What is the purpose of a diagnostic classification? Implications for inclusive education^*1

Abstract

This article critically examines the role of diagnostic classifications in inclusive education, considering their growing presence in everyday school life and their effects on individuals and educational practices. It begins by addressing the problem of treating diagnostic classifications as unquestionable truths, a tendency that reduces the complexity of the educational process and reinforces mechanisms of exclusion. The study aims to analyze different ways of understanding diagnostic classifications and their implications for promoting inclusive education. The methodology consists of a narrative literature review drawing on scholarship in psychology, education, mental health, and the social sciences. The article proposes a set of interpretive perspectives for rethinking the use of diagnostic classifications: as a starting point or an endpoint; as a scalpel or a map; and from either an essentialist or a pragmatic perspective. The findings indicate that diagnostic classifications can be valuable when understood critically, contextually, and instrumentally, supporting intersectoral action that takes into account individuals’ unique characteristics and the contexts in which they are situated. The article concludes that, although diagnostic classifications can provide valuable support for educational practice, their uncritical use reinforces stigma, constrains educational possibilities, and undermines the principles of inclusion. It therefore argues for an ethical and political stance that prioritizes dialogue across different forms of knowledge and a commitment to valuing human diversity.

Keywords:
Diagnoses; Inclusive education; School

Resumo

O artigo discute criticamente o papel dos diagnósticos na educação inclusiva, considerando sua crescente presença no cotidiano escolar e os impactos que produzem sobre sujeitos e práticas pedagógicas. Parte-se do problema da naturalização das classificações diagnósticas como verdades incontestáveis, que tendem a reduzir a complexidade do processo educativo e reforçar processos de exclusão. O objetivo é analisar diferentes formas de compreensão dos diagnósticos e suas implicações para a promoção de uma educação inclusiva. A metodologia adotada é uma revisão narrativa de literatura, com base em referenciais da psicologia, educação, saúde mental e ciências sociais. O texto propõe chaves interpretativas que permitem repensar o uso dos diagnósticos: como ponto de partida ou de chegada; como bisturi ou mapa; em uma abordagem essencialista ou pragmática. Os resultados indicam que os diagnósticos podem ser úteis quando compreendidos de forma crítica, contextualizada e instrumental, a serviço de ações intersetoriais que considerem a singularidade dos sujeitos e os contextos nos quais estão inseridos. Conclui-se que, embora os diagnósticos possam oferecer subsídios relevantes à prática pedagógica, seu uso acrítico reforça estigmas, limita possibilidades educativas e compromete os princípios da inclusão. Assim, defende-se uma postura ético-política que privilegie o diálogo entre saberes e o compromisso com a valorização da diversidade humana.

Palavras-chave:
Diagnósticos; Educação inclusiva; Escola

Introduction

This article revolves around a question that resonates across schools, universities, clinics, and everyday conversations. Even when it is not expressly asked, the answer is often implied, reflecting an underlying understanding of human beings, development, disability, inclusion, health, or education. The question is: What is the purpose of a diagnosis? This unfolds into several other questions: What does a diagnosis tell us? What do we do with it? Where does it come from? Where does it lead? How does a child with a diagnosis carry this burden-or is expected to carry it-throughout their life?

When we consider the term diagnosis in its broadest sense, we find that diagnostic classification more accurately conveys the meaning we intend to ascribe to it in this article. Accordingly, although we will hereafter use only the term diagnosis, as this is the form most commonly used in everyday discourse, we emphasize that our analysis is limited to understanding diagnosis as derived from a classificatory system. As Arantes (2022) explains:

[...] the term diagnosis has increasingly come to denote the use of a diagnostic category, that is, a diagnostic classification, within the two principal classification systems currently in use: the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Our first challenge here is to propose a broader understanding of diagnosis: as a narrative and contextualized account of a person in a particular situation and in relation to others in their social environment, whether within professional caregiving relationships or in the context of everyday care (Arantes, 2022, p. 81).

For the purposes of this analysis of diagnoses, our focus is on inclusive education³. It could just as well be directed to other domains, as diagnoses extend into family relationships, affective bonds, leisure, work, and many other areas of life. Our concern, however, is to examine how a particular understanding of what a diagnosis is and what it is for has entered the school setting and come to shape educational relationships, curricula, and the social interactions there, especially in relation to autistic people and those diagnosed with conditions such as attention deficit hyperactivity disorder (ADHD), dyslexia, among others. It is important to clarify that this study does not address diagnoses of physical diseases with well-established single causes, although many of the arguments presented here are equally applicable to such cases. Rather, our focus is on conditions whose causes cannot be directly attributed to a single, clearly defined biological factor. Accordingly, the discussion is situated at the intersection of psychology, mental health, and education.

The debate we engage with is not new. Numerous authors have examined it, making valuable contributions to a critical understanding of the medicalization and pathologization of life, as well as of the rationale underlying diagnostic processes and their relationship with education (Ceccim; Freitas; Angelucci, 2022; Moysés; Collares, 2011; Nacinovic; Rodrigues, 2020; Vasques, 2015, among others). Our aim is to contribute to this discussion through a series of analogies and interpretive perspectives that, we hope, will help readers navigate the web of meanings and value judgments that has developed around this issue.

