Many sociologists have made sociological diagnoses. A central part of being a sociologist is to formulate and examine various diagnoses such as alienation, disenchantment, or a blasé attitude, for example. Mary Richmond argued that “sociological diagnoses” could be used more clinically as an important part of creating effective and systematic social interventions (Richmond, 1917), an idea to which the early sociologist Jane Addams strongly objected, arguing that it would undermine equality and weaken the sociologist’s connection to society (Trost & Levin, 2010).
How should diagnoses be formulated, and on what grounds? What concepts should be used? Is it possible to construct a new conceptual framework grounded in sociology? Would this have advantages, such as reducing the negative effects of medicalization and therapeuticization, which are less alienating, less subjectifying of the patient, and less esoteric compared to psychiatric diagnoses (Moloney, 2013; Furedi, 2004; Rose, 2019)? Various problems may arise when creating sociological diagnoses, such as: whose understanding dominates; are they first, hand or third, hand explanations; will the sociological diagnoses be reifying, individualizing, or will they contribute to sociological consciousness/imagination; will they become esoteric; how should one define and codify sociological diagnoses; and how should one distinguish causes from symptoms?
This book proposes that “sociological diagnosis” is an appropriate concept. To ensure that it does not become reifying, overlook context and complexity, or be demoralizing and pathologizing, diagnoses will be proposed as heuristic, flexible, and supportive tools for creating “formulations” of the difficulties a person may be facing. Diagnoses are not intended to create a patient identity but rather to serve as a support for building sociological consciousness. Diagnoses can be viewed as cultural technologies for sensitizing the individual to the social dimension of existence, which can be made visible through sociology. They can be viewed as “weapons” (Bourdieu, 2001) for building resilience and agency. They are technologies directed at the self that simultaneously support the individual in turning their gaze outward toward the social and their own social embeddedness (Rose, 1996; Mills, 1959).
Sociological diagnoses could be seen as an attempt to strike a balance between subjectivism and objectivism, first, hand and third, hand explanations (Aspers, 2011). This would create space for the client’s own self, understanding to engage with the sociologist’s understanding. This is to avoid the absurdity of the client becoming alienated by receiving a diagnosis of alienation from a cold sociotherapist.
One criticism of psychotherapy is that third, hand explanations have historically dominated, particularly in psychoanalysis. This has been part of the creation of the “clinical gaze,” which carries with it a power dynamic and subjectifying effects (Rose, 1996). An assumption in motivational interviewing is to try to work in the opposite way, where the clinical gaze is replaced by an empathetic gaze (Miller, 2018), a gaze that recognizes that the client possesses inner resources that the therapist can draw out with the right approach. I imagine that it is possible to have the best of both worlds: drawing out the client’s resources while simultaneously incorporating sociological diagnoses more as a form of socio, education. Sociological diagnoses need not be treated as definitive, absolute facts; rather, they can serve more as heuristic tools for moving forward, since the assumption is that these are not fixed but are socially constructed and therefore highly malleable. One problem with viewing sociological diagnoses as heuristics is that the individual may experience them as very real. That experience should not be dismissed, but how it should be interpreted is what the client and therapist must discover together. Sociological diagnoses run the risk of being reified just like psychiatric diagnoses; therefore, a heuristic approach is helpful.
Sociological diagnoses should also serve to avoid individualizing problems. One aspect of what sociological diagnoses should lead to is creating a sense of forward momentum: recognizing that what is within you is also something that is wrong with society, and that you can and should do something about it, and in doing so, you heal yourself, a process of raising consciousness (Freire, 2000).
Viewing sociological diagnoses as heuristics rather than established facts could also help address another well, known problem in the creation of diagnoses: distinguishing between different diagnoses when “comorbidity” is common. Psychology has struggled with the fact that many diagnoses overlap, that a person can oscillate between diagnoses, and that they are generally imprecise, even though the intention is for them to provide clarity for treatment (Morrall, 2018, 158). Attempts to identify biological markers have so far proven difficult, partly because the diagnoses are so imprecise and blur into one another (Morrall, 2018, 158). This should not be taken to mean that it will not be possible to identify biological markers in the future (Morrall, 2018, 174, 182; Rose, 2019).
