Chapter draft for F. Kaslow (Ed.) Relational Diagnosis, Wiley, 1996.

Is Diagnosis a Disaster?: A Constructionist Trialogue Kenneth J. Gergen, h! "ynn #off$an, %&W #arlene 'nderson, h!

For so$e ti$e the three of (s ha)e *een deeply engaged in e+ploring the i$pli,ations of a so,ial ,onstr(,tionist )iew of -nowledge for therape(ti, pra,ti,e. Fro$ a ,onstr(,tionist standpoint, o(r lang(ages for des,ri*ing and e+plaining the world (and o(rsel)es) are not deri)ed fro$ or de$anded *y whate)er is the ,ase. .ather, o(r lang(ages of des,ription and e+planation are prod(,ed, s(stained, and/or a*andoned within pro,esses of h($an intera,tion. F(rther, o(r lang(ages are ,onstit(ent feat(res of ,(lt(ral pattern. 0hey are e$*edded within relationships in s(,h a way that to ,hange the lang(age wo(ld *e to alter the relationship. 0o a*andon the ,on,epts of ro$an,e, lo)e,

$arriage and ,o$$it$ent, for e+a$ple, wo(ld *e to alter the for$s of ,(lt(ral life1 to o*literate the lang(ages of ,ons,io(sness, ,hoi,e, or deli*eration wo(ld render $eaningless o(r present patterns of praise and *la$e, along with o(r ,o(rts of law. 2y the sa$e to-en, as we generate new lang(ages in o(r professions, and disse$inate the$ within the ,(lt(re, so do we insin(ate o(rsel)es into daily relations 3 for good or ill. 4t is against this *a,-drop that the three of (s wish to ,onsider the iss(e of diagnosis in general, and relational diagnosis in parti,(lar. We opt for the trialogi, ,on)ersation as a $eans of )i)ifying in pra,ti,e (as well as in ,ontent) the ,onstr(,tionist e$phasis on $eaning thro(gh relationship. KJG: 4 find $yself in,reasingly alar$ed *y the e+pansion and intensifi,ation of diagnosis in this ,ent(ry. 't the t(rn of the ,ent(ry o(r syste$ for ,lassifying $ental disorders was 5(ite r(di$entary in ter$inology and not *roadly a,,epted. #owe)er as the ,ent(ry has (nfolded, the ter$inology has e+panded e+ponentially, and p(*li, ,ons,io(sness of $ental defi,it ter$inology has grown a,(te. 4n the 1969 p(*li,ation of 4srael We,hsler7s 0he 8e(roses, a gro(p of appro+i$ately a do9en psy,hologi,al disorders were identified. With the 19:; p(*li,ation of the %an(al of sy,hiatry and %ental #ygiene (.osanoff, 19:;), so$e <= psy,hogeni, dist(r*an,es were re,ogni9ed. (4t is interesting to note that $any of the ter$s in,l(ded therin, s(,h as parestheti, hysteria, and a(tono$i, hysteria ha)e sin,e dropped fro$ ,o$$on (sage, and so$e of the$ 3 s(,h as $oral defi,ien,y, )aga*ondage, $isanthropy, and $ast(r*ation 3 now see$ 5(aint or o*)io(sly pre>(di,ial. 4n 19?6, with the '$eri,an sy,hiatri, 'sso,iation7s p(*li,ation of the first !iagnosti, and &tatisti,al %an(al of %ental !isorders (' ', 19?6) so$e ?=36= different psy,hogeni, dist(r*an,es were identified. 2y 19;@ 3 only twenty years later 3 the $an(al had gone thro(gh three re)isions. With the p(*li,ation of !&% 444. (' ', 19;@) the n($*er of re,ogni9ed illnesses $ore than tripled (ho)ering *etween 1;=36== depending on ,hoi,e of definitional *o(ndaries). !&% 4A e+pands the list e)en f(rther (' ', 199<). 't the present ti$e, one $ay *e ,lassified as $entally ill *y )irt(e of ,o,aine into+i,ation, ,affeine into+i,ation, the (se of hall(,inogens, )oye(ris$, trans)estis$, se+(al a)ersion, the inhi*ition of orgas$, ga$*ling, a,ade$i, pro*le$s, antiso,ial *eha)ior, *erea)e$ent, and non,o$plian,e with $edi,al treat$ent. 8($ero(s additions to the standardi9ed no$en,lat(re ,ontin(o(sly appear in professional writings to the p(*li,. Consider, for e+a$ple, seasonal affe,ti)e disorder, stress, *(rno(t, eroto$ania, the harle5(in ,o$ple+, and so on. What, we $ight as-, are the (pper li$its for ,lassifying people in ter$s of defi,itsB 's these ter$inologies are disse$inated to the p(*li, 3 thro(gh ,lassroo$s, pop(lar $aga9ines, tele)ision and fil$ dra$as, and the li-e 3 they *e,o$e a)aila*le for (nderstanding o(rsel)es and others. 0hey are, after all, the Cter$s of the e+perts,C and if one wishes to do the right thing, they *e,o$e lang(ages of ,hoi,e for (nderstanding or la*eling people (in,l(ding the self) in daily life. 0er$s s(,h as depression, paranoia, attention defi,it disorder, so,iopathi,, and s,hi9ophrenia ha)e *e,o$e essential entries in the )o,a*(lary of the ed(,ated person. 'nd, when the ter$s are applied in daily life they ha)e s(*stantial effe,ts 3 in narrowing the e+planation to the le)el of the indi)id(al, stig$ati9ing, and o*s,(ring the ,ontri*(tion of other fa,tors (in,l(ding the de$ands of e,ono$i, life, $edia i$ages, and traditions of indi)id(al e)al(ation) to the a,tions in 5(estion. F(rther, when these ter$s are (sed to ,onstr(,t the self, they s(ggest that one sho(ld see- professional treat$ent. 4n this sense, the de)elop$ent and disse$ination of the ter$inology *y the profession a,ts to ,reate a pop(lation of people who will see- professional help. 'nd, as $ore professionals are re5(ired 3 as they ha)e *een in in,reasing n($*ers o)er the ,ent(ry 3 so is there press(re to in,rease the )o,a*(lary. Elsewhere (Gergen, 199<) 4 ha)e ,alled this a C,y,le of progressi)e infir$ity.C LH: Ken7s thin-ing has *een $ost helpf(l in $y parti,(lar str(ggles to find a way o(t of the na$ing *ind, whi,h is the *elief that in order to *e helpf(l a*o(t a ,o$plaint, yo( ha)e to des,ri*e it and na$e it. 0he des,ri*ing and na$ing $a-es it real. %edi,al pra,titioners ha)e *een so s(,,essf(l in ,reating a ta+ono$y of physi,al distress that psy,hologi,al professionals ha)e so(ght to follow s(it. 0here is an i$pli,it ,ontradi,tion *etween the non3essentialist stan,e of so,ial ,onstr(,tion theory and the present )ol($e on relational diagnosis. 4f so,ial ,onstr(,tion theory ,hallenges psy,ho*iologi,al na$ing syste$s, it also ,hallenges the des,ripti)e tr(th of a relational sylla*ary. 8one of these self3,onfir$ing syste$s of na$ing pro)ide a ,o$forta*le resting pla,e for the so,ial ,onstr(,tionist. 't the sa$e ti$e, what is to *e,o$e of the profession of fa$ily therapy if it doesn7t >oin in the pra,ti,e of na$ingB 0he threatened e+tin,tion of o(r way of life is at sta-e. 0rying to thin- why 4 was drawn to so,ial ,onstr(,tionis$, 4 refle,ted that 4 had *een thro(gh se)eral Cdiagnosti, world)iewsC in $y lifeti$e, ea,h $ore ,on)in,ing than the last, and was *eginning to see this as e)iden,e of a )ery relati)isti, and >o-ing ,os$i, God. 's far as psy,hology was ,on,erned, 4 had ,o$e of age in total inno,en,e. 0he ,o$$(nity of left3wing artists 4 grew (p in had their own *rand of 5(alifying phrasesD rea,tionary, fas,ist, *(siness $an, .ep(*li,an, hilistine. Enly when 4 got to ,ollege did 4 find o(t a*o(t ne(roses and psy,hoses and C$ental illness.C %y earlier world)iew too- a hit, in addition to whi,h 4 fo(nd that $any of the new ter$s ,o(ld des,ri*e $yself. %y dis,o)ery of the fa$ily therapy $o)e$ent, whi,h too- the on(s off the person and p(t it on the Csyste$,C was

