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GNOSIS: BEYOND DISEASE AND DISORDER TO A DIAGNOSIS INCLUSIVE OF GIFTS AND CHALLENGES Robert L. R. Hutchins, Ph.D. Sonoma Developmental Center Eldridge, California ABSTRACT: A radical reorientation is needed for health to be the primary focus of diagnosis. Historically, medical diagnosis has focused primarily on disease and that diagnostic perspective puts our clients at risk of being reduced to clinical descriptions of pathology. This article introduces the Gnosis model, a concise pragmatic extension of the diagnostic axes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), that includes the person’s goals, gifts, abilities, and supports. Axis Axis Axis Axis Axis I II III IV V Gnosis DSM Diagnosis Calling and Goals Core Gifts and Abilities Physical Gifts Psychosocial and Environmental Supports System Gifts: Family/Community/Culture Clinical Disorders Personality Disorders/Mental Retardation General Medical Conditions Psychosocial and Environmental Stressors Global Assessment of Functioning Four examples of this Gnosis model are presented. The effect of using this more balanced diagnostic practice is described and discussed. Throughout millennia diagnosis has focused primarily on identifying diseases (Crookshank, 1926). The basic premise is that we must first clearly name a problem in order to treat or heal it. The process of diagnosing disease is an essential part of the healing process, but it shows only a partial view of a person. One can tell a story about a person in terms of what is strong and impressive or a story that selects out for attention what is diseased or disordered (White & Epston, 1990). The selection process can be a powerful defining moment for the person’s identity. Labeling someone as schizophrenic or borderline can be a virtual life sentence. It can impose a reality on that person that can be difficult if not impossible to escape. When we as clinicians focus solely on our clients’ problems, there is a serious risk that they will be reduced to clinical descriptions of pathology. Wouldn’t our clients be better served if we had a diagnostic tool that not only named their illnesses, but their gifts and abilities as well? This paper presents the Gnosis model as a way of meeting this need. Both the words Diagnosis and Gnosis come from the same Greek root meaning ‘‘to know.’’ Diagnosis initially meant to know clearly or directly, but through use has come to mean to know and correctly classify a disease or disorder (Crookshank, Email: [email protected] or [email protected] Copyright Ó 2002 Transpersonal Institute The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2 101 1926). Gnosis carries a connotation of direct, true knowledge and has been a synonym for direct knowledge of God, truth, or reality. Gnosis is used in this article as a broader term for knowing that is not limited to a pathological orientation. Instead, Gnosis is defined as a true, deep knowing of a person that includes both his or her gifts and challenges. THE CURRENT STATE OF DIAGNOSIS IN THE FIELD OF MENTAL HEALTH Before we explore the Gnosis model, it is important that we understand the current state of diagnosis within the field of mental health. Mental health diagnosis has modeled itself after the field of medicine by concentrating on pathology. Thus, diagnosis in psychiatry’s Diagnostic and Statistical Manual—DSM-IV (1994) focuses on diseases and disorders and their classification. Specifically, the DSM-IV assesses a person on five different axes in order to simultaneously present a person’s primary psychiatric problem(s), long term cognitive or character issues, stressors, and an overview of how well he or she is functioning in one brief summary. Clearly the DSM’s pioneering use of a multilevel assessment, which began with the DSM-III (1980), has provided a comprehensive and effective approach to planning treatment and predicting outcome. Diagnosis, however, has continued to be limited to categorizing and treating pathology. Decades ago, before the first DSM, humanistic and transpersonal psychologists and other healing arts professionals began to shift the overall context and frame of treatment away from pathology and toward health. In the healing arts, there has been a long-standing dialogue about the need to both know the individual and know and treat his or her disease (Crookshank, 1926; McWhinney, 1989). In 1968, Maslow suggested that we study the healthy aspects of human psychology instead of the sick aspects. Lukoff (1985) built on the work of Maslow by pioneering the diagnosis of mystical experiences with psychotic features and by establishing a non-disorder category in the DSM-IV for religious experiences. Before Lukoff, transpersonal experiences and ways of being were often interpreted as pathological, and transpersonal experiences that served a person’s growth and spiritual evolution rarely had a positive context that was considered in diagnosis. Thus, Lukoff helped to de-pathologize religious and mystical experiences for the broader community of mental health professionals. Wilber (1984, 1986, 1987) and Washburn (1994, 1995), two important transpersonal philosophers, expanded the framework for diagnosis when they described discrete stages or levels of personal and spiritual growth. Although their