern psychology’s obsession with objectivity and standardization. This is a critique that psychiatrist Thomas Szasz laid out in The Myth of Mental Illness. His argument – that what we call mental illness is often a metaphor for the struggle of living within difficult or dehumanizing social structures – was radical then and remains inconvenient now.

Szasz warned that psychiatry had become a means of social control, not healing. In naming distress as disease, it allowed the clinician to forget about the world beyond the consulting room. The context – poverty, racism, caste hierarchies, colonial legacies, gendered violence becomes noise to be filtered out, not meaning to be understood.

And so, we are left with a field that attempts to treat alienation without naming capitalism, to manage anxiety without confronting structural precarity, and to correct maladaptive behavior without asking whose norms it is being maladaptive to.

Mead, Meaning, and the Missing “Other”

Decades before Szasz, social philosopher George Herbert Mead offered an elegant framework to understand the self – not as a fixed essence residing inside us, but as a dynamic process emerging from our relationships with others. In Mind, Self, and Society, Mead argued that the self is fundamentally social. It arises only through our interactions with what he called the “generalized other.”

We become who we are through the responses of others. The self is not born in isolation but in relation. Consider a young boy who is quiet at home but disruptive in school. Over time, he begins to see himself as the troublemaker, not because of something innate, but because that is how teachers, peers, and disciplinary systems consistently respond to him. His sense of self — loud, defiant, resistant, is not merely expressed in those moments, but formed by them. It is a self that emerges in dialogue with the gaze of the other, a reflection of the world’s expectations more than his essence.

What does it mean, then, for a psychological science to locate the self only within the skull? What happens when we reduce the richness of intersubjectivity into a clinical checklist? The consequences are everywhere.

We see it in how therapy is framed as an individual’s journey of healing, detached from the communal worlds that wounded them. We see it in the valorization of “resilience” that asks people to endure injustice rather than challenge it. We see it in interventions that train poor children to regulate their emotions, but not their landlords to stop evictions.

To forget the social is to forget the self. And a psychology that forgets the self is not merely incomplete – it is dangerous.

Consequences Beyond the Clinic

The costs of this individualism are not abstract. They show up in the exhausted faces of single mothers handed parenting programs but not housing support. The rising numbers of college students labelled depressed, while the university system continues to erode any sense of meaning, belonging, or political agency. The rural farmer is told to practice mindfulness while he watches his crops fail for the third year in a row.

These are not hypothetical. These are lived realities. And they are shaped not just by neural circuits, but by neoliberal policy, broken social contracts, and the invisibilized violence of inequality. When psychology decontextualizes suffering, it often ends up blaming the sufferer.

Why This Matters in the Global South

In South Asia, where psychological services are still finding their footing, the danger is even greater. Imported models from the West, which are based on highly individualistic assumptions are often applied wholesale, without consideration for local cultural and material contexts.

We ask Dalit youth to boost self-esteem, but not their upper-caste teachers to examine their own biases. We encourage LGBTQ+ adolescents to come out, ignoring the very real threat of familial or state violence. We tell anxious students to challenge their irrational thoughts, instead of questioning why so many feel that their future is already lost.

This is not merely a mismatch. It is the violence of erasure.

Toward a More Ethical, Situated Psychology

What we need is a psychology that is accountable not only to evidence but to history, to context, and to power. A psychology that does not medicalize dissent or isolate trauma, but listens deeply to the stories people live inside of.

This does not mean abandoning the individual. But it means refusing to see them as the beginning and end of their own suffering. It means building bridges between psychology and sociology, between therapy and political economy, between personal healing and collective liberation. It means remembering that even the most private pain carries a public origin.

A Closing Reflection

I think of that boy again, sitting with his knees pulled to his chest. What would it have meant to ask not just what is wrong with him, but what has happened to him? What kind of psychology might have emerged from such a question?

The task ahead is not easy. It requires humility. It requires discomfort. It requires letting go of our fantasies of neutrality. But it also offers the possibility of a more truthful, more tender kind of care.

A psychology that does not turn away from the world, but walks right into it – with curiosity, with compassion, and with both eyes open.

Neil Nallan Chakravartula
Neil Nallan Chakravartula

Neil Nallan Chakravartula is an aspiring social and critical psychologist, currently pursuing his Master’s in Psychology at the University of Mumbai. He holds a BSc in Psychology from Christ University, Bangalore. With experience in clinical, community, and research settings, Neil is interested in the tangled intersections of mental health, society, and power. He enjoys asking difficult questions - especially the kind that make people in the clinical world just a little uncomfortable.

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