therefore a great relief. 4 felt pleased with $yself as the fa$ily syste$s $o)e$ent gathered speed. 0hen 4 was ,hallenged again. 4 dis,o)ered an arti,le *y a s,holar fro$ Entario, Gerald Eri,-son (19;;) who atta,-ed syste$i, thin-ing fro$ a post$odern point of )iew. 's 4 s,ra$*led to read a*o(t these new ideas, 4 reali9ed that all of the $odels in the fa$ily therapy field had great failings. 0hey were all $odernist and $ista-en. 0here were no syste$s o(t there, no patterns that ,onne,t, no le)els, no str(,t(res waiting to *e o*ser)ed. For $e this -ind of thin-ing p(t an end to diagnosti,s of any -ind. 0his is a *it tong(e in ,hee-, *(t 4 ass(re yo( that ea,h episte$ologi,al earth5(a-e lea)es enor$o(s da$age in its wa-e. E)ery ti$e yo( *(ild a world of ideas or >oin one, it is li-e a s,reening de)i,e that li$its yo( fro$ seeing other worlds. E(t of sight are those yo( left *ehind or those yo( (neasily s(spe,t $ay lie ahead. 0here is also a gathering ,oheren,e that see$s to go with the territory. 's ti$e passes, this ,oheren,e $ay *e,o$e in,reasingly well defined and $ore f(lly -nit. 0hat is why it is only ne,essary to da$age one pie,e of a world to *ring down $any related str(,t(res. 8e)ertheless, these worlds ha)e enor$o(s resilien,y. 4n $y lifeti$e, in the field 4 a$ in, 4 ha)e *een sha-en *y earth5(a-es se)eral ti$es. 4 ha)e tended to $o)e on to a new ,o$$(nity, *(t $any of the inha*itants of the old ones ha)e re*(ilt and gone on as *efore. 4t ta-es an earth5(a-e that stri-es at a deep str(,t(re le)el, li-e finan,es, to $arhistori, ,hange. 0he health ,are (phea)al, for *etter or worse, has gi)en one of the ,ities in $y field a $andate to *e the ,apital. Gathered (nder the $edi,ali9ed roof of !&% 4A, we find an atte$pt to en($erate and des,ri*e all e+isting pro*le$s of *eha)iorD life pro*le$s, death pro*le$s, $ind pro*le$s, disease pro*le$s, po)erty pro*le$s, ,lass pro*le$s, )iolen,e pro*le$s, se+ pro*le$s, wor- pro*le$s, lo)e pro*le$s. We see the proliferation of pathologi,al titles Ken has tal-ed a*o(t, and there see$s no (pper li$it on what ,an *e a*sor*ed into the syste$ of na$ing. 't the sa$e ti$e, 4 thin- this $ay *e the good fort(ne of fa$ily therapists. Conditions that are C$erelyC relational ha)e *een e+e$pted fro$ in,l(sion in !&% 4A, e+,ept for a *rief nod to a relationship3oriented a+is that $ay not e)en *e rei$*(rsed. &o perhaps we ha)e *een res,(ed fro$ the Crage to order.C #arlene 'nderson (199<) and Ken #ardy (199<) were re,ently as-ed to answer the ,harge that fa$ily therapy wo(ld *e $arginali9ed (nless it *e,a$e $ore identified with the C$a>or dis,iplinesC in $ental health (&hields, Wynne and Gawins-i, 199<). &o $(,h the *etter, they said. Enly *y re$aining the one health ind(stry that does not gi)e people la*els or diagnose ,onditions, ,an it represent an i$portant strea$ of e)ol(tion in the field. 0hat is $y position too. HA: 0he passionate plea for the in,l(sion of relational diagnoses in the !&%4A lo,ates fa$ily therapy within psy,hiatri, dis,o(rse, with its $edi,al heritage, its aspiration to $i$i, nat(ral s,ien,es, and its $odernist, positi)ist disposition. 0his is (nderstanda*le. 's Ken s(ggests, diagnosti, syste$s gi)e a sense of legiti$a,y, ,onfiden,e and predi,ta*ility *oth to the professional and to the ,lient. 4n *oth psy,hotherapy and the *roader ,(lt(re, a diagnosis i$plies that the o*>e,t of in5(iry and the $ethod of in5(iry are g*ased on sta*le ass($ptions li-e those in the *io$edi,al real$. 4t operates as a professional ,ode whi,h ahas the f(n,tion of gathering, analy9ing and ordering waiting3to3*e3dis,o)ered data. 's si$ilarities and patterns are fo(nd, pro*le$s are then fitted into a defi,it3*ased syste$ of ,ategories. 4n a larger sense, this fra$ewor- is *assed on the ass($ption that lang(age is representational and ,an a,,(ragtely depi,t Creality.C Whin 4 thin- of diagnosis, 4 thin- of ,y*erneti,ian, #ein9 )on Foerster7s re$ar-, C2elie)ing is seeing.C 4$pli,it in the !&% 4A is the ass($ption that psy,hotherapy is a relationship *etween an e+pert who has -nowledge and a non3e+pert who needs help. 0he p(*li,, the profession and the state ha)e gi)en a(thority ot the therapist to ,olle,t infor$ation a*o(t the ,lient and pla,e it on a pre deter$ined therapist $ap fro$ whi,h the diagnosis is then deri)ed and the treat$ent plan de,ided. 0his pro,ess red(,es (n,ertainty *y telling the therapist what the therapist o(ght to do and s(ggesting how the ,lient o(ght to ,hange in order to get well. Fro$ a post$odern pserspe,ti)e, a relational or C*etween personsC diagnosis is no different fro$ an indi)id(al or Cwithin3the 3personC diagnosis. 0he in,l(sion of fa$ily therapy ,riteria for C*eha)ioral healthC wo(ld si$ply pla,e a new layer of la*els (pon an old one. For politi,al, e,ono$i,, and legiti$ation reasons, this wo(ld *e a great step forward for fa$ily therapy, *(t in ter$s of its heritage as an alternati)e e+planatory )iew, it ,onstit(tes a great step *a,-. &i$ply to ass($e that the iss(e is a 5(estion of an indi)id(al )ers(s a relational ,lassifi,ation is to o)ersi$plify a set of ,o$ple+, e)er ,hanging h($an dyna$i,s. 4f one approa,hes these 5(estions fro$ a post$odern, so,ial ,onstr(,tionist perspe,ti)e, these are no longer rele)ant 5(estions. &o,ial ,onstr(,tionis$ frees one to thin- in ter$s of indi)id(als3in relationship rather than an indi)id(al3 relationship di,hoto$y. 4t also lo,ates psy,hologi,al -nowledge in a so,iohistori,al ,onte+t and treats it as a for$ of dis,(rsi)e a,ti)ity (!an9iger, 199=, "(ria, 19@11 Gergen, 19@:, 19;?). !is,(rsi)e a,ti)ity refers to Wittgenstein7s (1966) ,hallenge to see lang(age as representational 3 an e+pression of the nat(re of things 3 and his alternati)e idea that we generate des,riptions and e+planations in the $eans of ,oordinating o(rsel)es with ea,h other. 4t is the lang(age that ,onstr(,ts what we ta-e to *e the person and the relationship. !iagnoses, for instan,e, are so,ially ,onstr(,ted $eanings p(t forth *y the do$inant professional ,(lt(re. ' diagnosis is an agree$ent in lang(age to $a-e sense of