Some of these value judgments are reflected in the stance one takes: Are diagnoses good or bad? Do they exist or not? Should they have a place in schools? With regard to the last question, although we may aspire to a school where labels are irrelevant, where every child is seen and understood on their own terms and recognized in the uniqueness that makes them unlike anyone else, the reality is far less ideal: diagnoses have become an increasingly common presence in schools (Christofari; Freitas; Baptista, 2015). Children are divided into those with a diagnostic report and those considered normal, those who “have no report yet, but should be assessed” and those who “cause no trouble.”

Under the current regulatory framework, Decree No. 12,686 of October 20, 2025, later amended by Decree No. 12,773 of December 8, 2025, reaffirmed that a medical report is not required to guarantee the provision of specialized educational services or access to educational rights for students eligible for inclusive special education. This is a legally significant measure, as it shifts the focus away from diagnosis as a condition for access to public policy. However, regulatory change alone is insufficient to transform long-established practices. Establishing an assessment process that is genuinely pedagogical rather than subordinated to classificatory logic requires time, professional development, and institutional change.

What lies behind this demand for diagnoses? The deterioration of schools, the devaluation of teachers, insufficient investment in education, and the ascendancy of neoliberalism certainly contribute to this phenomenon (Cavalcanti et al., 2024; Safatle; Silva Júnior; Dunker, 2020). It is against this bleak backdrop that diagnoses have come to permeate schools, accompanied by a salvation discourse suggesting that, if the many different disorders of living could be identified and properly medicated, the teaching-learning process could finally proceed without major disruptions (Bordin, 2008), reinforcing the perception of the school as a “victim of an unsuitable clientele” (Collares; Moysés, 1992, p. 28).

We therefore begin from the recognition that diagnoses are already part of school life and, while there is certainly room to discuss what exactly they are doing there, we will seek to identify ways of approaching certain classifications. With these initial considerations in place, this study aims to analyze ways of understanding diagnoses and their implications for inclusive education. This is a narrative literature review in which we draw on selected studies to develop our argument. The article is structured as follows. We first critically examine how the foundations of contemporary diagnosis were established, focusing primarily on the Diagnostic and Statistical Manual of Mental Disorders (DSM). We then discuss what inclusion actually means and how it may benefit from or be hindered by the use of labels. Finally, we present several analogies and interpretive perspectives for understanding diagnoses. For each of these, we will consider whether it is conducive or harmful to inclusion.

Diagnoses

Any discussion of diagnosis presupposes an earlier, underlying question: if diagnostic classifications can be assigned to pathologies, what defines something as pathological? Canguilhem (2024) argues that the distinction between the normal and the pathological is not merely biological or statistical, but normative. He thus challenges the idea that medicine can simply describe diseases objectively, since what is considered pathological depends on cultural, historical, and social norms. This does not mean rejecting biology or medicine, but rather recognizing that normality cannot be reduced to a fixed, universal criterion. Diagnosis, then, far from simply recognizing an objective state, participates in a field of normativity that encompasses both the functioning of the organism and social and cultural values.

To reiterate, our primary interest in this article is in diagnoses whose causes cannot be directly or exclusively attributed to biological factors - autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), learning disorders, conduct disorders, among others. We emphasize that we are referring to the establishment of causality, not correlations. In other words, in many of the diagnoses we are considering, biological alterations may be observed, but it cannot be claimed that these alterations cause the symptoms that lead to the diagnosis (Yatham, 2023).

In the context of mental health, psychiatry has historically faced a series of challenges concerning its identity as a scientific discipline and its status as a branch of medicine. From its earliest days, questions about the nature of mental disorders and the effectiveness of treatments have generated intense debate (Pinto, 2020). One of the main points of contention has been the search for a biological substratum for mental disorders.

The so-called multifactorial hypothesis has become established in psychiatry, according to which multiple factors contribute to the genesis and development of a psychiatric event. In the reality of many psychiatric services, however, this recognition amounts to little more than an abstraction, despite the extent to which reform laws and transformative practices have highlighted it in recent years. The weight assigned to some factors relative to others differs profoundly and directs the therapeutic approach: biological knowledge is hegemonic, while other forms of knowledge play a marginal role. There is a hard psychiatry, centered on clinical practice, and a soft psychiatry that loosely encompasses everything else. The former is dominant and aligned with the economic interests of pharmaceutical companies; the latter is dominated and deprived of genuine institutional power (Venturini et al., 2003, p. 58).

In recent decades, psychiatry has increasingly centered its work on clinical diagnoses and pharmacological treatments, often focusing on chemical imbalances in the brain associated with mental disorders. This approach, however, has been criticized for oversimplification and a lack of scientific evidence (Ortega; Vidal, 2020; Safatle, 2020). Beginning in the 1980s, with the DSM-3, a marked shift took place in how diagnoses were established. Whereas nosological classifications had earlier had a psychodynamic foundation, taking into account the underlying causes of disorders, they now came to rely on a classification system based on signs and symptoms that could be observed or identified through clinical interviews (Pinto, 2020).

The aim is to create a single nomenclature; a common language for researchers and clinicians of different theoretical orientations; an approach based solely on direct observation of the phenomena in question; and a classification system independent of any theoretical assumptions, focusing on nosography while setting etiological issues aside. This approach disregards the subjectivity both of the person being “classified” and of the person doing the classifying. Psychopathology progressively loses its place as the foundation of practices related to human psychological suffering, giving way to a nosography that seeks to meet ideals of standardization and scientific rigor. (Vasques, 2015, p. 111).