Another strength of a heuristic approach is that, rather than settling on a specific interpretation, one works with the client to discover and discuss various interpretations in an effort to achieve a balance among them. It has already been suggested that psychotherapy should move in this direction (Milton & Legg, 2000). All the various sociological diagnoses serve as a foundation for interpreting and discovering society and the meanings and understandings that exist within it. This is generally something sociotherapy tends to strive for (Fritz, 2020), but it has also been suggested that this needs to occur more frequently in psychotherapy, such as CBT (Sheila & Hollanders, 2003).
Another problem with diagnoses is that they can easily become esoteric. The problem with esoteric concepts creates a higher barrier to change (Lindblom, 2023). This can lead the client to experience yet another social failure, that of not having sufficient cultural capital, and to once again encounter a person in a position of greater power with more knowledge. Some concepts I’ve considered as sociological diagnoses are more complicated than others, in the sense that they are further removed from everyday understanding and language. Power, obedience, oppression, emotional energy (social energy), norms, and roles are easier to grasp compared to concepts such as “habitus difficulties,” the “wellness syndrome,” or “false consciousness.” How many concepts does one learn in psychotherapy? When does one become overwhelmed? After all, there are quite a few concepts one learns in psychoeducation.
A final challenge with sociological diagnoses is that the possibility of claiming a person falls, from a microsociological perspective, into a multitude of sociological diagnoses would lead to extreme overdiagnosis, far greater than what some claim exists within psychiatric diagnoses. One could say that a person more or less falls into all sociological diagnoses, since these diagnoses have been constructed by contemporary society. Psychologists generally follow a heuristic to assign as few diagnoses as possible, in order to create focus and manageability for both the patient and the therapist, and to provide a starting point. This practice could also be justified through a sociological analysis. Which are the most important ones to start with?
Several concepts and sociological diagnoses compel the therapist and the client (when the client is ready) to acknowledge the complexity of our lives, which should make us better prepared and more grounded to truly bring about change. Sociological diagnoses have the advantage of showing that you are part of a society where others are facing difficulties alongside you, you are not alone. These sociological diagnoses would be part of a form of socio, education (cf. psychoeducation) but much more like an educational project in which one learns about the surrounding world through sociology.
Another way to view all these sociological diagnoses is that a sociological diagnosis manual could be used more satirically to highlight just how many sociological diagnoses everyone in society could receive immediately, which could put psychiatric diagnoses into perspective and destigmatize them, or counter “sanism” (Ingram, 2015) as a form of discrimination. This could demonstrate how everyone is actually underdiagnosed in terms of sociological diagnoses, where this underdiagnosis serves as a socio, educational insight into the fact that we face many different social problems that, together, create complexities capable of fostering a sociological imagination. Much of what is considered normal, functional, and healthy is viewed by sociology as irrational or “pathological” (Fromm, 1993; Honneth, 1996). Socioanalysis should build upon this, drawing on the sociological insight that normality is not unproblematic.
One suggestion as an alternative to diagnoses is “formulations” developed together with the client, as Rose, for example, has argued (2019, 187). Radical psychologists have also employed this approach in the form of “psychological formulations” (Johnstone & Dallos, 2006). These formulations should be detailed descriptions of the situation in which the person finds themselves (Rose, 2019). The concept of “formulations” serves to clarify that the focus of making diagnoses is actually to formulate accurate descriptions of the situation. Otherwise, there is a risk of oversimplifying the analysis and overlooking social contexts, such as the person being caught up in relationships of oppression (Rose, 2019).