so$e *eha)ior or e)ent in a ,ertain way. 2(t a so,ial ,onstr(,tionist perspe,ti)e warns (s that this -ind of agree$ent $ay $islead (s into holding the diagnosis to *e tr(e. 4s it the diagnosti, reality we sho(ld *e treating in therapyB &o,ial ,onstr(,tionis$ in)ites alternati)e 5(estionsD What is the intent of a diagnosisB What 5(estions are *elie)ed to *e answered *y diagnosisB What infor$ation is tho(ght to *e gainedB What does one want a diagnosis to ,o$$(ni,ate and to who$B 4f there are $any ways to thin- a*o(t, to des,ri*e what $ay *e tho(ght of as the sa$e thing (i.e., *eha)iors, feeling), how ,an we respe,t and wor- within all realitiesB &ho(ld we ,onsider the possi*ility of $(ltiple diagnosesB #ow ,an we *ring the ,lient into the pro,essB #ow ,an, and is it possi*le, for a diagnosis to *e $eaningf(l for all in)ol)edB #ow ,an it *e ,olla*orati)e, tailored to the indi)id(al, (sef(lB What other words ,an we (seB 4f we re>e,t diagnosti, ter$s, sho(ld we try to pers(ade the helping syste$ to ,hange its nosologyB #ow do we de)elop a way in whi,h $(lti)erses ,an ,o3e+istB 4f one )iews life as dyna$i,, (nsta*le, and (npredi,ta*le then in5(iry a*o(t it $(st *e e)er a,ti)e. 4f one )iews -nowledge as so,ially ,reated and -nowledge and -nowers as interdependent, then it $a-es sense to in,l(de the ,lient in the diagnosti, pro,ess. 0his $o)es diagnosis fro$ the real$ of a pri)ate dis,o(rse to a shared in5(iry in whi,h diagnosis *e,o$es a $(t(al dis,o)ery pro,ess. 4n a serendipito(s way ,lients ha)e *e,o$e in)ol)ed in ,reating their own diagnoses and ideas a*o(t treat$ent. E(r ,(lt(re3*o(nd h($an nat(re ,o$pels (s to want to -now what is wrong, to ha)e a na$e for a pro*le$. With the help of the $edia, diagnosti, lang(age and preferred treat$ents ha)e lea-ed into the p(*li, do$ain. We all ha)e ,lients who ,o$e in with self3diagnoses s(,h as C,o3dependentC and Cad(lt ,hild of an al,oholi,C and ,lients who re5(est ro9a, for depression or a twel)e step gro(p for addi,tion. 4 5(estion, howe)er, whether these self3diagnoses do not often yield (nwor-a*le pro*le$s for *oth the ,lient and the professional. !iagnoses, offi,ial and (noffi,ial, often ,on,reti9e identities that li$it people1 they ,reate *la,- *o+es with few, o*s,(re e+its1 and they for$ o*sta,les to $ore )ia*le and li*erating self definitions ('nderson, 1996). 4 re,ently tal-ed with a ,o(ple who had appeared on a tele)ision tal- show fo,(sed on gender iss(es in ,o(ples. 0he show7s g(est e+pert had diagnosed the h(s*and as Cirresponsi*leC (an indi)id(al des,ription), the wife as an Cad(lt s(r)i)or of ,hildhood in,estC (an indi)id(al des,ription) and the ,o(ple as C,o3dependentC (a relational des,ription). When 4 saw the$ they were e$*roiled in a *attle to $a-e hi$ responsi*le, to pro$ote her Cs(r)i)orhoodC and to $a-e the$ independent of ea,h other. 0hey were prisoners of diagnosis3,reated (nwor-a*le pro*le$s. Er, as Ken Gergen s(ggests, e)ery $o)e they $ade was dysf(n,tionali9ed. 0his is the tyranny of diagnosis. 0hin-ing of therapy and diagnosis fro$ a post$odern so,ial ,onstr(,tionist perspe,ti)e redefines the therapist3,lient relationship and ,hallenges professional -nowledge. 4t $o)es therapy fro$ a relationship *etween a -nower and on who is ignorant to a ,olla*orati)e partnership in whi,h the de,iding of, the e+ploring of, and the Csol)ingC of pro*le$s is a pro,ess of shared in5(iry in whi,h the diagnosis is not fi+ed and the pro*le$ $ay shift and dissol)e o)er ti$e. 4t in)ites the ,lient7s )oi,e and their e+pertise on their li)ed e+perien,es. 2ringing in the ,lient7s )oi,e 3 the words and ter$s that ha)e signifi,an,e for the ,lient 3 gi)es prod(,ti)e life to e)eryday lang(age. 0he yield is a $ore >ointly ,reated and th(s $ore ,ooperati)e lang(age, that generates $ore possi*ilities than professional )o,a*(laries 3 *ased on pre3-nowledge that prod(,es lifeless, sterile loo-3a3li-es 3 and s(ppresses the (ni5(eness of the indi)id(al ,lient7s narrati)e ('nderson, 1996). ' ,onstr(,tionist stan,e fa)ors a $ore $(t(al, personali9ed -nowledge. 0his )iew of therapy and diagnosis entails (n,ertainty, and 4 reali9e that so$e $ight 5(estion this ethi, of (n,ertainty, *(t 4 5(estion the ethi, of ,ertainty. 0his is why 4 do not fa)or adding a Crelational diagnosisC to the one already in (se. Kaslow (199:) en)isages the Cfor$(lation of a lang(age and a typology that ,an *e (tili9ed, with a high degree of ,onsens(s a*o(t definitions and ,riteria sets, *ased on solid reasear,h findings, *y fa$ily therapists e$anating fro$ $any dis,iplines and theoreti,al pers(asionsC wi,h wo(ld e)ent(ate in a C)alidated nosology of relational disorders.C 0here are $any reasons, *oth theoreti,al and pra,ti,al, for do(*ting this possi*ility1 and there are $any reasons for arg(ing against s(,h an end. "i-e Ken and "ynn, 4 s(ggest that rather than tal- a*o(t a relational diagnositi, syste$, we need to ,onsider new and $ore pro$ising dire,tions for fa$ily therapy and psy,hology. Ef ,o(rse this lea)es (s sha-en. %any 5(estions are left hanging. What do therapists do with their professional -nowledge and past e+perien,eB #ow do we then ,o$$(ni,ate with professional ,olleag(es, ,lients and ins(ran,e ,o$paniesB 0he ethi,al 5(estions that fa,e (s in this new era of $anaged health ,are are far *roader and $ore da(nting, for instan,e, than si$ply whether s(*$issions for ins(ran,e rei$*(rse$ent are fa,t(ally ,orre,t. KJG: 's 4 ha)e *een deli*erating on yo(r ,o$$ents, "ynn and #arlene, 4 ha)e *een trying to ta-e the role of an essentialist, diagnosti,ian, and as-ing $yself what 5(estions 4 wo(ld raise. Ene of these is a 5(estion 4 ha)e often fa,ed $yself, and it ,on,erns the e+isten,e of what we wo(ld generally ta-e to *e Cthe real world.C 4n $ore ho$ely fashion, one as-s Cisn7t there so$ething these ter$s refer to, and aren7t these -inds of *eha)iors deeply pro*le$ati, *oth for the indi)id(als (or fa$ilies) as well as the so,ietyB We $(st ha)e so$e way to tal- a*o(t these patterns within

o(r profession, so$e way to share o(r -nowledge of effe,ti)e treat$ent. &o don7t we re5(ire >(st these for$s of ter$inologyBC 'nd, s(,h an interrogator $ight add, we need s(,h ter$s e)en if we agree with the ,onstr(,tionist arg($ent that these $ay not *e the only or the $ost a,,(rate ways of des,ri*ing s(,h a,tions. 4 wo(ld )iew this as a reasona*le 5(estion, granting that we spend $ost of o(r ti$e in ,(lt(ral traditions where the Creal worldC ,o(nts. #owe)er, granting in this sense that there is Cso$ething these ter$s refer to,C the 5(estion *e,o$es, as yo( s(ggest #arlene, whether and for what we re5(ire the professional la*elsB 't the o(tset, the arg($ent si$ply doesn7t hold that the diagnosti, ter$s des,ri*e o*ser)a*le *eha)iors. 8one of o(r ter$s, either fro$ !&% 4A, or fro$ the newly de)eloping )o,a*(lary of relational diagnosis, a,t(ally refer to the spe,ifi, $o)e$ents of people7s *odies thro(gh ti$e and spa,e, the so(nds they e$it, the li5(ids or s$ells they e+(de 3 or anything else we ,o(ld assess with a set of $e,hani,al instr($ents. .ather, they refer to hypotheti,al pro,esses, $e,hanis$s, or p(rposes lying *ehind or ser)ed *y a set of *eha)iors. 4f 4 say an indi)id(al is Cdepressed,C *ased on a set of ite$s fro$ a depression in)entory, it is not the ,he,-$ar-s on the paper to whi,h 4 a$ referring *(t what these ,he,-$ar-s s(ggest a*o(t a state of $ind. Fet, 4 ha)e no a,,ess to a state of $ind1 this 4 pres($e a priori (or yo( $ight say, *e,a(se of the parti,(lar $yths a*o(t the $ind whi,h 4 inherit fro$ ,(lt(ral history.) 4n the sa$e way, 4 don7t as a therapist o*ser)e dysf(n,tional *eha)ior. 4 o*ser)e *eha)ior whi,h 4 la*el as dysf(n,tional gi)en a set of )al(es whi,h 4 hold a*o(t what is f(n,tional. 0o *e s(re, these are a,ade$i, arg($ents si$ply designed to deflate the pres($ption that professional la*els ha)e (na$*ig(o(s referents (see also &ar*in and %an,(so, 19;=1 Wiener, 1991). #owe)er, shortly 4 will propose that *e,a(se of this pro*le$, the therape(ti, ,o$$(nity stands in great danger. 8ow, if o(r la*els are *(t s,antily tied to o*ser)a*les, the 5(estion of Cwhy la*elC ta-es on new di$ensions. We ,an not say that we need the la*els to ,o$$(ni,ate professionally a*o(t the ,ases we ,onfront, *e,a(se there is no gro(nds to *elie)e that what yo( $ean (in ter$s of spe,ifi, *eha)ior) *y Coppositional defiant disorder,C or Cpartner relational pro*le$C is the sa$e thing that anyone else $eans1 and sho(ld we agree, there is no $eans of s(*stantiating this ,on,l(sion o(tside o(r lo,al agree$ent. 0h(s, the diagnosti, ter$s help (s to thin- that we are all wor-ing on the sa$e pheno$ena, *(t this is to ,reate a false sense of se,(rity. !o the professional diagnoses then help the ,lientB &(rely this is the $ost signifi,ant 5(estion we sho(ld *e as-ing. 0here is reason for de*ate here, for so$e ,lients $ay indeed prefer the se,(rity of a professional ter$ to repla,e what they feel are their own flo(ndering atte$pts to ,o$prehend. 0he a)aila*ility of the diagnosis s(ggests that s(,h ,ases are possi*ly ,o$$on, well -nown, well (nderstood, and 5(ite effe,ti)ely treata*le. 'nd, while to gi)e a diagnosis (nder s(,h ,onditions wo(ld *e an a,t of *ad faith on the therapist7s part, there $ight *e a$eliorati)e pla,e*o effe,ts. 't this point 4 a$ drawn to the wisdo$ of #arlene7s ,o$$ents ,on,erning the e)er3shifting ,hara,ter of daily a,ti)ity, the ,o$$(nal ,onstr(,tion of $eaning, and the ways in whi,h lang(ages f(n,tion in daily life. For, it $ight *e as-ed, in the long r(n is it not a greater ,ontri*(tion to the li)es of o(r ,lients (and indeed o(r own), if we ha)e $(ltiple ways of (nderstanding o(r a,ti)ities, if we ,an see how different gro(ps $ight des,ri*e what we do, if we (nderstand how these )ario(s des,riptions add or s(*tra,t fro$ life7s 5(alityB %ost of (s are f(lly aware that we o(rsel)es are too ,o$ple+ to slot into ,ategories, that relationships are s(*>e,t to infinite interpretation, that the sa$e a,tions and the sa$e des,riptions $ay $ean different things at different ti$es and with different ,onse5(en,es. Wo(ld we not wish o(r ,lients to ta-e ad)antage of these for$s of ,(lt(ral wisdo$B 4n whose ser)i,e do we Cfree9e the fra$eBC Earlier 4 $entioned the possi*ility of danger. 2oth "ynn and #arlene endorse a field of fa$ily therapy that is (ni5(e in its a)oidan,e of a professional nosology, a field that in $y opinion wo(ld th(s *e at the ,(lt(ral forefront. 4n the long r(n there is reason to *elie)e that the other helping professions will follow s(ite. For there is $(,h grass roots antipathy de)eloping for the -inds of diagnoses to whi,h patients ha)e *een e+posed o)er the years, organi9ations of e+3$ental patients who feel they ha)e *een ill ser)ed *y the pra,ti,es of the $ental health professions (Cha$*erlin, 199=), and fe$inist gro(ps who feel wo$en to *e )i,ti$s of the e+isting nosologies (see, for e+a$ple, Caplan, 19;@1 1991). 'nd there are professionals fro$ aro(nd the glo*e who (li-e (s) feel that diagnosti,s are $ore in>(rio(s than helpf(l. 0he day will soon ,o$e (and indeed 4 will lend $y efforts to the o(t,o$e) in whi,h those who re5(ire assistan,e for their pro*le$s will *ring for$al litigation against those who diagnose. When diagnosti, ,ategories *e,o$e part of one7s per$anent re,ords, and s(,h re,ords *e,o$e a)aila*le for )ario(s e)al(ati)e p(rposes, the $ental health profession will ha)e no legiti$ate gro(nds on whi,h to defend the pra,ti,e of diagnosis. LH: 4 agree with yo(r warnings, Ken and #arlene, a*o(t the har$f(lness of diagnosti, la*eling, or what 4 ,all Cpsy,hiatri, hate spee,hC. 0o find o(t what is a,t(ally e+perien,ed as hatef(l, 4 ha)e *een e+peri$enting with ,ons(ltations in wor-shops. 4 will tal- with a therapist a*o(t a fa$ily sit(ation (4 ha)e a*andoned the ter$ C,aseC) while the fa$ily is sitting there o)erhearing (s. 4 will then as- the fa$ily to ,o$$ent on o(r ,on)ersation. 8e+t 4 will as- the a(dien,e, in s$all gro(ps, to arri)e at so$e ideas to refle,t *a,- to the fa$ily. 0he gro(ps ta-e t(rns telling $e their ideas, whi,h 4 write down on a flip,hart, *(t only after these are filtered thro(gh fa$ily $e$*ers7 rea,tions. 0his has *een a )ery interesting pro,ed(re, in that we ,reate a fa$ily3sensiti)e set of des,riptions rather than the (s(al