Initially, the aim was to address the underdiagnosis of mental disorders by prioritizing sensitivity over specificity-that is, sensitivity so as not to miss potential cases at the expense of the specificity required to avoid misdiagnosis (Frances, 2013). In addition, the DSM prioritizes simplicity, making it easy to disseminate and use in clinical practice. Even so, the explicit intention was never for diagnosis to be used on its own, but rather as a complement to clinical assessment: “Case formulation for any patient must include a careful clinical history and a concise summary of social, psychological, and biological factors [...]. Therefore, simply listing the symptoms in the diagnostic criteria is not enough” (American Psychiatric Association, 2023, p. 21). Yet the DSM has become so widespread that it has taken on a life of its own, moving beyond the walls of medical offices and exchanges among health professionals and into the streets, schools, homes, and, more recently, social media.

It was hypothesized that advances in research would eventually reveal the biological markers underlying each disorder, thereby establishing psychiatry within the biological sciences (Pinto, 2020). Despite substantial investment, the biological substratum of most mental disorders established in the DSM has so far proved unsatisfactory in terms of causal relationships. “Despite decades of significant investment in biomarker research, the lack of progress in discovering clinically useful biomarkers for psychiatry is disappointing” (Yatham, 2023, p. 263).

Neuroscience emerged as a promising line of research aimed at understanding the biological processes underlying mental disorders. However, as Vidal and Ortega (2020) argue, the idea that this field could provide a complete and definitive explanation of how the individual functions remains, to date, in the realm of myth. Although research on neurotransmitters and brain circuits, for example, has significantly advanced our understanding of the brain and its functions, it has yet to provide comprehensive explanations for the complexity of the human mind and mental disorders.

Vidal and Ortega (2020) argue that believing neuroscience can provide all the answers is ultimately a matter of faith, not established science. Although the critical and unstable state of diagnosis is already widely recognized and discussed within psychiatry, and has even given rise to new proposals for nosological classification (Henriques, 2021), DSM diagnoses continue to circulate and have concrete effects on the everyday lives of individuals and institutions.

Neoliberalism, as the dominant economic and political system today, plays an undeniable role in generating and perpetuating crises, as well as in proposing solutions to those same crises. Mental health is no exception. By prioritizing the market and profit maximization, neoliberalism shapes how mental health is understood and treated. Mental health becomes a profitable “niche,” in which diagnoses proliferate and a wide range of treatments and solutions are marketed (Broderick; Roscigno, 2021; Fernandes et al., 2024; Frances, 2013; Safatle, 2020).

Does inclusion require diagnoses?

What, then, is the conception of inclusive education from which we ask what purpose a diagnosis serves? We draw, on the one hand, on the broad, comprehensive, and community-based conception of mental health consolidated in Brazil through the Psychiatric Reform (Amarante; Nunes, 2018). On the other, we also draw on the social model of disability, an understanding that emerged from the struggle of social movements and was internationally endorsed by the Convention on the Rights of Persons with Disabilities. Although they come from distinct fields that do not always engage with one another (Arantes, 2024), both conceptions converge in emphasizing that no mental health condition or disability (Reed, 2024) can be understood by considering the individual in isolation. Individuals and their conditions must always be understood in light of social, historical, and economic factors and in interaction with the contexts they live in.

Diagnosis has, by its very nature, been viewed as something individual (even though some criteria may involve interaction with the environment), and thus runs counter to this understanding. The absence of causality is disregarded, while the isolated determinant remains. It is in this context that, in recent decades, scholars have denounced the medicalization of education, that is, the application of a medical lens to educational relationships as a narrative that takes precedence over all others (Beltrame; Gesser; Souza, 2019).

Human diversity is continually produced through a broad process of medicalization that assigns individuals a series of labels and classifications, placing them within a network of pathological explanations. Medicalization is a mechanism that transforms political, social, and cultural problems into personal issues to be treated or medicated. It isolates individuals from their context in order to scrutinize their particularities and render them pathological (Christofari; Freitas; Baptista, 2015, p. 1080).

In this sense, treating the child in isolation as the target of interventions, as though the aim were to correct the child while absolving the context, is an outdated and misguided practice and, one might add, a cowardly and dishonest one. The conception of inclusive education adopted here holds that “when the cause is shifted away from the child’s body (whether or not the child actually has the conditions mentioned), its place is taken by a complex set of factors-the child, teacher training, the school, the family, and the Brazilian government” (Bordin, 2008, p. 247). In other words, the point is to develop a more complex understanding of the reality at hand, which is impossible when attention is confined exclusively to diagnostic classification, reducing the analysis to the child. Moreover, focusing on diagnosis in isolation and in fatalistic terms perpetuates a view of the child with a disability as lacking, and of disability as a deficit.

The school, as a space for teaching and learning, and the teacher, as a professional who makes pedagogical decisions, must navigate the dialectic between each student’s singularity and the collective that constitutes a classroom. Diagnoses have become rigid classification tools that reinforce stereotypes and reduce the teacher’s role to implementing external prescriptions rather than actively engaging in developing pedagogical strategies. Inclusion requires schools to understand themselves as dynamic spaces capable of developing educational responses that transcend diagnosis and the biomedical model, while valuing the singularity of each individual in their relationship with knowledge without excluding them from the collective, thereby enabling not only access to mainstream schools but also continued attendance, participation, and learning.