An alternative to such phrasing is to describe the “difficulties” the person is facing, which have also been referred to as “problems in living” (Szasz, 1961). There is a parallel to a practice in the school system where students are said to be “in” a situation, rather than having “difficulties.” This is to use language to guide teachers away from individualizing and reifying the difficulty as something localized within the student. When discussing, for example, difficulties in love, one can speak more broadly about the client’s involvement in various microsociological processes, such as: emotional labor, an imbalance in care within the relationship, the exploitation of the power of love, placing too much importance on the relationship, and attributing too much meaning to that relationship. Different forms of difficulties would be broader and more fluid than diagnoses. The socio, analysis conducted together with the client in a Socratic dialogue, combined with socio, education, leads to identifying various states and/or difficulties the client faces in their life. These may be difficulties in different spheres, or they may be cross, sphere difficulties that, within a network, reinforce one another. Difficulties may relate to friendship, love, work, family, leisure, meaning, etc. Different difficulties are influenced by different conditions. Formulations and difficulties can certainly be used in conjunction with sociological diagnoses. Sociological diagnoses become a way to formulate comprehensive descriptions and pinpoint difficulties.
One approach is to center sociological diagnoses around the concept of “pathologies” (Fromm, 1990; Honneth, 1996). Freud focused on diagnosing the individual and attributed the explanation for the diagnosis to the individual and traumas linked to the family. However, Freud also speculated on the possibility of “research into the pathology of civilized communities,” a line of thought later pursued by Fromm (1990). Fromm is an example of a thinker who, within his Freudo, Marxist framework, continued this tradition by identifying “social pathologies” (Fromm, 1990). Honneth is one of the successors who further developed the concept of social pathologies (1996), and the term continues to be used (e.g., Engdahl, 2016; Zurn, 2013). As a synonym for “pathologies,” the term “distortions” is used in Swedish, which is also an intriguing metaphor. However, using pathologies and distortions as metaphors in a sociotherapeutic context carries the risk of being too strong and too dark. This terminology is more appropriate in critical theory for capturing societal problems, but telling someone that they suffer from various social pathologies and distortions would be less appropriate. Furthermore, one could say that:
In his discussion of Honneth’s view of social pathologies, Zurn uses the terms “first-order” and “second-order disorders”. Zurn and Honneth run the risk of mirroring psychiatric and biomedical discourse about human beings. The effect is that while they attempt to offer discursive and epistemic resistance to psychiatric hegemony, they simultaneously mirror several central concepts. Honneth argues that the good life is the opposite of pathologies, but the good life will, of course, risk being understood in terms of being more or less sound or healthy. Other metaphors used, such as “social well, being,” have similar problems, as they are limiting metaphors. Zurn points out that the social pathologies perspective needs to focus more on the therapeutic and emancipatory (2013). To do this, we need the right metaphors. What should these metaphors be? Should “getting well” be equated with a vaccine, a cure, or medicine? The proximity of these metaphors to pathology shows that this is not a productive path to take, as it would bring too much of biomedical discourse into sociology. Zurn uses the metaphor “distortions” (2013). This is closer to “imbalance” as a metaphor. However, Zurn links it to an understanding of social pathologies as something that most people must experience (2013). This contradicts ABT, where imbalances occur at different levels and can be manifest or latent. Zurn makes the same mistake that critical theory has made in the past: attempting to conduct totalizing analyses that fail to recognize that groups such as the Amish have different balances. The concept of “pathologies” also has the drawback that it is tricky to discuss whether a society is more or less “sick,” as well as when a society has reached a minimum level of “health” to be categorized as healthy (Berglund, 2026).
This line of reasoning is drawn from Berglund (2026), where the purpose of the discussion is to show why the metaphor of balance and imbalance is preferable because it is more pedagogical and somewhat gentler to encounter in sociotherapy and socio, education. Balance is also a central theme in sociology and a recurring metaphor and figure of thought, both explicitly and implicitly (Berglund, 2026).
The concept of “pathologies” has also been used by Durkheim, who contrasts it with “normality” (Durkheim, 1982). Normality is viewed as healthy, and anything deviating from it is pathological (Law, 2011). The problem is that Durkheim’s reasoning is both circular and nominal, meaning that society itself serves as the standard for what is healthy and what is not (Law, 2011). Honneth’s use of pathologies is better in that it allows for the problematization of normality, compared to Durkheim, but “pathologies” as a concept remains flawed.