professional ones i$posed fro$ o(tside. 4 re$e$*er one in,ident in)ol)ing a stor$y ,o(ple who ,o(ldn7t stay together and ,o(ldn7t stay apart. Ene a(dien,e gro(p had ,o$$ented that the ,o(ple see$ed to ha)e an addi,tion to ,risis. 'nother gro(p, referring to a lo,al spot whi,h was -nown as the 2(ngee Capital of 8orth '$eri,a, li-ened their relationship to a pair of $arried *(ngee >($pers. 0he ,o(ple o*>e,ted to the first idea, *(t war$ly a,,epted the se,ond. Eperations li-e this repla,e the (s(al e+pert $odel for diagnosis with a less pe>orati)e one. 4n doing ho$ewor- for this pie,e, 4 fo(nd $yself e+a$ining so$e of the $ore relational s,he$es for diagnosis. Ene that a,t(ally $ade it into the !&% 4A (199<), at least into the 'ppendi+, is fa$ily psy,hiatrist "y$an Wynne7s CGlo*al 'ssess$ent of Fa$ily F(n,tioning &,aleC (G'.F) whi,h parallels the CGlo*al 'ssess$ent of F(n,tioning &,aleC (G'F) for indi)id(als, reported (nder '+is A. G'.F refle,ts the early thin-ing a*o(t fa$ily therapy that was *ased on the idea that the fa$ily is a Csyste$C, that is, a (nit ,o$posed of s(*parts a,ting interdependently (pon ea,h other. 0his analogy was apparently ,ontri*(ted *y 0al,ott arsons (19?1), whose nor$ati)e $odel for fa$ily f(n,tioning was a powerf(l i$age in the field (ntil re,ently, when the late psy,hologist #arold Goolishian (19;;) ,hallenged it. 'nother effort to ,reate a relational fra$ewor- for diagnosis has *een offered *y Karl 0o$$ (1991), a psy,hiatrist fro$ Canada. 0o$$ *elie)es that a fa$ily in whi,h there is a patient is one in whi,h the ,o$$(ni,ation is do$inated *y har$f(l patterns. 0hese patterns are not prod(,ed *y the fa$ily syste$ per se, *(t are a res(lt of )i,io(s ,y,les in whi,h efforts to stop the pattern only reinfor,e it. 0o$$ ,alls these se5(en,es athologi,al 4nterpersonal atterns ( 4 s), and sees therapy as a $atter of repla,ing the$ with #ealing 4nterpersonal attern (#4 s). 's a ,onstr(,tionist, 4 find *oth Wynne7s and 0o$$7s for$(lations an i$pro)e$ent on !&% 4A7s ,ategories in that they are not so (n-ind to the indi)id(al, *(t 4 still feel (n,o$forta*le with their ass($ption of an ontologi,ally transparent pathology. Fort(nately, the re,ent >($p to a narrati)e analogy has p(t diagnosis on a new tra,-. 0his tra,- >ettisons the notion of an o*>e,ti)e assess$ent of pathology, preferring to thin- of these for$(lations as stories, or for$s of dis,o(rse. 4n one swift shift of $etaphor, we are ,atap(lted into a post$odern (ni)erse where CrealityC is pla,ed in 5(otes. White and Epston (199=), a$ong others, sho)ed the ,anoe fro$ the *an- *y opposing the Cpro*le$3sat(ratedC story and >oining for,es with the fa$ily to find a new, $ore hopef(l one. ' -indred so(l to White is Chris Kin$an of 2ritish Col($*ia. 4n wor-ing with First 8ations yo(th, Kin$an has *een )ery ,on,erned to help ,reate alternati)es to the (s(al stereotyped pi,t(res of pro*le$ati, teens. While trying to ,o$e (p with a narrati)e *ased set of diagnosti, tools, he has *een e+peri$enting with the ter$ Cdis,o(rse,C (sing it to fra$e the sit(ation of a yo(ng ,lient *y lo,ating it (nder headings li-e, C!is,o(rses of Fo(th and eersC or C!is,o(rses of Fo(th and &,hoolC (Kin$an and &anders, 199<). 0hese des,riptions are arri)ed at *y ,on)ersations with the indi)id(al in 5(estion and with other people in the fa$ily or ,o$$(nity. 4 $ention these efforts *e,a(se e)en tho(gh $any of (s deplore the psy,hiatri, profession7s e+traordinary atte$pt to ,o)er all *ases in a gra* for territory, the appearan,e of !&% 4A has a,ted as a $ost i$portant gadfly. 0he field of fa$ily therapy see$s to ha)e *een preparing itself for this fight in )iew of the in,reasingly swift a,,eptan,e of a so,ial ,onstr(,tionist and narrati)e point of )iew. 4 wo(ld li-e to $a-e one last point in saying that this ,onstr(,tionist )iew is ,ongr(ent with the $o)e$ent toward (ser friendliness in fa$ily therapy (.ei$ers and 0rea,her, 199?). ' re,ent news report on $alpra,ti,e s(its against $edi,al pra,titioners fo(nd that the n($*er of s(its ,orrelated with a poor C*edside $annerCD those who ta-e ti$e with their patients, listen attenti)ely to the$, and show -indness, are s(ed far less often than their *r(s5(er ,o(nterparts. 4n an era of $anaged ,are, the ,lient7s story is going to *e listened to $ore ,aref(lly, and there will *e a $o)e toward in,l(ding the (ser in the ,on)ersation, espe,ially the ,on)ersation aro(nd diagnosis. 't the sa$e ti$e, e)en when 4 disagree with a position, 4 li-e to >oin with what is already in pla,e. 4n this respe,t, 4 find that the str(,t(ring of diagnosis aro(nd a+es of )arying h(es offers a (sef(l starting point. 4t is easy to i$agine this for$at transfor$ing into a .osho$on3li-e array of differing perspe,ti)es. C(sto$ers ,o(ld ha)e a spe,ial a+is to the$sel)es or a separate pla,e to ,o$$ent on ea,h a+is. &in,e the pro,ess of definition is the pri$ary fra$ing a,t of any -ind of therapy or ,ons(ltation, it deser)es as $(,h ti$e as is needed. 'ttention to this aspe,t see$s to $e ,r(,ial, not only in e+posing the *edro,- nat(re of therapy as a politi,al as opposed to a $edi,al e)ent, *(t in allowing all parties to ha)e their day in ,o(rt. HA: 4 a$ parti,(larly ,apt(red *y Ken and "ynn7s interest in the ,lient7s )oi,e33the ways in whi,h so$e ,lients either >ointly thro(gh organi9ed asso,iations or sing(larly thro(gh the ,o(rts are se,(ring an arena for the ,ons($ers7 senti$ents and grie)an,es. Ken spea-s of the days of litigation to ,o$e. 4 thin- they ha)e already *eg(n. %edia reports of patients s(ing therapists (and winning) are no longer an ano$aly. We read reports of patients who s(ed therapists for ,reating false $e$ory syndro$es and $(ltiple personalities. .e,ently parents s(ed their si+teen year old da(ghter7s therapist for not thoro(ghly in)estigating her a,,(sations of se+(al a*(se. &(,h a,tions threaten the false sense of se,(rity that diagnosis gi)es the professional and highlight the ,o$ple+ity of h($an *eha)ior and intera,tions. "i-ewise, s(,h a,tions sho(t the i$portan,e of g(aranteeing the ,ons($er7s )oi,e, *e it ,lient, ins(ran,e