Interpretive perspectives in support of inclusive education

The debate over the role and usefulness of classifications such as diagnoses, in both health and education, highlights the limitations inherent in any form of classification. On the one hand, classifications can provide an organized framework for understanding and addressing complex issues. They offer a shared vocabulary and a means of naming, bringing to light, and categorizing different phenomena. This can be particularly useful in contexts such as health care, where accurately identifying or establishing individual conditions and needs may be essential to providing appropriate support (Arantes, 2022). It is important, however, to recognize that classifications simplify reality and are therefore inherently limited. They can also have significant consequences. A psychiatric diagnosis, for example, can influence how a person is perceived and treated by others, leading to stigma and discrimination (Hacking, 1995, 2007; Henriques, 2021). Similarly, labels in education can affect a student’s self-esteem and academic and social development.

Classifications should therefore be approached with caution and an awareness of their inherent limitations. Rather than accepting them uncritically, we should question their validity and usefulness in specific contexts. We should recognize that classifications are tools constructed within particular social and historical contexts, not absolute truths, and that their application should always be guided by the principle of benefiting the individual concerned without absolving those around them of responsibility. In doing so, we can promote their responsible and ethical use, contributing to a deeper and more respectful understanding of human diversity.

With these reflections in mind, we now propose some analogies that may provide interpretive perspectives, lenses through which to examine more closely the impact of diagnoses as classification systems in schools and, from there, form a position. Once again, we ultimately question whether diagnoses should ever have entered the educational sphere. But since they are already there, and increasingly pervasive, we as teachers must know how to position ourselves critically and carefully in relation to them, in defense of students.

One final observation: presenting the analogies in pairs is not intended to impose a Manichaean framework on the analysis, as though it were simply a matter of distinguishing between a “good” and a “bad” path. Analogies serve the didactic purpose of simplifying complex situations. Although this text uses analogies as interpretive perspectives to outline how diagnoses should and should not be approached, we recognize and caution against the risks of oversimplification. After all, that is precisely what we oppose and argue against.

Diagnoses as a starting point or an endpoint

Are diagnoses starting points or endpoints? Although this analogy may seem, and indeed be, somewhat self-explanatory, exploring its implications more closely may help us question the uses and abuses of diagnostic categories in schools. This polarity also appears in other works, albeit with some differences (Déo; Pereira, 2011; Freitas, 2016; Hattge; Klaus, 2014; Sanches, 2011).

The situation recurs endlessly. In the classroom, a teacher notices something unusual about a child’s development and learning. “They need a diagnostic report”, many conclude. The search mobilizes school administrators, family members, and health professionals. At last, the desired report is obtained. Those involved, though not all of them, breathe a sigh of relief: we finally have what we expected.

When diagnoses are treated as endpoints, they invite inaction and may even justify school failure. They also open the door to viewing medication as the only means of enabling learning. We see this when children are accepted in the classroom only if medicated or when curricular adaptations are based on a supposed inability to learn attested by the diagnosis. Under this logic, for example, if a student has a diagnostic report for attention-deficit/hyperactivity disorder, only continuous use of methylphenidate will enable them to learn. The diagnosis is taken as a truth about the student’s brain and cognitive functioning, pointing to something that cannot be corrected, except through medication, since the phenomenon is assumed to be individual and biological. Thus, a biologizing discourse on human behavior reduces complex issues that must be understood in terms of social context, relationships, a child’s singularity, and pedagogical interventions to the individual and biological level. Diagnosis as an endpoint thus becomes the answer sought within the individual, allowing them to be labeled and placed in the position of someone incapable of learning (Rufato, 2021).

By contrast, when diagnoses are treated as starting points, they are seen as health-related information about an individual that can provide education professionals with valuable insight into that student and inform strictly pedagogical decisions. In other words, this is intersectoral collaboration in action (Pletsch; Sá; Mendes, 2021). It is important to establish that educational action must always begin with the individual, their singularity, needs, and potential. A diagnosis may therefore be part of the information available about a student, but should not structure pedagogical decisions. Here, however, by diagnosis as a starting point we mean primarily the opposite of treating it as a mere trophy to be displayed and then doing nothing with it except using it to justify a student’s lack of learning.

A medical report that reaches the school with nothing more than a term drawn from the International Classification of Diseases or the DSM is therefore of little use. By contrast, if the report describes the characteristics of the individual examined that led the health professional to formulate that diagnosis, it provides information that, if produced through careful and ethical work, can help the school develop pedagogical responses, though never in isolation. These responses will take into account that there is a child or adolescent in the class who has characteristics that significantly influence how they learn and perceive the world. In this case, the diagnosis provides a set of information about the individual that, together with observations made in the school environment and exchanges with family members, can become valuable material for the actions that belong to this sphere: pedagogical actions. Even so, this information contained in the diagnosis should not be treated as an absolute and self-contained truth when determining those actions.

Note, therefore, that while diagnosis as an endpoint invites inaction on the part of schools and education professionals, diagnosis as a starting point invites action, intersectoral collaboration, and productive, horizontal dialogue among professionals to promote the child’s or adolescent’s development and learning. In the latter case, expressions such as “child with a diagnostic report” or “special child” have no place, as they reveal a stigmatization that tends to reify the individual as incapable of learning. What is called for instead is the school’s critical reception of information from health professionals, which must be compared with and, necessarily, considered alongside observations made in the school and other settings, all of which are constantly changing.