systems differ in significant ways, both Wilber and Washburn agree that ‘‘an individual must develop a healthy and strong ego before he or she can successfully transcend that ego, and that failure to do so results in a pathological state, often accompanied by great subjective distress. Both also agree that a well-prepared individual can progress to trans-egoic states that foreshadow ultimate reunion with the Absolute’’ (Lukoff, 2000). The works of Wilber and Washburn provide a meta-diagnosis or a framing of the range of states described in clinical diagnoses into a larger spectrum of 102 The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2 consciousness. Although outside the scope of the present effort, one can imagine a transpersonal DSM that names and classifies human potential in some standardized way, perhaps using and expanding Wilber or Washburn’s system. However, we are still a long way from such a transpersonal method of diagnosis. Unfortunately there is still no universally accepted health-oriented clinical diagnostic tool equivalent to the DSM. The Gnosis model serves as a step toward filling that gap. The intent of this article is to make seeing the uniqueness and health in a person central to diagnosis and treatment. GNOSIS MODEL The concept of Gnosis serves to complement and expand the DSM-IV axes. The Gnosis/Diagnosis combination, referred to as the Gnosis Model, is intended to provide a broader and more complete picture of an individual’s mental health. Just as transpersonal psychology includes the psychologies that came before it in a larger context, the addition of the Gnosis axes includes the DSM-IV axes while making the DSM’s pathological focus only a subset of the overall understanding of the person. Using the current DSM axes as a departure point for a more balanced approach produces the following levels of analysis. Table 1 Gnosis Model Axis Axis Axis Axis Axis I II III IV V Gnosis DSM Diagnosis Calling and Goals Core Gifts and Abilities Physical Gifts Psychosocial and Environmental Supports System Gifts: Family/Community/Culture Clinical Disorders Personality Disorders/Mental Retardation General Medical Conditions Psychosocial and Environmental Stressors Global Assessment of Functioning Origin and Development of Gnosis As a young clinician, I fell in love with the concept of diagnosis. Knowing and naming a problem seemed marvelous, like a hunter catching its prey or a detective successfully solving a mystery. As a result, I spent years enthusiastically diagnosing. I wrote a dissertation that was a kind of mythic diagnosis of the core or archetypal patterning of a person’s life (Hutchins, 1984). When I started working with people with developmental disabilities in 1987, the field was about to undergo a revolution. The passage of the Americans with Disabilities Act in 1990 and its enactment into law in 1992 marked a turning point in developmental services. A human rights movement emerged in the ‘‘disabilities’’ field insisting that people’s gifts and abilities be the focus of attention, not their deficits (Snow, 1994). This new paradigm focused on what a person could do rather than what a person could not do. Similarly, support became seen as the key ingredient in success rather than overcoming problems or appropriate adjustment. Thus, the philosophy of de- Gnosis: Beyond Disease and Disorder 103 velopmental services had suddenly leapt from an expert-driven, interdisciplinary team model to a person-centered, humanistic model of treatment. With this person-centered humanistic model of treatment as a guide, the idea for a gifts and abilities diagnosis came to me in 1994 during a spiritual retreat. At first, the simple shift from pathology to gifts and abilities seemed like a minor revelation. It was like shifting from a photographic negative to its printed picture, with the dark places being replaced by the light. It seemed obvious and simple: if we can diagnose for what is diseased or disordered, then we can diagnose for what is healthy. The levels of interpretation used by the DSM-IV (1994) were clearly useful. Instead of focusing on a person’s problems, however, the focus became a person’s gifts and abilities. The first versions of Gnosis involved simply replacing the pathology focus with a focus on gifts and abilities. Core Gifts and Abilities replaced the DSM-IV’s Axis I, Gifts of Character replaced Axis II, Physical Gifts replaced Axis III, etc.; Supports replaced Stressors etc., etc. Thus, initially I only focused on the positive aspects of certain clients who otherwise had long and illustrious negative histories. My colleagues reported that they could understand what I was attempting to do, but they felt it was either unrealistic or unbalanced. It was then that I began combining the positive diagnosis with a more traditional DSM diagnosis, which seemed more acceptable to both the staff and the clients. I recognized that seeing only the positive was as limiting to a person’s reality (in a similar although inverse way) as seeing only a person’s pathology. A real Gnosis, a true and deep knowing of a person, must include both a person’s gifts and his or her challenges. Over the past 8 years, the Gnosis model has evolved through several different versions with axes shifting, being added, or being dropped. This process of refining