,o$pany, $anaged health ,are agent or therapist. "i-e "ynn, 4 a$ drawn to the hope that a narrati)e perspe,ti)e ,an pro)ide a possi*le relief fro$ the defi,ien,y and illness lang(age in the $ental health field. 8arrati)e (nderstanding ta-es into a,,o(nt the *eliefs and intentions and the narrati)e histories and ,onte+ts that (nderpin, shape and gi)e signifi,an,e to those a,tions. 's s(,h, narrati)e (nderstanding offers the possi*ility of (nderstanding, and e5(ally i$portant, not (nderstanding the a,tions of others. 4 wo(ld li-e to e,ho Goolishian7s ,o$$ent in his plenary paper for the #o(ston Gal)eston 4nstit(te7s ,onferen,e, 0he !is3diseasing of %ental #ealth, held in E,to*er, 1991. #e said, CWe $(st rely on the ,apa,ity that people ha)e for the narrati)e ,onstr(,tion of their life and we $(st redefine therapy as a s-ill in parti,ipating in that pro,ess...4t will ta-e $ore than relational lang(age...We $(st de)elop a lang(age of des,ription that $o)es (s o(t of the ling(isti, *la,hole in whi,h we are now ,apt(red.C 4nspired *y Wittgenstein7s words in C(lt(re and Aal(eD 8o*ody ,an tr(thf(lly say of hi$self that he is filth. 2e,a(se if 4 do say it, tho(gh it ,an *e tr(e in so$e sense, this is not a tr(th *y whi,h 4 $yself ,an *e penetrated1 otherwise 4 sho(ld ha)e to go $ad or ,hange $yself. Goolishian ,ontin(ed, CE(r lang(ages of des,ription are not only nor$ati)e *(t they ha)e, o)er the years, ended (p for,ing so,ially ,onstr(,ted self narrati)es on o(r ,lients of (selessness and filth.C 4s it possi*le that as a res(lt they often sele,t the option Cto go $adBC KJG: Ene hope that the three of (s shared in this effort, was that the trialog(e as a for$ of writing wo(ld itself de$onstrate so$e of the ad)antages of a ,onstr(,tionist orientation to relational diagnosis. What happens if we depart fro$ $onolog(e (whi,h parallels the sing(lar )oi,e of diagnosti, la*eling pra,ti,es) and approa,h a $(lti3)o,al ,on)ersation (fa)ored *y the ,onstr(,tionist)B 4n so$e degree 4 thin- we ha)e $ade good on this hope, inas$(,h as ea,h of (s has *ro(ght a (ni5(e )oi,e to the ta*le, drawing fro$ different e+perien,es, relationships, and literat(res. E(r ,ase is ri,her *y )irt(e of o(r >oint3parti,ipation. 't the sa$e ti$e, *e,a(se there is so $(,h general agree$ent a$ong (s, the trialogi, for$ hasn7t *losso$ed in f(llest degree. We ha)e not yet ,ashed in on its ,atalyti, potential. 0o e+plore this possi*ility, 4 want to fo,(s on a point of disagree$ent. #ow ,an we treat ,onfli,t within this ,on)ersational spa,e in a way that is different fro$ a $onologi,al orientation (where the interlo,(tor typi,ally shields internal ,onfli,ts in fa)or of a,hie)ing f(ll ,oheren,e)B 0he fa,t is that 4 do not in the ,ase of diagnosti,s fa)or "ynn7s preferen,e for >oining Cwhat is already in pla,e.C 's she points o(t, Cthe pro,ess of definition is the pri$ary fra$ing a,t of any -ind of therapy or ,ons(ltation,C and, *y )irt(e of o(r )ario(s ,riti5(es, proposes to $(ltiply the range of definitions, e)en to in,l(de those of the ,lients the$sel)es. erhaps 4 feel $ore ,riti,al toward diagnosis, *(t 4 as-, if it is in>(rio(s to o(r C,lients,C why >oin what is in pla,eB Why sho(ld we a,,ept the pro,ess of definition as a pri$ary feat(re of therapy or ,ons(ltationB 8ow 4 reali9e that it is perhaps easier for $e to ta-e this strong position, *e,a(se 4 a$ not a therapist and do not depend on $aintaining the therape(ti, traditions for $y li)elihood. 4 need not *e so ,on,erned with what is already in pla,e *e,a(se 4 ha)e fewer worries a*o(t what it does to $y relationships within the tradition (and $y fa$ily) sho(ld 4 de)iate sharply fro$ it. 'nd too, we ha)e already seen "ynn7s ,on,ern that the profession $aintain itself in a realisti, world of ,o$petition with the $ore diagnosti,ally prone $ental health professionals. 0h(s, as a ,onstr(,tionist 4 $(st (nderstand the intelligi*ility of "ynn7s preferen,es in ter$s of the relational $atri+ in whi,h she li)es. 'nd )i,e )ersa. 2(t where does s(,h re,ognition ta-e (sB 'nd, to play o(t the parallels with professional3,lient relations, what $ight follow if *oth the professional and the ,lient reali9ed the paro,hial nat(re of )ario(s diagnosti, la*els, respe,ting ea,h other *(t reali9ing that s(,h (nderstandings represent only one tradition a$ong $anyB 0here is no single answer to these 5(eries. 0he $ore general 5(estion of how to go on in a world of $(ltiple and ,onfli,ting realities is as profo(nd as it is ,o$ple+. #owe)er, let $e s(ggest that at least one possi*ility in the present instan,e is to lo,ate an alternati)e intelligi*ility with whi,h we ,an *oth li)e ,o$forta*ly. 4 a$ thin-ing here pri$arily in ter$s of ,lini,al pra,ti,es. 4t see$s to $e that we $ight share in the *elief that the pro,ess of la*eling $ay so$eti$es ha)e )al(e, that it is so$eti$es in>(rio(s, *(t that it is not essential to the pro,ess of therapy. 0hat is, therape(ti, effi,a,y does not depend ,hiefly on slotting ,lients into a set of predeter$ined and p(*li,ly a,-nowledged ,ategories. 4f we ,o(ld agree on this ass($ption, then we $ight as- whether it wo(ld *e possi*le to esta*lish so$e for$ of Cno fa(ltC ins(ran,e ,o)erage for therapy. &(,h poli,ies ha)e *een a $a>or *oon to di)or,e ,o(rts, where esta*lishing the original so(r,e of $arital pro*le$s has pro)ed i$possi*le. We enter $(,h the sa$e thi,-et in atte$pting to diagnose Cthe pro*le$C in ,ases of $ost h($an s(ffering. 4f ins(ran,e ,o$panies no longer re5(ired diagnoses for third party therapy *illings, then diagnosis ,o(ld *e,o$e optional 3 a)aila*le when (sef(l *(t not essential for treat$ent. 4f e)ery ins(red party in a gi)en ins(ran,e plan had the right to a li$ited n($*er of ,ons(ltations, then the fa,t that the