We therefore argue that inclusive education can coexist with diagnoses only if they are viewed as starting points in the sense described here, with the individual at the center and diagnoses as potential aids. Otherwise, inclusion becomes impossible-a conclusion that, unfortunately, we see many people reach both within and beyond schools.

Finally, treating diagnosis as an endpoint presupposes a static understanding of development determined exclusively by biology. It disregards the fact that human development occurs in a constant dialectical relationship with the social contexts individuals live in. By contrast, diagnosis as a starting point understands development in its complexity, as intertwined with learning and changes in context. For this very reason, it must be continually reviewed and reassessed.

Diagnoses as scalpels or maps

The second pair of analogies we consider is that of diagnoses as scalpels or maps. Many of the conclusions we seek to draw build on those reached in the previous section, but this pair of analogies will allow us to add further elements to our analysis of the (im)possibilities of diagnoses for inclusive education.

Let us begin with diagnosis as a scalpel. This raises a seemingly banal question: are scalpels a problem? The answer is: it depends. A scalpel is a powerful tool in the hands of a trained surgeon. In untrained hands, however, it can cause carnage. In one case, it saves lives; in the other, it takes them. If we understand diagnoses as tools used by health professionals, we can see it is not so simple to regard them as good or bad in themselves. Indeed, in healthcare, diagnoses can create conditions of possibility for treatment and enable dialogue among professionals, as argued by proponents of the shift that began with DSM-3 (Frances, 2013). Health professionals must, however, be aware of the weaknesses underlying many diagnoses related to learning or psychological issues. This point has already been widely debated in the fields of mental health and psychiatry (Pinto, 2020). It is well established that there are no proven biological causes for diagnoses such as dyslexia, ADHD, or ODD, and that they are determined through clinical interviews based on signs and symptoms.

When diagnoses reach the school, however, they risk working like scalpels. In untrained hands, they cut short learners’ vitality and their recognition as individuals capable of development and learning. In other words, when terms drawn from the medical realm circulate among education professionals, they tend to make students almost strangers to the school. Students come to be seen as belonging to the medical or healthcare sphere and lose their right to be students, fully entitled to a place in the school. Diagnoses such as ADHD and ODD - fragile nosological entities - arrive as absolute truths, shrouded in the mysterious aura of revered medical knowledge (Bordin, 2008) - or evidence-based knowledge, to use a term dear to contemporary neopositivism. If it came from a doctor, then it must be true.

Thus, diagnosis requires careful and skilled understanding if it is to be used appropriately. When used improperly or superficially, diagnosis can do more harm than good, with negative consequences for the individual. It is worth noting that the mere fact that a diagnosis was made by a health professional does not guarantee that it was carefully established. On the one hand, gaps also remain in healthcare training; on the other, as we have seen, questions must be raised about the very existence and conception of current mental health diagnoses.

Should we conclude, then, that education professionals need training in diagnosis to be able to foster an inclusive school? Despite what the many neuroeducation courses proliferating online would have us believe, we argue that they do not. Once again, if diagnoses are sets of information about an individual, it is this information that should reach the school, to be considered together with, and on an equal footing with, perceptions of the individual from family members, teachers, and others. Based on this body of information, teachers should make pedagogical decisions. Once again, intersectoral collaboration comes into play.

This is precisely the sense diagnosis takes on when viewed as a map or compass, in keeping with the direction we propose in this article. The same emphasis on diagnosis can be found in other contexts (Simonetti, 2004), but our focus here is on the possibilities that viewing diagnosis as a map can offer schools and teachers. Just as a map provides guidance and helps people situate themselves in relation to a territory, a well-formulated diagnosis can provide valuable information that helps education professionals better understand a student’s needs and potential. Used in this way, diagnosis can guide teaching and support strategies, charting paths toward inclusion.

On the other hand, we must be mindful of the limits of the analogy. While a map is intended as a faithful cartographic representation of a territory, if diagnosis is understood as a map, then it must be viewed only as an unstable, uncertain, and unreliable one, particularly when it comes to pedagogical decisions based on it. If diagnosis is regarded as a compass, north must be understood as a constantly shifting point, requiring professionals to continually reorient themselves. They should never take a diagnosis as an absolute truth about an individual, as we will see below, but rather as a provisional set of considerations that, if critically understood, can contribute to the pedagogical decision-making we have discussed throughout.

Diagnoses under an essentialist or a pragmatic approach

In this third section, we move beyond analogies but retain an interpretive framework. Once again, some of our conclusions will be similar to those already drawn, but we hope to uncover further ways of understanding the complexity of the relationship between diagnoses and inclusive education. With this in mind, we argue that diagnoses can be viewed through either an essentialist or a pragmatic approach, echoing arguments already made by other scholars (Oliveira, 2023).

The essentialist approach understands diagnosis as a totalizing explanation of the individual, one that pertains to their very essence. This perception has given rise to what Ortega (2008) calls “bioidentities,” that is, identities grounded in diagnoses. If I am diagnosed with ADHD or borderline personality disorder, for example, this would then be my science-attested truth as an individual. This seems to be how diagnoses have been appropriated by common sense and by schools (Bordin, 2008). From a position of scientific, and therefore unquestionable, truth, the individual comes to be recognized and addressed through terms associated with diagnoses. As we have seen, diagnostic classifications can be useful tools for guidance, but they should not be regarded as absolute truths about an individual, as this may have disturbing effects on their very subjectivity (Christofari; Freitas; Baptista, 2015).