was fed by my own extensive clinical experience in person-centered settings and feedback from colleagues and students. Specifically, simple versions were circulated to colleagues and taken to conferences for feedback. In addition, the Gnosis model was introduced to undergraduate and graduate students in psychology during their clinical practica on diagnosis. At present, it is being taught to psychology interns and new psychologists as the format for case presentations during group supervision at my developmental center. I also recently gave a medical education lecture on the Gnosis model to physicians. As a result, some clinicians, students, and interns have taken this tool into their clinical practices. I welcome your comments, and I am intensely interested in the effects of using this model with people and systems. Gnosis Axes The Gnosis model on one hand utilizes the current DSM-IV’s axes to describe diseases and disorders and on the other hand introduces a parallel set of axes to outline a person’s gifts and abilities. These new Gnosis axes are a simple distillation of a person-centered, wellness paradigm that orients itself around a person’s calling, goals, and core gifts, and the support systems necessary to realize them. The Gnosis axes, themselves, are fairly self-evident in meaning and level of interpretation. A Gnosis for gifts and abilities, like a traditional diagnosis, uses all available sources of information about 104 The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2 a person. A Gnosis is most successful when it is a co-created. Thus, a Gnosis is best done in direct collaboration with the client and his or her circle of support. Axis I (Goals or Calling). This axis refers to a person’s calling or life goals, his or her sense of mission, vision, or destiny. Hillman’s book entitled Soul Code (1996) provides a description of this kind of teleological knowledge. Hillman theorizes that, ‘‘each person bears a uniqueness that asks to be lived and that is already present before it can be lived’’ (p.6). It is this knowledge of destiny, the innate knowing in a tiny acorn that it has the potential to be a great oak tree, which is captured in Axis I. This axis can easily be used to differentiate short term, long term, and life goals. Thus under this axis one might note a person’s calling as a writer and then note such specific goals as writing a novel or theoretical treatise. Axis II (Core Gifts and Abilities). This axis refers to those gifts and abilities that are essential to a person. Gifts in music, mathematics, or art are some obvious gifts that might be included. This axis is also used for gifts of character, such as perseverance, honesty, and trustworthiness. This axis excludes physical gifts and abilities as these are covered in Axis III. One accessing question for this axis is ‘‘What is the unique contribution that this person makes through her or his life?’’ A female artist friend provides a clear example of such core gifts. She is both deeply creative and open-handedly generous to the extent that she gives away much of her art. The centrality of her gifts of creativity and generosity come through in the blissful, childlike pleasure she takes in creating and sharing her work with others. Axis III (Physical Gifts and Abilities). This axis refers to a person’s physical gifts and abilities. These gifts include athletic prowess, gross and fine motor skills, and physical appearance. A female colleague provides a good example of someone with physical gifts and abilities. She transformed herself through martial arts training into a woman of great physical grace and presence. Her physical skills are now a source of inspiration as she teaches others. Axis IV (Psychosocial and Environmental Supports). Psychosocial supports are the people, ideas, and relationships that assist a person (i.e., the software of support). Psychosocial supports are classified as either current or needed. Current psychosocial supports are those that a person already has in his or her life. This is usually the immediate support system surrounding a person, such as family, friends or caregivers. Needed psychosocial supports are the additional peoples, ideas, and relationships considered necessary for a person to actively move toward his or her life dreams and/or to express his or her gifts and abilities. A good example of needed supports comes from a support group I led several years ago in which a bright and capable 40-year-old woman admitted that she had always wanted to be a doctor. With support from the group and some providential serendipity, she took the steps to apply and enter medical school. She is now a physician. Environmental supports are the environments and physical tools that assist a person (i.e., the hardware of support). Like psychosocial supports, environmental supports are classified as either current or needed. Current environmental supports are those Gnosis: Beyond Disease and Disorder 105 already functioning in a person’s life, such as an electric wheelchair. Other examples of current environmental supports might include certain forms of technology, such as computers, email, and the internet, or the physical aspects of a social support system, such as a co-housing development. Needed environmental supports are the additional environments and