The category fits, but the person does not

A May 2026 New York Times opinion essay made a concession that rarely appears in mainstream mental health writing: neither genetics nor brain imaging can distinguish a person with ADHD, depression, or autism from one without. The piece still affirms the clinical value of psychiatric diagnosis, which is exactly why the admission deserves a second look. If the biological substrate cannot carry the label on its own, something else is doing the explanatory work — and what that something is has direct consequences for how a Catholic therapist practices.

What the original article reveals

The Times essay does not argue against diagnosis. It argues, carefully, that diagnosis is a functional description rather than a biological discovery. A cluster of behaviors, sufficiently impairing and sufficiently consistent, earns a label. The label names something real. It does not name a lesion, a defective gene, or a measurable neurological threshold. What it names is a pattern in a person — and a pattern always belongs to someone.

Gabor Maté's epidemiological work sharpens this. Drawing on the Kaiser Permanente Adverse Childhood Experiences data, Maté argues that the brain architecture psychiatry later treats as a given was itself shaped by relational environment in early childhood.[^2] The organism presenting with attentional difficulties at thirty-five is not presenting a static defect. It is presenting the record of an adaptive history: a nervous system that learned, under specific conditions, to function in a particular way. Diagnosis names the outcome. It does not account for the formation.

The Aristotelian-Thomistic tradition would say the difficulty is not in affirming that body and soul are distinct — they are — but in determining where the body's record ends and the soul's freedom begins.[^3] That difficulty is not merely philosophical. It is the daily problem of any clinician deciding whether a presenting symptom is primarily neurological, primarily formational, or irreducibly both.

One consideration the article cannot supply

Benjamin Suazo's account of the Thomistic vis cogitativa offers a tool the DSM does not.[^4] The cogitative sense is the faculty by which a person evaluates particular sensory experience as beneficial or harmful — the pre-rational appraisal that precedes and shapes deliberate choice. Suazo proposes a clinically useful distinction: if symptoms can be associated with circumstances the person perceives and appraises, the origin lies in the cogitative sense and is amenable to formational work; if symptoms arise independently of any such appraisal, biological causation is more probable.

This distinction matters because it locates suffering more precisely. A person whose attentional difficulties intensify in situations she reads as unsafe is not presenting the same clinical picture as a person whose difficulties are environmentally invariant — even if both meet DSM criteria for ADHD. The label applies equally; the appropriate response does not.

What follows from this is not a reason to distrust diagnosis but a reason to hold it lightly. A diagnostic label, honestly given, names a pattern. The cogitative account asks why that pattern runs through this particular person, in these particular conditions, with this particular history. That question is one Catholic anthropology is equipped to ask, and most diagnostic frameworks are not.

What a Catholic therapist can do

William Nordling identifies a dimension of suffering that falls outside the diagnostic picture entirely: the distress that arises when a person's actions diverge from their own deepest values.[^5] No symptom checklist captures this, because it is not a symptom. It is a moral and vocational fact about the person — and it requires a different kind of attention.

McWhorter, drawing on Benedict Ashley, argues that a Catholic therapist cannot employ value bracketing in an unqualified way.[^1] Mental health, on a Catholic account, is not only freedom from conditioned factors that impair functioning. It is also freedom for further moral and spiritual development. The therapist who attends only to symptom relief is working with a truncated picture of what recovery is for.

In practice, this means three things. First, take the diagnosis seriously as a description of functional impairment, but do not let it become the primary frame for the person's identity. A label that names a pattern is not an account of a person, and the gap between the two becomes most consequential when the person is still forming and looking for frameworks that can bear the weight of an identity.

Second, use Suazo's distinction actively. When symptoms appear to track the person's appraisal of specific situations — relationships, performance demands, uncertainty — treat that as a signal that formational work is both possible and indicated. When symptoms appear independent of appraisal, calibrate toward biological support and reduce the formational pressure accordingly.

Third, name vocation. Nordling's point is that some suffering is not pathology but orientation — the person's implicit knowledge that she is not yet living in the direction she is for. That knowledge does not appear on a symptom inventory. It appears in the session, if the therapist has the anthropological categories to recognize it. A Catholic therapist who has internalized the CCMMP's ten premises is in a position to hear it.

[^1]: McWhorter, drawing on Benedict Ashley, on value bracketing and the Catholic therapist's anthropological obligations. [^2]: Gabor Maté, In the Realm of Hungry Ghosts; Kaiser Permanente ACE study data on early relational environment and brain architecture. [^3]: Aristotelian-Thomistic anthropology on the body-soul composite; Vitz, Nordling, and Titus, A Catholic Christian Meta-Model of the Person (2020), Premise 4 (personal unity). [^4]: Benjamin Suazo, Psicopatología y mal moral, on the vis cogitativa as a clinical hinge between biological predisposition and formational habit. [^5]: William Nordling, clinical applications of the CCMMP; on vocation-related distress as a moral rather than symptomatic fact.