By constructing its nosological categories according to strictly objective criteria, which are then internalized as referring to one’s essence, psychiatry annihilates subjectivity, the affective and pa(th)etic dimensions of life, and everything pertaining to the subjective, while also objectifying the person through the countless empty abstractions produced by the disembodied language of contemporary psychiatry. In turn, individuals thus categorized, by internalizing this entire logic, objectify themselves, moving away from their true essence as they lose touch with the pa(th)etic aspect of existence, in a process of self-objectification or self-violence (Oliveira, 2023, p. 161).

By contrast, the approach known as pragmatic, which we consider the most appropriate and cautious given the fragile foundations of mental health diagnoses, considers diagnosis in terms of its instrumental use. Diagnosis may, for example, enable people with disabilities to access certain rights. Two observations are important here. First, since the Ministry of Education’s Technical Note No. 04/2014, a so-called medical report cannot be required for access to specialized educational services (AEE): “the submission of a medical report (clinical diagnosis) by a student with a disability, pervasive developmental disorder, or high abilities/giftedness cannot be considered indispensable, since AEE is pedagogical rather than clinical in nature” (Brasil, 2014, p. 3). As already noted, this position was reinforced in 2025 by Decree No. 12,686. A related observation is that access to rights should not be tied to diagnoses or medical reports (Arantes, 2022).

Diagnoses can also delineate groups for which public policies are designed. Inclusive special education itself defines a target population that, at least in part, becomes intelligible through diagnoses. In this case, diagnostic classifications are understood as political devices. Moreover, their use may “serve as protection against derogatory terms used by society to refer to other human beings (such as weird, strange, stupid, lazy, retarded [...] etc.)” (Oliveira, 2023, p. 165).

Final considerations

This article sought to contribute to the discussion of diagnoses and their relationship with inclusive education, showing that this relationship is complex, multifaceted, and slippery. We sought to explore the extent to which diagnosis may play a role in promoting well-being and supporting personal and educational development, although we remain reluctant to adopt the position that its presence does more good than harm. Nevertheless, given the presence of diagnoses in educational settings, whether invited in or imposed from outside, it is crucial that they be used carefully and critically, always with a view to promoting the participation, continued attendance, and learning of all students.

Diagnoses are tools that can bring clarity and understanding to complex situations. They provide a means of naming, allowing health professionals to identify and communicate with one another about a person’s characteristics or conditions. This act of naming, but above all the set of information being named, can serve as a starting point for targeted actions, such as specific treatments or educational interventions. From a broader conception of diagnosis, however, Arantes (2022, p. 82) invites us to “propose, for example, that a diagnosis in the field of education be constructed around the questions ‘what does this child know?’ or ‘how do they learn?’ or, better still, ‘how should we structure support to expand their knowledge?’”

Drawing on yet another analogy, Vasques states: “Like a frame of sorts, diagnosis frames the child, and within that frame we place them, believing that they can be modified, adapted, and corrected” (2015, p. 117). Therefore, when discussing the relationships among psychology, mental health, and inclusive education, it is essential to adopt an approach that recognizes the complexity of human diversity and embraces intersectoral collaboration as fruitful dialogue and exchange among professionals from different fields, without subordinating one to another. We must question the normative standards that perpetuate exclusion and work to build educational environments that value and respect each person’s singularity. Only then can we truly counter processes of medicalization and pathologization and promote a more just and inclusive education.