physical tools considered necessary for a person to actively move toward his or her life dreams and/or to express his or her gifts and abilities. Axis V (Systems Gifts and Problems). This axis refers to the social systems that assist or hinder a person: system gifts or system problems. It can be used for social systems that bestow gifts and abilities on a person and those that support the unfoldment of a person’s gifts and abilities. It can also be used for social systems that remove gifts and abilities from a person and those that obstruct the unfoldment of a person’s gifts and abilities. Axis V is divided into three sub-axes: family, community, and cultural. Each subaxis is classified as either current or needed. Examples of family gifts that have been bestowed might include exquisite pastry-baking skills passed down through generations of women in a French family or debating skills promoted in a lawyer’s family. Community gifts might include such life-changing, active support as that received from participation in Alcoholics Anonymous or from living in a community of ethnically diverse yet like-minded individuals. Gifts of culture might include a person’s folklore, such as cultural hero stories (e.g., Horatio Alger) or cultural routines (e.g., the American work ethic of being on time and working hard). As for social systems that hinder a person, the social system axis provides a way to address systems’ issues that are clearly missing from the current DSM-IV’s levels of analysis. In order to make an accurate diagnosis, one must know the systemic level at which a problem occurs and at which it can best be treated. A person’s problems may be a function of individual biology, psychology, social/environmental setting, or social systems within which the person lives and functions. Thus, a person’s problem might not be a function of his or her own pathology, but rather a function of the social or cultural systems surrounding him or her. For example, attempting to cope with racism as an individual’s problem may assist that person in day-to-day living, but do little to actually treat or solve the problem. Conversely, changing an entire social system of treatment, as has occurred with the development of the Supported Living model for people with developmental disabilities, can solve many problems without requiring any change on the part of the individual. As a result, Axis V is often used to summarize the positive and/or negative effects of the social systems surrounding a person. It is my position that the DSM-IV should be expanded to include an axis for social systems analysis, and that the DSM’s current Biopsychosocial model (Engel, 1980) needs to be expanded to a Biopsychosociocultural model. If and when the DSM-IV has an axis that addresses issues such as poverty, racism, and rigid top-down hierarchical organizational structures, then the Gnosis axes can simply reflect positive gifts. Finally, system gifts that are needed (as opposed to current) provide an opportunity 106 The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2 to visualize the system level of supports needed for a person’s life to come to full expression. Please note that there is no attempt here to provide specific criteria for health or for a person’s gifts and abilities. Such criteria would be useful and would perhaps make this tool more effective. However, the DSM-IV (1994) is literally the product of hundreds of people and many contributing organizations, and classifying and codifying health would likely take a similar number of people and organizations, if not more. Using the Gnosis Model Using the Gnosis model and axes is more than merely enhancing the DSM-IV (1994). It involves shifting one’s central focus and clinical concerns to a view that incorporates a person’s problems as well as his or her goals, gifts, and abilities. The effect of this shift can be profound. The shift has to be more than a change in talk or the dominant theory; it must also be a change in walk or the actual practices that implement it. Thus, it must be a change in the treatment system. Such a change in view can mean the difference between being treated as a diseased or disabled person for whom experts make decisions and being treated as a person who can make decisions for him or herself. The system using the Gnosis model can take any form so long as it helps the person be seen as a whole and focuses on realizing the person’s goals and gifts and overcoming his/her challenges. Four examples are presented below. Two are actual clients whose identities have been disguised; two are composites. I have tried to present a broad range of possible conditions. The Gnosis model can be applied to anyone regardless of challenges or gifts. Take these examples as merely suggestive, not as prescriptive or limiting. I am interested in others exploring and using the Gnosis model and carrying on a dialogue about our discoveries. In each story there are two sections: Pre-Gnosis and PostGnosis. As you read these stories please consider what view you would have of these people and their lives if you only had access to their DSM-IV diagnoses. What is added by having a Gnosis as well as a diagnosis? Claire’s Story Pre-Gnosis. Claire (Table 2) is a talented visual artist in her early 30s. She has three children, ages 4, 8, and 