indi)id(al (or fa$ily) felt their s(ffering was se)ere eno(gh to de$and professional attention $ight *e s(ffi,ient. %ight we e+plore the possi*ilities together of instit(ting s(,h poli,ies a,ross the $ental health professionsB .efle+i)ely spea-ing, it see$s to $e that o(r present trialog(e has now $anaged to press o(r >oint thin-ing on these topi,s forward 3 so that the three of (s are ,hanged d(ring the ,o(rse of o(r ,on)ersation. 4 a$ not in pre,isely the sa$e pla,e 4 was when 4 entered the ,on)ersation. 4f this is so, is there not a lesson here for the traditional tenden,y in the profession toward $onolog(eB !iagnosti, la*eling has a way of Cstopping the ,on)ersation.C 0he professional anno(n,es Cyo( are GC or CFC and there is no o*)io(s $eans of the diagnosis *eing transfor$ed *y the s(*se5(ent ,on)ersation with the ,lient. %onolog(e ins(lates itself fro$ ,hange1 diagnosti,s radi,ally tr(n,ate the possi*ilities for therape(ti, transfor$ation. HA: Ken s(ggests that o(r trialog(e has not ,reated the ,atalyti, potential that hoped to a,hie)e. For $e, it has ,reated $ore tho(ghts than $y written words re)eal. 4 ha)e $ore of a dialog(e in $y head a*o(t diagnosis, and 4 fre5(ently *ring the iss(es of diagnosis into $y ,on)ersations with ,olleag(es and st(dents. 's in therapy, is the ,atalyti, potential e)er )isi*leB Can o(r words on paper f(rther the dialog(e a*o(t diagnosis for othersB 4 hope so. 4 will tell a story a*o(t a ,ase that )i)idly ill(strates the ,o$ple+ities of h($an pro*le$s and how diagnosis and diagnosis dri)en treat$ent ,an o)ersi$plify and e+a,er*ate the$D C4 as-ed $y da(ghter, why do yo( ha)e this e+oti, white wo$anHs diseaseBC 0hese words were spo-en *y the e+asperated father of Joan, a si+teen year old 'fro '$eri,an girl who, in her efforts to ,ontrol her weight, was star)ing herself to death. &he $et the essential ,riteria for 'nore+ia 8er)osa. Joan was hospitali9ed a year ago at a pri)ate psy,hiatri, hospital where her treat$ent in,l(ded indi)id(al, fa$ily and adoles,ent gro(p therapy. &he was dis,harged after := days when her psy,hiatri, hospitali9ation ins(ran,e *enefits were e+ha(sted and ad$itted to a pri)ate hospital $edi,al (nit where her pro*le$ was diagnosed as a $edi,al disorder. &he was dis,harged after one wee- when the ins(ran,e ,o$pany ,hallenged the $edi,al diagnosis, ha)ing deter$ined it was a prees+isting psy,hiatri, diagnosis, and therefore denying ,o)erage. 0he hospital physi,ian (rged the fa$ily to ,o$$it their da(ghter to a ,o(nty ,harity psy,hiatri, hospital where she ,o(ld re,ei)e psy,hiatri, ,are for := days at no ,harge. 0he fa$ily ref(sed. 0he physi,ian said that Joan was Cthe $ost diffi,(ltC and Cthe $ost de)io(s anore,ti,C that he had treated. #e feared she wo(ld Cslip thro(gh the ,ra,-sC if she did not re,ei)e ,ontin(o(s inpatient psy,hiatri, treat$ent. #is fear was ,orro*orated *y her and the fa$ilyHs *eha)iors. 4n tal-ing a*o(t the fa$ily he said fr(stratedly,C WeHre not on the sa$e page of the *oo-. 8o, weHre not e)en in the sa$e *oo-.C #e *elie)ed that the fatherHs responses did not $at,h the da(ghterHs life3threatening illness, and his *elief was )alidated ea,h ti$e the father, who was a $inister, tal-ed a*o(t spirit(ality and e+pressed his faith in his da(ghterHs Cfinding her wayC and Ctr(sting the pro,ess.C 0he physi,ian was also fr(strated with and p(99led *y the fa$ilyHs insin,erity and *y a fa$ily in whi,h the father was $ore a*sor*ed with the da(ghterHs eating disorder than the $other. #e said the fatherHs ,al$ness, as he des,ri*ed the father ,arrying his li$p da(ghter into the hospital e$ergen,y roo$, was C*i9arre.C 0wo wee-s after the $edi,al hospital dis,harge Joan dran- a *ottle of syr(* to ind(,e )o$iting, and *egan )o$iting (n,ontrolla*ly. #er parents too- her to the ,o(nty ,harity hospital where she was ad$itted *e,a(se the staff tho(ght Joan was s(i,idal. Joan insisted that she was not trying to -ill herself. 4n the ,o(nty hospital she had indi)id(al therapy and was dis,harged after two wee-s with the ,ondition that her fa$ily agree to engage in intensi)e fa$ily therapy. &he was referred to a pri)ate psy,hiatri, ,lini, whose inta-e s,reened her o(t *e,a(se the ins(ran,e *enefits were e+ha(sted. 0he pri)ate ,lini,, in t(rn, referred Joan to a nonprofit ,o(nseling ,enter. 0he referral was $ade to a spe,ifi, therapist3in3training who the inta-e person at the pri)ate ,lini, -new had personal e+perien,e with an eating disorder. JoanHs parents too- her to see the ,o(nseling ,enter therapist where it was agreed that the therapist wo(ld ,ontin(e to see Joan and that the parents wo(ld $eet with the therapist whene)er the therapist, Joan, or the parents felt it ne,essary. 0he fa$ily ,ontin(ed to ,ons(lt their fa$ily physi,ian who felt JoanHs pro*le$ was o(t of his real$ of e+pertise. #e referred Joan 33 si$(ltaneo(sly with the referral to the nonprofit ,o(nseling ,enter 33 to a pri)ate pra,ti,e therapist who spe,iali9ed in eating disorders. 0he fa$ily too- Joan to the spe,ialist who added the diagnosis %a>or !epression, &ingle Episode and initiated indi)id(al therapy for Joan and fa$ily therapy for her and her parents. #e too said that the fa$ily was Cthe $ost *i9arre fa$ily 4 ha)e e)er seen.C #e felt that Joan had Ctoo $(,h power o)er her parentsC and was C)i,ti$C of, and in t(rn was Ca,ting o(t her parentHs estrange$ent and ,onfli,t.C When he fo(nd o(t that the parents had a(thori9ed a ho$e3*o(nd s,hool progra$ for Joan he warned the ,o(nseling ,enter therapist that CJoan $(st go to s,hool...donHt yo( -now that anore,ti,s $anip(late and isolate.C #e saw the s,hool de,ision as e)iden,e that Joan had too $(,h power o)er her parents and now the ,o(nseling ,enter therapist and her s(per)isor. 0he pri)ate therapist ,ontin(ed to see Joan and the fa$ily and the ,o(nseling ,enter therapist ,ontin(ed to see Joan, so$eti$es twi,e a wee-, and to o,,asionally $eet with $e$*ers of her fa$ily in different ,o$*inations. Who ,a$e to the sessions depended on what as *eing tal-ed a*o(t and who wanted to ,o$e. 0he ,o(nseling ,enter therapist

tho(ght the parents were ,ooperati)e. 0hey always -ept their appoint$ents and often re5(ested additional appoint$ents. !ad (s(ally *ro(ght Joan to the sessions *e,a(se $other wor-ed and went to ,ollege. Joan tal-ed with the ,o(nseling ,enter therapist fre5(ently a*o(t the people who were C*(ggingC her *y trying to *e helpf(l. .eferring to a pre)io(s therapist, Joan said, C#e tho(ght he -new all a*o(t $e >(st *e,a(se 4H$ an anore,ti,.C &he tal-ed a*o(t how he ,onfronted her and a,,(sed her of *eing se,reti)e, isolating, and dishonest. &he wished people wo(ld let her *e herself. 0he therapist as-ed ,(rio(sly, C#ow do 4 treat yo(BC Joan said, C4 li-e wor-ing with yo( *e,a(se yo( donHt treat $e li-e 4H$ an anore,ti,. Fo( let $e *y $yself.C Joan tal-ed a*o(t how she wanted to *e a teenager with teenage pro*le$s, how she was worried a*o(t the way she e+pressed her anger, and how ill at ease she was with what her peers were doing. &he e+pressed an+iety a*o(t so,ial aw-wardness, *oys, the dar-, *eing lonely, e+pe,tations at ho$e that she sho(ld ta-e ,are of her yo(nger *rothers, ta-ing (p sla,- for ,hores her sister did not do, and wanting a >o* to earn so$e $oney. &he said she felt li-e an C(gly d(,-lingC and that people always ,o$$ented on how pretty her sister was. &he said, C4 want to *e an indi)id(al where others ,annot ,opy $e.C Joan e+pressed ,on,ern a*o(t her parentHs relationship, worrying that they were Cso distantC and that C$o$ *(ries herself in her wor-C and des,ri*ed how her $otherHs Csta,-s of paper had ta-en o)er the ho(se.C &he e+pressed her worry a*o(t how her parents get Cso stirred (pC when they tal- with the eating disorder therapist. 0he therapistHs ,(riosity a*o(t the fatherHs 5(estion, CWhy do yo( ha)e this e+oti, white wo$anHs diseaseBC led her to learn that the fa$ily li)ed in an all white neigh*orhood and that Joan had all white friends. (Joan did not see the ra,ial iss(e as a pro*le$ the way her father and *rother did). &he learned that the father was a pro$inent *la,- $inister and that the $other was a de)o(t Catholi,. 0he da(ghter went to ,h(r,h with the $other and the son went to ,h(r,h with the father. 0he father, pers(aded *y his religio(s *eliefs, felt that the da(ghterHs illness was Cthe wor- of the de)il.C C'll things happen for a p(rpose...God is testing her strength,C he said, and he *a,-ed (p his *elief with 2i*li,al 5(otes. #e was fir$ in his *elief that C0his is so$ething she is wor-ing o(t..4 tr(st her that she will wor- thro(gh this..tr(st her to $a-e de,isions a*o(t what is *est for her..to find her own way.C 0he $other see$ed gen(inely ,on,erned, C4 want Joan to feel that 4 a$ here for her.C (Ef ,o(rse, Joan tho(ght the $other was Cintr(si)e.C) 0he $other hoped that the therapist ,o(ld Chelp Joan with her e$otionsC and ,o(ld Chelp Joan tal- with the fa$ily a*o(t what is really *othering her.C JoanHs sister, li-e her $other, tho(ght it wo(ld *e helpf(l Cif she wo(ld >(st tal- to (s a*o(t it.C JoanHs older *rother pinpointed the stressf(l relationship *etween Joan and her yo(nger sister as the ,(lprit. #e felt strongly that if they were in a s,hool where the $a>ority of st(dents were *la,- that Joan, and her sister as well, wo(ld not ha)e pro*le$s or the split *etween the$ *e,a(se C4n an all *la,- s,hool yo( ha)e to sti,- together to prote,t yo(rself.C #e had se)eral other tho(ghts a*o(t JoanHs pro*le$ 33 all relating to ,(lt(ral iss(es. #e agreed with the dad that, C2la,- girls donHt ha)e anore+ia.C 4n refle,ting on her wor- with Joan and her fa$ily, the ,o(nseling ,enter therapist said, C't first 4 too- the diagnosis that the fa$ily and 4 had inherited serio(sly. 4 *elie)ed it. 4nfl(en,ed *y $y pre,on,eptions of anore,ti,s as rigid, ,ontrolling, isolating, perfe,tionists, 4 did not 5(estion the psy,hiatristHs and the eating disorder spe,ialistHs opinions and re,o$$endations. 4 tried hard to help Joan and her fa$ily. 4 tried to tal- with Joan and her fa$ily a*o(t the diagnosis and ,on)in,e the$ of the e+pertsH opinions on the indi)id(al and fa$ily dyna$i,s asso,iated with anore+ia ner)osa. 0he harder 4 tried, the worse Joan *e,a$e, and the $ore (pset and worried 4 *e,a$e.C "i-e the others *efore her, the $ore the therapist tried to treat the diagnosis the $ore f$aily $e$*ers a,ted in ways that )erified her pre,on,eptions a*o(t anore,ti,s and their fa$ilies and hen,e ,onfir$ed the diagnoisis. Fr(stration $o(nted (ntil, as the therapist p(t it, C's 4 got to -now Joan and her fa$ily, 4 grad(ally reali9ed that 4 was getting to -now another Joan, another $other, and another father. %y interest in what they were ,on,erned a*o(t led to ,on)ersations in whi,h Joan and her fa$ily fo(nd ,a(ses and answers that were $eaningf(l to the$. 0o $y s(rprise 4 too was *eginning to tr(st that Joan wo(ld find her answers and her own way. 4 reali9ed that 4 was seeing and hearing the person not an anore,ti, and a dysf(n,tional fa$ily.C 0hro(gh the therapist7s in5(isiti)enss a*o(t ea,h person7s ideas, she learned far $ore a*o(t the fa$ily and its $e$*ers than si$ply p(rs(ing what the diagnosis per$its. 0he dysf(n,tional nonsense of their a,tions and *eliefs now $ade sense. 's the therapy with Joan and her fa$ily ill(strates, there are as $any definitions of Ca pro*le$,C in,l(ding what ,as(ed it and its i$agined sol(tions, as there are people in ,on)ersation a*o(t the pro*le$. 'nd these ideas ,an ,hange o)er ti$e. 's 4 thin- a*o(t Joan and her fa$ily 4 -eep ret(rning to the notions of $onolog(e and dialog(e that Ken $entioned. E$*edded in $y earlier ,o$$ents is a *ias toward the pro,ess, or the essen,e, of therapy as a dialog(e. !iagnosis is part of this dialog(e. re,on,eptions ,an lead a therapist to an inner $onolog(e and ,an lead to d(eling $onolog(es *etween ,lient and therapist 3 and a$ong professionals. 0he therapist7s a*ility to 5(estion and not hold onto her pre,on,eptions allowed her to *e open and ,(rio(s a*o(t others. Joan and her fa$ily and the therapist >oined in