References

• AMARANTE, Paulo; NUNES, Mônica de Oliveira. A reforma psiquiátrica no SUS e a luta por uma sociedade sem manicômios. Ciência & Saúde Coletiva, Rio de Janeiro, v. 23, n. 6, p. 2067-2074, 2018. https://doi.org/10.1590/1413-81232018236.07082018
  » https://doi.org/10.1590/1413-81232018236.07082018
• AMERICAN PSYCHIATRIC ASSOCIATION. Manual diagnóstico e estatístico de transtornos mentais: DSM-5-TR. 5. ed., texto rev. Porto Alegre: Artmed, 2023.
• ARANTES, Ricardo Lugon. Os diagnósticos e os autismos nas conversas com a educação. In: CECCIM, Ricardo Burg; FREITAS, Cláudia Rodrigues; ANGELUCCI, Carla Biancha (org.). Fármacos, remédios, medicamentos: o que a educação tem com isso? v. 2. Porto Alegre: Rede Unida, 2022. p. 81-87.
• ARANTES, Ricardo Lugon. Pontes sobre o abismo: entremeios entre saúde mental e o campo das pessoas com deficiência. 2024. Tese (Doutorado em Psicologia) - Universidade Federal do Rio Grande do Sul, Porto Alegre, 2024.
• BELTRAME, Rudinei Luiz; GESSER, Marivete; SOUZA, Simone Vieira de. Diálogos sobre medicalização da infância e educação: uma revisão de literatura. Psicologia em Estudo, Maringá, v. 24, e42566, 2019. https://doi.org/10.4025/psicolestud.v24i0.42566
  » https://doi.org/10.4025/psicolestud.v24i0.42566
• BORDIN, Sonia Sellin. Excesso de diagnóstico na leitura e escrita: vivências com a linguagem no CCazinho. Estudos da Língua(gem), Vitória da Conquista, v. 6, n. 2, p. 243-275, 2008. https://doi.org/10.22481/el.v6i2.1074
  » https://doi.org/10.22481/el.v6i2.1074
• BRASIL. Ministério da Educação. Secretaria de Educação Continuada, Alfabetização, Diversidade e Inclusão. Diretoria de Políticas de Educação Especial. Nota Técnica nº 04/2014/MEC/SECADI/DPEE: orientação quanto a documentos comprobatórios de alunos com deficiência, transtornos globais do desenvolvimento e altas habilidades/superdotação no Censo Escolar, Brasília, DF, 23 jan. 2014.
• BRODERICK, Alicia A.; ROSCIGNO, Robin. Autism, inc.: the autism industrial complex. Journal of Disability Studies in Education, Leiden, v. 2, n. 1, p. 77-101, 2021. https://doi.org/10.1163/25888803-bja10008
  » https://doi.org/10.1163/25888803-bja10008
• CAVALCANTI, Ana Elizabeth et al Que autista, afinal? Percurso, São Paulo, p. 131-144, 2024. https://doi.org/10.70048/percurso.73.131-144
  » https://doi.org/10.70048/percurso.73.131-144
• CECCIM, Ricardo Burg; FREITAS, Cláudia Rodrigues; ANGELUCCI, Carla Biancha. Fármacos, remédios, medicamentos: o que a educação tem com isso? v. 1. Porto Alegre: Rede Unida, 2022.
• CHRISTOFARI, Ana Carolina; FREITAS, Cláudia Rodrigues de; BAPTISTA, Claudio Roberto. Medicalização dos modos de ser e de aprender. Educação & Realidade, Porto Alegre, v. 40, p. 1079-1102, 2015. https://doi.org/10.1590/2175-623642057
  » https://doi.org/10.1590/2175-623642057
• CANGUILHEM, Georges. O normal e o patológico. Rio de Janeiro: Forense, 2024.
• COLLARES, Cecília; MOYSÉS, Maria Aparecida Affonso. Diagnóstico da medicalização do processo ensino-aprendizagem na 1ª série do 1º grau no município de Campinas. Em Aberto, Brasília, DF, v. 11, n. 53, 1992. Disponível em: https://rbep.inep.gov.br/ojs3/index.php/emaberto/article/view/2142/1881 Acesso em: 14 abr. 2025.
  » https://rbep.inep.gov.br/ojs3/index.php/emaberto/article/view/2142/1881
• DÉO, Adriana Fortes; PEREIRA, Jeanete Aparecida Ferri. A triangulação entre deficiência intelectual, funcionalidade humana e apoios. Revista Dica, Agudos, v. 3, n. 4, p. 1-14, 2011. Disponível em: https://www.revistafaag.com.br/revistas_antiga/upload/4_87-266-1-PB.pdf Acesso em: 23 abr. 2025.
  » https://www.revistafaag.com.br/revistas_antiga/upload/4_87-266-1-PB.pdf
• FERNANDES, Amanda Dourado; COUTO, Maria Cristina Ventura; ANDRADA, Barbara Costa; DELGADO, Pedro Gabriel Godinho. A “indústria” do autismo no contexto brasileiro atual: contribuição ao debate. [S. l.: s. n], 2024. Material técnico.
• FRANCES, Allen. Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma, and the medicalization of ordinary life. New York: William Morrow, 2013.
• FREITAS, Marcos Cezar. O aluno incluído na educação básica: avaliação e permanência. São Paulo: Cortez, 2016.
• HACKING, Ian. Kinds of people: moving targets. In: Proceedings of the British Academy. Oxford: Oxford University Press, 2007. p. 285-318.
• HACKING, Ian. The looping effects of human kinds. In: SPERBER, Dan; PREMACK, David; PREMACK, Ann James (org.). Causal cognition: a multidisciplinary debate. Oxford: Oxford University Press, 1995. p. 351-383.
• HATTGE, Morgana Domênica; KLAUS, Viviane. A importância da pedagogia nos processos inclusivos. Revista Educação Especial, Santa Maria, v. 27, n. 49, p. 327-339, 2014. Disponível em: https://www.redalyc.org/articulo.oa?id=313131528005 Acesso em: 12 abr. 2025.
  » https://www.redalyc.org/articulo.oa?id=313131528005
• HENRIQUES, Rogério da Silva Paes. Classificação psiquiátrica: tensionamento atual entre realismo e nominalismo. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 31, e310328, 2021. https://doi.org/10.1590/S0103-73312021310328