11. Claire’s husband, Tom, abandoned her and quit his well-paid computer-programming job. This left Claire, who had been a homemaker, without income and support. Claire and her children moved in with another single parent family. She went through her family savings in the first 4 months and began to pay her bills with credit cards. She was traveling on a bus looking for jobs when she suddenly felt she could not breathe, her heart started pounding, and she felt she was going to die. She got off the bus at the next stop, and the feeling of dread and doom receded as she walked. At first she thought it was just a bad day, but a week later, on her way to another job interview, the same thing happened again. After the fourth time, Claire talked with a friend who was a therapist. This friend recognized her problem as panic attacks. Claire went to see a psychiatrist who prescribed an Gnosis: Beyond Disease and Disorder 107 Table 2 Claire Gnosis Diagnosis Axis I Calling: Artist, mother. Goals: High paying job to support her family and return to more joyous and less strained parenting. Clinical Disorders: 300.01 Panic Disorder without Agoraphobia. Axis II Core Gifts and Abilities: Caring, generous, and empathetic. Clear communicator and social organizer. Clear voice, gift for singing harmony and playing by ear. Personality Disorders/Mental Retardation: Some compulsive traits, but no diagnosis. Axis III Physical Gifts: Physically strong. Good with her hands. General Medical Conditions: Gastroesophageal reflux, insomnia. Axis IV Psychosocial Supports Current: Strong godparents for children, and good women friends. Environmental Supports: Shared house with other single parent. Psychosocial/Environmental Problems: Problems with primary support group: Severe parenting and financial stresses after divorce. Axis V System Gifts, Family: Family of strong faith who provides emotional and financial support when needed. System Gifts, Community: University re-entry program provides counseling, childcare and parenting support. System Gifts, Culture: Women’s movement has helped build support structures for women like Claire. Global Assessment of Functioning Scale: 50 serious symptoms interfering with life during acute period. antidepressant. Subsequently she stopped having panic attacks, but she still felt anxious and overwhelmed. Post-Gnosis. Claire’s parents and her children’s godparents helped her through this difficult period. Her parents provided interim financial support and took the children over most holidays. The godparents provided respite by taking the children on alternate weekends. The godfather also connected Claire to a Women’s Return to Work program at the nearby state university. This program assessed her gifts and abilities and assisted her in setting goals and building a support system. She took advantage of the university counseling center for herself and for family therapy. Her social support system and finances became more stable. Concurrently she was able to learn cognitive behavioral techniques to handle her anxiety. John’s Story Pre-Gnosis. John (Table 3) is a handsome young man who is good with his hands. John was physically and sexually abused as a child. He grew up in a large, singleparent, minority family. He got into drugs and sex in his early teens. In his early 20s, while drunk, he molested a cousin. Consequently he was arrested, convicted of molestation, and imprisoned for 18 months. During probation he was cooperative, and he looked forward to making a new life for himself. He was helpful and well liked. Unfortunately no employer was willing to hire a convicted sex offender. After 108 The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2 Table 3 John Gnosis Diagnosis Axis I Calling and Goals: Marry girlfriend, get a good job as a mechanic. Clinical Disorders: 296.0 Bipolar Mood Disorder, Manic with mood congruent psychotic features. Rule out Pedophilia 315.00 Reading Disorder/Dyslexia. History of alcohol/drug abuse. Axis II Core Gifts and Abilities: Personable, genuinely likable, well-spoken, polite, helpful, humorous (can laugh at himself), and creative storyteller. He has gifts in understanding engines and things mechanical. Personality Disorders/Mental Retardation: Rule out Antisocial Personality Disorder, history suggests possible personality disorder not apparent in current setting. Axis III Physical Gifts: Good gross and fine motor General Medical Conditions: None. skills, handsome, attractive smile. He is good with his hands and likes to build things and take them apart. Axis IV Psychosocial and Environmental Supports: Current: Committed girl friend. Job Coach in autobody work. Junior college course in auto mechanics. Needed: Job as mechanic. Psychosocial/Environmental Problems: Stigma of being sex offender. Multiple job rejections, inappropriate job placement. Axis V System Gifts, Family: Large caring family nearby. System Gifts, Community: Gnosis oriented group home. System Gifts, Culture: Minority culture supportive of those discriminated against like John. System Problems: Social stigmas of sexual offense, mental illness, and racist stereotypes against minority males prevent meaningful opportunities to work in the community. Global Assessment of Functioning Scale: 35 severely impaired during acute episode. a long job search, he was placed