dialog(e 3 a ,on)ersational pro,ess in)ol)ing a shared in5(iry that led to shifts in the Cpro*le $C a$d $ew possi*ilities for all of the$. 0his leads $e to "ynn7s ,o$$ent on >oining. 4 a$ not s(re if *y >oining "ynn $eans agreeing with or (sing as a starting point for ,on)ersation. 8e)ertheless, 4 do not *elie)e that diagnosis or pro*le$ defining ne,essarily need to *e part of the therapy, altho(gh ,lients do (s(ally want to tal- a*o(t their pro*le$. 0hat is why they ,o$e. #ow pro*le$s and sol(tions e$erge and dissol)e thro(gh dialog(e, howe)er, is *eyond the s,ope of this trialog(e. (&ee 'nderson and Goolishian, 19;;1 and 'nderson, 199?.) 4 agree that thin-ing of diagnosis in ter$s of either3or o)ersi$plifies and ,lo(ds. &e)eral 5(estions ha)e *een inti$ated in this dis,(ssion on diagnosis and 4 thin- are worth highlighting. 4f there is a diagnosti, pro,ess, toward what ai$ and who deter$ines that ai$B What $eaning does the diagnosis ha)e for ea,h person in)ol)edB %ost i$portantly, what $eaning does it ha)e for the ,lientB 4s it a (sef(l $eaningB 4s it respe,tf(lB !oes it allow for the opening of doors 3 the ,reation of potentials 3 or does it ,lose doors and restri,t possi*ilitiesB !oes it perpet(ate the pro*le$B !oes it ,reate new pro*le$sB 0hese are the 5(estions we sho(ld ,onfront prior to de)eloping yet a new range of diagnositi,s. "ynn $entioned $anaged health ,are. 4 thin- that $anaged health are will f(rther $arginali9e the ,lientHs )oi,e. %anaged health ,are is already di,tating and poli,ing diagnoses. 4t is not (n(s(al for a $anaged health ,are ,o$pany to ref(se to a(thori9e ser)i,es e+,ept for the diagnosis assigned *y their ,ase $anager. 0herapy is not only a politi,al and a $edi,al e)ent *(t also an e,ono$i, e)ent. 2(t this leads (s to another topi,. LH: 4t does see$ that the ,on)ersation is now ta-ing (s into new spa,es. 0he 5(estion 4 ha)e is whether the shift wo(ld ha)e happened if 4 had not C>oined the oppositionC or if Ken had not ,hosen to CdisagreeCB 4f we had (sed a de*ate for$at fro$ the o(tset, with ea,h person ta-ing a different side, ,o(ld we ha)e rea,hed this point earlierB Catherine 2ateson said at a re,ent ,onferen,e that to ha)e the -ind of i$pro)isational ,on)ersation she finds (sef(l, people first ha)e to esta*lish that they ha)e a ,o$$on ,ode. &o perhaps it is a $atter of stages. What do the two of yo( thin-B 4n response to #arleneHs last ,o$$ents, it see$s to $e that therapists str(ggling to find a ni,he in $anaged ,are apparently see no other way o(t *(t to stay within the diagnosti, fra$ewor-. 'ltho(gh 4 ha)e opted o(t of this fra$ewor-. 4 felt that 4 sho(ld p(t $yself *a,- in to represent their Cside.C 2(t 4 thin- #arlene is right to say that this shift toward the $edi,al $etaphor not only distan,es (s fro$ o(r ,(sto$ers *(t $a-es (s less effe,ti)e. 0hen, sin,e no one ad$its to the $etaphor, we throw in $ystifi,ation as well. 4 a$ glad, #arlene, that yo( in,l(ded s(,h a )i)id story to ill(strate the dile$$a. 4 also greatly li-ed KenHs idea of Cno fa(ltC psy,hotherapy. With this s(ggestion, he has p(t hi$self in the ,ategory of C,a(sal agnosti,.C 4 got this ter$ fro$ a re,ent 8o*el pri9e winner, the e,ono$ist .onald Coase ( assell, 1991), who pioneered the idea that yo( didnHt ha)e to esta*lish ,a(se in ,ases of ,onfli,t o)er, say, responsi*ility for poll(tion. 4f yo( left it to the parties the$sel)es to fig(re o(t, they wo(ld pro*a*ly ,o$e (p with a $ore wor-a*le sol(tion on their own. 0he idea of e+,hanging air rights is an e+a$ple. CoasesH -ind of thin-ing, li-e KenHs, starts to gi)e e)ery*ody *reathing roo$. What is espe,ially interesting here is that what Ken is ad)o,ating is already ,o$ing to pass. 0he ,(tting edge of fa$ily therapy is $o)ing away fro$ a ,on,ern with pro*le$s and their ,a(ses. 0he *rief sol(tion oriented approa,hes that ha)e gained s(,h pop(larity and the narrati)e approa,h of %i,hael White are f(t(re3oriented, e+,ept for ways in whi,h the past predi,ts what White (19;9) ,alls C(ni5(e o(t,o$es.C 'n e)en $ore e+tre$e )ersion of that position, of ,o(rse, is the Cnot -nowingC stan,e of the late #arry Goolishian and #arlene. 0he therapist who ta-es that stan,e does not ,on,ern herself with ,a(ses e+,ept to the degree that they for$ part of different peopleHs stories. &he ass($es that the ,o$plaint wo(ld not ha)e ,o$e to her attention if it had *een e$*edded in ways of tal-ing that were helpf(l. 0he fo,(s is therefore as $(,h on ,hanging the style of the ,on)ersation as on what the ,on)ersation is a*o(t. 'nother idea that 4 thin- $ight sha-e things (p is to di)est o(rsel)es of the ,orp(s of tho(ght -nown as $odern psy,hology or the st(dy of the Cpsy,he.C 0he idea of the psy,he is (sef(l *e,a(se CitC is presented as a representation of an entity sitting inside the person li-e a tiny foet(s. 0his $a-es it easy to thin- of CitC as s(s,epti*le to fail(re, *rea-down or distortions in growing. #owe)er, d(ring psy,hologyHs period of s(pre$a,y in this $odernist ,ent(ry it has failed to present any ,lassifi,ation of disorders e5(al to that whi,h $edi,al resear,h and pra,ti,e has ,o$e (p with. 0he $ost ,(rsory loo- at !&% 4A shows it to *e *(ilt on ,o*we*s. 0his is *e,a(se Cin)isi*le illnesses,C as 4 ,all the$, are not analogo(s to disorders e+pressed in the *ody and are not, therefore, s(s,epti*le to ,ategory and $eas(re$ent. 4t is an e+er,ise in a*s(rdity to ,lai$ that they are. 4t is interesting to thin- of getting rid of the whole e+tended fa$ilyD Cpsy,hologyC, Cpsy,hiatry,C Cpsy,hotherapyC and the li-e. Ken has already done a *rilliant >o* in ,ontesting $any of these ,on,epts, together with their ass($ptions a*o(t the reality of the Cself.C For instan,e, he has s(ggested that psy,hology, in its e+planation for e$otional distress, is wedded to a d(*io(s *elief in the stages a so3,alled Cpsy,heC $(st go thro(gh to *e properly $at(re. sy,hiatry, when it is not *eing as $edi,al as possi*le, ,ontin(es to s(*s,ri*e to this idea of an intrapsy,hi, (nit, e)en tho(gh it is no

