Megan writes that diagnoses do not “reflect anything in reality” and that “In any other industry, the word for using a name for something that does not actually exist in order to get reimbursed by insurance would be fraud, right?” I disagree with that, up to a point. The person coming to see the therapist is typically doing so because they have some kind of real problem. It is true that the diagnoses themselves are not “real things” – the actual problem is unique and involves a complex interaction between the person and the systems in which they are embedded – o the diagnoses might best be understood as somewhat or sometimes very misleading labels that get put over real complex problems. Anyway, since something real is going on and because help for the situation should arguably be paid by insurance, there isn’t anything like fraud going on. I think we need ways of talking about that which acknowledge that mental and emotional problems can be real even though labels and much of the “help” offered is unhelpful: otherwise we come across as advocating for a colder society where it would be harder for people to reach out for help of any kind, and might seem we are lacking interest in finding the kind of help that would truly be helpful.