in a sheltered workshop with disabled people. The paid work ran out, and he was expected to sit and watch TV with his disabled coworkers. At that point he appeared depressed. He stopped getting out of bed and refused to go to work, saying there was no point. Soon thereafter he began to talk rapidly about being a rock promoter, and he claimed that people had stolen his fortune. His sleep was disturbed, and he sought to make phone calls all over the country to supposed music contacts. He was started on neuroleptic medication. His anger and irritation increased, he started threatening staff, and he was eventually sent back to jail. Six months later he returned to the group home, and the Gnosis process began. Post-Gnosis. John was well liked at his group home. When John returned to the group home, the stigmatization process that had led to his decompensation was reversed. Staff pointedly treated him as a respected equal. He focused on his mechanical gifts and was able to seek meaningful work. Then a staff friend was enlisted to be his job coach in an auto body shop. A year later, he started an auto mechanics training course at the local junior college. Probably most important, a former girl friend reconnected with him, and they became a committed couple. Their relationship grew to be solid and satisfying. At present, they are planning to marry. Concurrent with the social support, he was placed on a mood stabilizing anticonvulsant. The helpful factors in his treatment seemed to be returning him to full membership Gnosis: Beyond Disease and Disorder 109 in society and connecting him with goals and a feeling of having a meaningful future. The medication was eventually discontinued, and John continues to do well without it. He finished probation and now is seeking employment as a mechanic in a large auto shop chain. Charlie’s Story Pre-Gnosis. Charlie (Table 4) is a man in his 40s with a ready smile and a persistent attitude. Charlie was living with 40 other people in a large group setting. He was well liked but not well understood. His receptive language was very good and his comprehension excellent, but his expressive language was unclear. The staff did not have time to adequately listen to him and learn who he was. His own goals were not articulated or understood. He used a hand-propelled wheelchair to move about. His seizures were not well controlled and were very debilitating for him. He occasionally got angry, threw things, and hit people. Post-Gnosis. His life has transformed through shifting to a wellness-oriented system of care. Six years ago, Charlie moved from his large, institutional, problemdominated home to a Gnosis-oriented home that focused on his goals and gifts and Table 4 Charlie Gnosis 110 Diagnosis Axis I Calling: Write his stories. Goals: Walk; reduce seizures; have a meaningful, intimate relationship; get paid well; and be respected for his work. Clinical Disorders: No diagnosis. Occasionally explosive, not diagnosable. Axis II Core Gifts and Abilities: Good friend; persistent, clear decision-maker; creative and original story ideas. Personality Disorders/Mental Retardation: Mild to moderate mental retardation and cognitive challenges. Axis III Physical Gifts: Physically strong with stupendous, infectious smile. General Medical Conditions: Expressive Aphasia, Seizure Disorder, and problems of balance. Axis IV Psychosocial Supports: Current is one-to-three staffing, awake overnight staff, movement trainer, and co-writer with computer skills. Needed are friend and girlfriend. Environmental Supports: Current is Rifton walker, plus bed with padded rails. Needed is none. Psychosocial/Environmental Problems: Mild: due to living with those not of his choosing. Axis V System Gifts, Family: Foster family reconnected. System Gifts, Community: Small customized home with staff team that supports his full participation in decision-making. System Gifts, Culture: California after revised Lantermann Act, 1993, can be supportive of people with disabilities in person-centered systems. Global Assessment of Functioning Scale: 45—Pervasive physical problems require consistent staff support and supervision. The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2 provided the supports he needed to realize them. Staff members at his new home had the time to fully listen to him. As a result, he became a published author through cowriting with staff members. He started walking again with a Rifton walker. He significantly reduced the frequency of his seizures through volunteering to be the first person in his institution to have a Vagal Nerve Stimulator implanted. He reconnected with his foster family, and he began dating a new girlfriend. Anne’s Story Pre-Gnosis. Anne’s (Table 5) father died when she was 10, and her mother began to drink heavily. Her mother moved them away from her friends in the city to a small town in the country. During this period, Anne’s mother was verbally abusive, and Anne became depressed and suicidal. At one point, she was rejected by her best friend and felt powerless and hopeless. She became unable to speak voluntarily for 2 weeks. At that point, a therapist suggested medication. She then pulled herself together enough to avoid hospitalization and medication. One day, while walking on the beach, Anne felt crushed by her mother’s rejection. She then realized that she was not perfect in the way her mother wished, but she was perfect in the way nature wished. She understood that she was like all of the rough waves in the ocean: she was part of the whole, and the whole was beautiful. She heard an unseen, benevolent male voice say, ‘‘Love your brother; the Majesty is to share.’’ Table 5 Anne Gnosis Diagnosis Axis I Calling: Be a writer, creative artist, and teacher to ‘‘Love and share the Majesty.’’ Goals: Find teachers and community to support her vision. Clinical Disorders: 296.2 Major Depressive Disorder, Single Episode. Axis II Core Gifts and Abilities: Intellectually brilliant, creative, artistic, intense, and passionate about life. Personality Disorders/Mental Retardation: No diagnosis. Axis III Physical Gifts: Generally healthy and well coordinated. Penetrating deep blue eyes. Sexually open. General Medical Conditions: Terminated pregnancy at 17. Mononucleosis and pneumonia in past year. Axis IV Psychosocial Supports: Current is empowering second mother figure and strong girlfriend. Needed is none. Environmental Supports: Current is physically residing in second mother figure’s home. Needed is none. Psychosocial Problems: Alcoholic, verbally abusive mother. Environmental Problems: Several moves during adolescence resulting in loss of community/friendships. Axis V System Gifts, Family: As noted above. System Gifts, Community: Supportive college psychology department. System Gifts, Culture: Humanistic transpersonal world community provides context and direction. Global Assessment of Functioning Scale: 50 (current)–serious symptoms during acute 2-week period. Gnosis: Beyond Disease and Disorder 111 Post-Gnosis. A motherly psychology professor met and took a liking to Anne. This woman accepted and cared for Anne. She saw Anne not only as gifted but also as a gift in and of herself. Anne moved in with the professor and lived with her the last year before college. She then entered a humanistic psychology program that continued and deepened her sense of health and well-being. Since then, her mood has fluctuated, but she has never returned to being at risk for suicide. Beyond simple health, she has also become a teacher and exemplar of her vision. DISCUSSION The Gnosis model intentionally highlights what most clinicians already do in their practices. Any competent clinician, regardless of orientation, seeks to foster and support a person’s gifts and abilities as well as aid him or her in overcoming personal challenges. In addition, clinicians in supported-living, person-centered planning and futures-planning formats have been using person-centered methods, which the Gnosis model summarizes, for decades (O’Brien, 1992, 1998; Smull, 1992). Finally, clinicians with a humanistic or transpersonal orientation have focused on health for 40 years or more. What has been missing across the board has been a practical way to marry the traditional medical approach with the approaches developed in humanistic, transpersonal, and person-centered work. The Gnosis model provides such a synthesis. Gnosis Limitations The problem with any brief summary of conclusions about a person, regardless of its ability to filter out bias, is that it produces a limited and diminished version of that person. It is similar to only getting the headlines about a person and not the real substance. With this in mind, the Gnosis model should merely serve as headlines that lead us to the fuller, richer story. Headlines, after all, are meant to summarize and draw us into the story, not to stand alone. Thus, when using the Gnosis model, we should seek to tell a client’s story more in the manner of a literary biography or a novel. We must continue to remember that our clients are people with problems and abilities, not merely problems and abilities by themselves. Final Thoughts on Gnosis Most clinicians have participated in numerous clinical case reviews in which extensive descriptions of a person’s problems dominated the consciousness of the group to the exclusion of all else. This pathological focus has tended to create a negative, trance-like state within the group and poison the view of the client and his or her potential for healing. The Gnosis model, with its more inclusive process that insists on seeing other, more positive aspects of a person, can help the group break out of this trance. The response of clinicians to using the Gnosis model has been uplifting and life affirming. In my work with many clients who are non-verbal or limited in their 112 The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2 ability to express themselves, staff members are often relied upon to describe their clients. The effect of talking about a client’s gifts and abilities has been to help staff members access those gifts, create a more positive reality, and tell a story of strength. Instead of hiding the diagnosis in the clinical record and avoiding talking directly with the client about it, as one might do with a psychiatric diagnosis and a volatile client, staff members have actively displayed Gnosis evaluations as a wall poster in clients’ rooms. It became clear the Gnosis process was on the right track when the mother of one of the clients asked to use his Gnosis as half of his memorial service program after he tragically died. CONCLUSION