$ore pers(asi)e than !es,artesH little ho$(n,(l(s. 's for psy,hotherapy, the word and what it has represented are (ndergoing rapid ,hange. &in,e the $iddle of this ,ent(ry, 4 ha)e *een wat,hing the ,o(rse of what 4 ,all the so,ial therapies (*ased on ideas a*o(t relational diffi,(lties) as opposed to the psy,hologi,al therapies (*ased on ass($ptions of intrapsy,hi, dysf(n,tion). 4t $ay well *e that ,o(nseling, ass($ing that it is not sta$ped o(t *y $anaged ,are, will e)ent(ally end (p in the so,ial ,a$p, lea)ing psy,hiatry and psy,hology to the $aterial world of $e$ory, ,he$i,al i$*alan,e, and genes. Calling ,o(nseling a Cso,ial therapyC at least enlarges its s,ope. 0his widening pro,ess started with the anti3psy,hiatry $o)e$ent of the $id3twentieth ,ent(ry, for whi,h we $ay than- re*el philosophers li-e 0ho$as &9as9 (19@<) and ..!. "aing (19@1). Fa$ily therapy, the *astard $(tant that ,a$e into *eing aro(nd the sa$e ti$e, has *een another so(r,e of ,hange. 0here ha)e *een s(,,essi)e widenings sin,e that original i$p(lse, representing an effort to in,l(de progressi)ely $ore of the so,ial ,onte+t. Ene ,o(ld say that fa$ily therapy was only stage one1 stage two highlighted the professional ,onte+t1 throwing gender into the ring $o)ed (s to the le)el of the so,iety1 and now the ,on,ern with $(lti,(lt(ral iss(es is p(shing (s to in,l(de inter3so,ietal iss(es world wide. 0here is still a ,onser)ati)e ele$ent in the fa$ily field whi,h has -ept a )ersion of de)elop$ental theory on whi,h to *ase its ideas a*o(t dysf(n,tion and ,(re. 2y this 4 $ean the life stage te$plate on whi,h )ario(s )ersions of what 4 ,all Cfa$ily repression theoryC ha)e *een played o(t. 0his theory in,l(des all e+planations for e$otional distress s(pposedly ,a(sed *y repressed or (nresol)ed $e$ories. Fa$ily therapy orientations that lo,ate reasons for pro*le$s in losses that ha)e not *een grie)ed, anger that has *een s(ppressed, or (ntold fa$ily se,rets, fall into that ,ategory. 0his psy,hodyna$i, te$plate is also enshrined in widespread fol- *eliefs a*o(t the relationship *etween e+pressing e$otions and $ental health. 2(t the free radi,als in fa$ily therapy ha)e always *een those who re>e,ted the e$otional repression theories for a $ore interpersonal fo,(s on ,o$$(ni,ation and e+,hange. 4n any ,ase, the three of (s represent the position of a growing n($*er of relational therapists and resear,hers who are willing to ,hallenge the (se of la*els for $ental disorder and the e+pansionist p(sh to $edi,ali9e the whole enterprise. E(r hit list in,l(des all and any diagnosti, syste$s 3 *iologi,al, psy,hologi,al, or relational 3 that ha)e *een proposed. 4f we ,o(ld *(t ,ease o(r psy,hologi9ing, perhaps the dis,ipline of therape(ti, ,on)ersation ,o(ld *e released fro$ the grip of 8ewtonian s,ien,e and pla,ed (nder the aegis of lang(age arts, where we *elie)e it *elongs. References '$eri,an sy,hiatri, 'sso,iation (19?6) !iagnosti, and statisti,al $an(al for $ental disorders, First ed. Washington, !.C.D '$eri,an sy,hiatri, 'sso,iation. '$eri,an sy,hiatri, 'sso,iation (19;@) !iagnosti, and statisti,al $an(al for $ental disorders, 0hird ed. re)ised. WashingtonD !.C.D '$eri,an sy,hiatri, 'sso,iation. '$eri,an sy,hiatri, 'sso,iation (199<) !iagnosti, and statisti,al $an(al for $ental disorders, Fo(rth ed. Washington, !.C.D '$eri,an sy,hiatri, 'sso,iation. 'nderson, #. (1996) C therapy and the F word. '$eri,an Fa$ily 0herapy 'sso,iation 8ewsletter. ?=, 19366. 'nderson, #. (199<) .ethin-ing fa$ily therapyD ' deli,ate *alan,e. Jo(rnal of %arital and Fa$ily 0herapy, 6=, 1<?31?=. 'nderson, #. (199?) Colla*orati)e lang(age syste$sD 0oward a post$odern therapy. 4n .. %i-esell, "(ster$an, !.!., and %,!aniel, &. (Eds.) 4ntergrating fa$ily therapyD #and*oo- of fa$ily psy,hology and syste$s therapy. Washington, !CD '$eri,an sy,hologi,al 'sso,iation. 'nderson, #. and Goolishian, #. (19;;) #($an syste$s as ling(isti, syste$sD reli$inary and e)ol)ing ideas a*o(t the i$pli,ations for ,lini,al theory. Fa$ily ro,ess, 6@, :@13:9:. 'nderson, #. and Goolishian, #.'. (1996) 0he ,lient is the e+pertD ' not3-nowing approa,h to therapy. 4n &. %,8a$ee and K. Gergen (Eds.) 0herapy as &o,ial Constr(,tion. "ondonD &age. Caplan, .J. (19;@) 0he $yth of wo$en7s $aso,his$. 8ew For-D &ignet.

Caplan, .J. (1991) What7s happening these days with the !&%B Fe$inis$ and sy,hology, 1, :1@3:19. Cha$*erlin, J. (199=) 0he e+3patients7 $o)e$entD Where we7)e *een and where we7re going. Jo(rnal of %ind and 2eha)ior. 11, :6: ::6. !an9iger, K (199=) Constr(,ting the s(*>e,tD #istori,al origins of psy,hologi,al resear,h. 8ew For-D Ca$*ridge Ini)ersity ress. Eri,-son, G. (19;;) 'gainst the grainD !e,entering fa$ily therapy. '$eri,an Jo(rnal of %arital and Fa$ily 0herapy, 1<, 66?36:6. Gergen, K.J. (19@:) &o,ial psy,hology as history. Jo(rnal of ersonality and &o,ial sy,hology, 66, :=93:6=. Gergen, K.J. (19;?) 0he so,ial ,onstr(,tionist $o)e$ent in $odern psy,hology. '$eri,an sy,hologist, <=, 6663 6@?. Gergen, K.J. (199<) .ealities and relationships, so(ndings in so,ial ,onstr(,tion. Ca$*ridgeD #ar)ard Ini)ersity ress. #ardy, K. (199<) %arginali9ation or de)elop$entB ' response to &hields, Wynne, and Gawins-i. Jo(rnal of %arital and Fa$ily 0herapy, 6=, 1:931<< Kaslow, F.W. (199:) .elational diagnosisD 'n idea whose ti$e has ,o$eB Fa$ily ro,ess, :6, 6??36?9. Kin$an, C. and &anders, C (199<) Inra)eling addi,tion $ythologies. &ardis, 2CD Aalley Ed(,ation and 0herapy &er)i,es. "aing, ..!. ans Esterson, '. (19@1) &anity, $adness and the fa$ily. 8ew For-D 2asi, 2oo-s. arsons, 0. (19?1) 0he so,ial syste$. Glen,oe, 4lD Free ress. assell, . (1991) For a ,o$$on3sense e,ono$ist, a 8o*el 3 'nd an i$pa,t on the law. rofile of e,ono$ist .onald Coase, C0he Wee- in .e)iewC, 8ew For- 0i$es, E,t. 6=, pg.6 .ei$ers, &. and 0rea,her, ' (199?) 4ntrod(,ing (ser friendly fa$ily therapy. "ondonD .o(tledge. .osanoff, '.J. (19:;) %an(al of psy,hiatry and $ental hygiene. 8ew For-D Wiley. &ar*in, 0., and %an,(so, J. (19;=) &,hi9ophreniaD %edi,al diagnosis or )erdi,tB El$sford, 8.FD erga$on. &hields, C., Wynne, ". and Gawins-i, 2 (199<) 0he $arginali9ation of fa$ily therapyD ' histori,al and ,ontin(ing pro*le$. Jo(rnal of %arital annd Fa$ily 0herapy, 6=, 11@31:9. &9as9, 0. (19@<) 0he $yth of $ental illness. 8ew For-D #arper and .owe. 0o$$, K. (1991) 2eginning of a 7#4 s7 and 7 4 s7 approa,h to psy,hiatri, asssess$ent. 0he Calgary arti,ipator, 1, 6136<. Wes,hler, 4. (1969) 0he ne(roses. hiladephiaD &a(nders. White, %. (19;9) 0he e+ternali9ing of the pro*le$ and the re3a(thoring of li)es and relationships. 4n &ele,ted apers. 'delaideD !(lwi,h Centre (*li,ations. White, %. and Epston, !. (199=) 8arrati)e $eans to therape(ti, ends. 8ew For-D 8orton.

Wiener. %. (1991) &,hi9ophreniaD a defe,ti)e, defi,ient, disr(pted, disorgani9ed ,on,ept. 4n W.Fla,-, !. %iller, and %. Wiener (Eds.) What is s,hi9ophreniaB 8ew For-D &pringer3Aerlag. Wittgenstein, ". (19?:) hilosophi,al in)estigations. E+fordD 2la,-well. Wittgenstein, ". (19;=) C(lt(re and )al(e. E+fordD 2la,-well.

.et(rn to !o,($ent age