  » https://doi.org/10.1590/S0103-73312021310328
• MOYSÉS, Maria Aparecida Affonso; COLLARES, Cecília Azevedo Lima. Revendo questões sobre a produção e a medicalização do fracasso escolar. In: VICTOR, Sonia Lopes; DRAGO, Rogério; CHICON, José Francisco (org.). Educação especial e educação inclusiva: conhecimentos, experiências e formação. Araraquara: Junqueira & Marin, 2011. p. 21-41.
• NACINOVIC, Rafaela do Carmo Pacheco; RODRIGUES, Maria Goretti Andrade. Medicalização da educação especial: tensões na inclusão. Educação, Sociedade & Culturas, Porto, n. 57, p. 203-221, 2020. https://doi.org/10.34626/esc.vi57.20
  » https://doi.org/10.34626/esc.vi57.20
• OLIVEIRA, Stephan Malta. Diagnóstico psiquiátrico, essencialismo e barbárie: considerações a partir da fenomenologia da vida. Revista Ágora Filosófica, Recife, v. 23, n. 3, p. 148-169, 2023. https://doi.org/10.25247/P1982-999X.2023.v23n3.p148-169
  » https://doi.org/10.25247/P1982-999X.2023.v23n3.p148-169
• ORTEGA, Francisco. O sujeito cerebral e o movimento da neurodiversidade. Mana, Rio de Janeiro, v. 14, p. 477-509, 2008. https://doi.org/10.1590/S0104-93132008000200008
  » https://doi.org/10.1590/S0104-93132008000200008
• PINTO, Jairo Vinícius Merege de Mello Cruz. Abordagens transdiagnósticas e seus usos para o desenvolvimento de marcadores objetivos em psiquiatria. 2020. Tese (Doutorado em Medicina) - Universidade Federal do Rio Grande do Sul, Porto Alegre, 2020.
• PLETSCH, Márcia Denise; SÁ, Miriam Ribeiro Calheiros de; MENDES, Geovana Mendonça Lunardi. A favor da escola pública: a intersetorialidade como premissa para a educação inclusiva. Revista Teias, Rio de Janeiro, v. 22, n. 66, p. 11-26, 2021. https://doi.org/10.12957/teias.2021.58619
  » https://doi.org/10.12957/teias.2021.58619
• REED, Geoffrey M. What’s in a name? Mental disorders, mental health conditions and psychosocial disability. World Psychiatry, Hoboken, v. 23, n. 2, p. 209, 2024. https://doi.org/10.1002/wps.21190
  » https://doi.org/10.1002/wps.21190
• RUFATO, Glaucia Botan. Dificuldades de aprendizagem na escola e o uso excessivo de medicamentos. Revista Cocar, Belém, v. 15, n. 33, 2021. Disponível em: https://periodicos.uepa.br/index.php/cocar/article/view/4669 Acesso em: 17 abr. 2025.
  » https://periodicos.uepa.br/index.php/cocar/article/view/4669
• SAFATLE, Vladimir. A economia é a continuação da psicologia por outros meios: sofrimento psíquico e o neoliberalismo como economia moral. In: SAFATLE, Vladimir; SILVA JUNIOR, Nelson da; DUNKER, Christian (org.). Neoliberalismo como gestão do sofrimento psíquico. São Paulo: Autêntica, 2020. p. 17-46.
• SAFATLE, Vladimir; SILVA JUNIOR, Nelson da; DUNKER, Christian (org.). Neoliberalismo como gestão do sofrimento psíquico. São Paulo: Autêntica, 2020.
• SANCHES, Isabel. Do “aprender para fazer” ao “aprender fazendo”: as práticas de educação inclusiva na escola. Revista Lusófona de Educação, Lisboa, v. 19, n. 19, 2011.
• SIMONETTI, Alfredo. Manual de psicologia hospitalar: o mapa da doença. São Paulo: Casa do Psicólogo, 2004.
• VASQUES, Carla Karnoppi. O diagnóstico e a escolarização de alunos com transtornos globais do desenvolvimento. In: BAPTISTA, Cláudio Roberto (org.). Escolarização e deficiência: configurações nas políticas de inclusão escolar. São Carlos: Marquezine & Manzini: ABPEE, 2015. p. 107-120.
• VENTURINI, Ernesto et al Habilitar-se em saúde mental: observações críticas ao conceito de reabilitação. Arquivos Brasileiros de Psicologia, Rio de Janeiro, v. 55, n. 1, p. 56-63, 2003. Disponível em: http://pepsic.bvsalud.org/scielo.php?pid=S1809-52672003000100007&script=sci_arttext Acesso em: 15 maio 2025.
  » http://pepsic.bvsalud.org/scielo.php?pid=S1809-52672003000100007&script=sci_arttext
• VIDAL, Fernando; ORTEGA, Francisco. Somos nosso cérebro?: neurociências, subjetividade, cultura. São Paulo: n-1, 2020.
• YATHAM, Lakshmi N. Biomarkers for clinical use in psychiatry: where are we and will we ever get there? World Psychiatry, Chichester, v. 22, n. 2, p. 263-264, 2023. https://doi.org/10.1002/wps.21079
  » https://doi.org/10.1002/wps.21079

*

English version by Fernando Effori de Mello. The authors take full responsibility for the translation of the text, including title of books/articles and the quotations originally published in Portuguese.

Data availability:

The complete dataset supporting the findings of this study is included in the article.

³

Here, we use the term inclusive education in its broad sense, as an organizing principle for educational practice guided by the goal of ensuring the participation, continuation of studies, and learning of all students. This understanding encompasses inclusive special education, intended for students with disabilities, autism spectrum disorder (ASD), and high abilities/giftedness, but is not limited to these groups.

Editor:

Prof. Dr. Marília Pinto de Carvalho

Publication Dates

• Publication in this collection
  21 Sept 2026
• Date of issue
  2026

History

• Received
  17 May 2025
• Reviewed
  09 Feb 2026
• Accepted
  09 Mar 2026