The intent of a conceptual process, such as diagnosis, is to select what we choose to value as worthy of attention and discard what we choose to value as unworthy of attention. Thus, it functions like the zoom lens on a camera to either narrow or widen the view of the world that we see. When we use a problem-focused diagnostic process, we can easily lose sight of the whole individual. The disease becomes the primary focus, often to the exclusion of the person. The Gnosis model brings the person and his or her concerns back to the forefront, while still honoring the need to provide treatment for his or her problems. This article is a call to re-see our clients and each other in terms of each person’s goals, gifts, abilities, and the supports needed to fully realize them. The effect of such a process on people whose lives have been dominated by problems can be profound. The effect of implementing systems of care based on these premises can be liberating. REFERENCES AMERICAN PSYCHIATRIC ASSOCIATION. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. AMERICAN PSYCHIATRIC ASSOCIATION. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. CROOKSHANK, F. G. (1926). Theory of diagnosis. Lancet, 2, 939–942. ENGEL, G. L. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137(5), 535–544. HILLMAN, J. (1996). The soul’s code: In search of character and calling. New York: Random House. HUTCHINS, R. L. R. (1984). The inner story: Psychological patterning as seen in dreams, imagery, and sandplay. Unpublished doctoral dissertation, California Institute of Transpersonal Psychology: Menlo Park. HUTCHINS, R. L. R. (1994). Changeworks: A manual for making meaningful change. Sonoma, CA: Sonoma developmental center. HUTCHINS, R. L. R. (1994). Supportworks: A manual for creating a meaningful life. Sonoma, CA: Sonoma developmental center. HUTCHINS, R. L. R. (1998). Beyond diagnosis to gnosis: Diagnosis for gifts and abilities not just deficits and pathology. Working draft. Santa Rosa, CA: Narrative Training Associates. Gnosis: Beyond Disease and Disorder 113 LUKOFF, D. (1985). Diagnosis of mystical experiences with psychotic features. Journal of Transpersonal Psychology, 17(2), 155–181. LUKOFF, D. (2000). Arguments for making a diagnosis (of a spiritual emergency) Spiritual Emergency Resource Center [on line website] available http://www.virtualcs.com/se/dxtx/ diagnosticcriteria-mystical.html. MASLOW, A. H. (1968). Toward a psychology of being (2nd ed.). Princeton, NJ: Van Nostrand. MCWHINNEY, I. A. (1989). A textbook of family medicine. Chapter eight: Clinical method (pp. 111–158). New York: Oxford University Press. O’BRIEN, J. & LOVETT, H. (1992). Finding a way toward everyday lives: The contribution of person centered planning. Harrisburg, PA: Pennsylvania Office of Mental Retardation. O’BRIEN, J. & O’BRIEN, C. L. (1998). A little book about person centered planning. Toronto: Inclusion Press. SHAPIRO, J. P. (1994). No pity: People with disabilities forging a new civil rights movement. New York: Random House. SHER, B. (1983). Wishcraft: How to get what you really want. New York: Random House. SHER, B. (1991). Teamworks: Building support groups that guarantee success. New York: Random House. SMULL, M. & HARRISON, S. B. (1992) Supporting people with severe reputations in the community. Alexandria, VA: National Association of State Directors of Developmental Disabilities Services, Inc. SNOW, J. (1994). What’s really worth doing and how to do it. Toronto: Inclusion Press. WASHBURN, M. (1994). Transpersonal psychology in psychoanalytic perspective. Albany, New York: State University of New York Press. WASHBURN, M. (1995). The ego and the dynamic ground: A transpersonal theory of human development (2nd ed.). Albany: State University of New York Press. WHITE, M. & EPSTON, D. (1990). Narrative means to therapeutic ends. New York: Norton. WHITE, M. (1993). Deconstruction and therapy. In S. Gilligan & R. Price (Eds.). Therapeutic conversations (pp. 22–61). New York: Norton. WHITE, M. (1995). Re-Authoring lives: Interviews & essays. Adelaide, Australia: Dulwich Centre Publications. WILBER, K. (1984). The developmental spectrum and psychopathology: Part one, stages and types of pathology. Journal of Transpersonal Psychology, 16(1), 75–118. WILBER, K., ENGLER, J. & BROWN, D. P. (1986). Transformations of consciousness: Conventional and contemplative perspectives on development. Boston: Shambhala. The Author Robert Hutchins currently serves as a psychologist to the State of California’s, Sonoma Developmental Center and to community group homes. He has been a mental health clinician since 1977 and a psychologist since 1987. His clinical work includes six years as founding consultant/team member of a self-directed-work-team charged with the responsibility to create a new system of care for those with developmental challenges. His written work includes workbooks to assist in goal setting and support building and articles on seeing beyond disabilities to our shared basic humanness. Robert has been married for 28 years and has two young children. Please contact Robert if you are interested in applying the Gnosis Model in your practice. He is particularly interested in systems that might want to further field test the model. 114 The Journal of Transpersonal Psychology, 2002, Vol. 34, No. 2