Between Diagnosis and Meaning – Jaspers, Jung, Freud, and the Question of Gender Identity

How should we understand mental illness and identity? Karl Jaspers offered psychiatry a balance between medical explanation and hermeneutical understanding. Freud and Jung deepened the interpretive route. Today’s Gender Identity debates expose the unresolved tension between these approaches—whether identity is a medical condition to be treated or a symbolic process to be interpreted.

Karl Jaspers’ General Psychopathology remains a touchstone for psychiatry because it set out two distinct paths: the medicalising route of explanation (Erklären), where mental illness is approached like physical disease, and the hermeneutical path of understanding (Verstehen), where lived experience and meaning are integral. Jaspers insisted that both belong to psychiatry, but the balance has rarely been kept¹. Recent scholarship has revisited Jaspers’ work, emphasising its enduring relevance and its ability to rehumanise psychiatry in an age of biologically driven diagnosis².

Where Jaspers leaned toward description and diagnostic rigour, Freud and Jung pressed the hermeneutical route further. Freud mapped unconscious drives and conflicts; Jung explored symbolic processes and archetypes. Both placed meaning and narrative at the centre, seeing symptoms as communications from the psyche rather than only dysfunctions of the brain³. Their work opened space for listening to how personal, cultural, and mythological factors shape distress.

This divergence speaks directly to today’s Gender Identity controversies. The medicalising approach frames gender dysphoria as a diagnosable condition, often treated through affirmation protocols, puberty blockers, and surgical interventions. International guidelines such as the WPATH Standards of Care prioritise affirmation models, presenting them as evidence-based medical responses. In the UK, the Cass Review has recommended a more cautious stance, calling for comprehensive psychological assessment before intervention, reflecting Jaspers’ concern for diagnostic precision and explanatory models⁴.

The hermeneutical route, by contrast, asks what psychic meaning these experiences carry. Freud might have seen gender questioning as a negotiation of unconscious identification and desire; Jung as an encounter with contrasexual archetypes, shadow projections, or individuation trials. Both would emphasise that the psyche communicates symbolically, and that gender conflict may signal deeper transformation. To treat gender dysphoria solely as a disorder is to miss its symbolic, cultural, and mythopoetic dimensions⁵.

This raises urgent questions. Are affirmation models, when applied as default protocols, bypassing the hermeneutical work of helping individuals make meaning from inner conflict? Is gender transition always the resolution, or can it sometimes be a symbolic enactment of other psychic struggles? Conversely, can symbolic interpretation alone be sufficient if it ignores embodied suffering, social hostility, or the medical realities of distress? These tensions highlight the polarity Jaspers identified between explanation and understanding.

David Healy, in his book, The Suspended Revolution: Psychiatry and Psychotherapy Re-examined, evaluates Jaspers alongside Freud and Jung illuminates the stakes of this debate. A psychiatry that only explains risks collapsing meaning into mechanism. A psychology that only interprets risks neglecting bodily realities and social care. For gender identity, both poles matter: the medical and the hermeneutical, the diagnosis and the dialogue, the body and the symbol. The wider culture, too, tends to polarise—either insisting on biological determinism or treating identity as wholly self-declared—both collapsing Jaspers’ balance.

The challenge is not to choose one path, but to resist their separation. Gender Identity concerns may demand precisely the suspended balance Jaspers sought, enriched by Freud’s and Jung’s hermeneutics of meaning. Only then can the suffering of individuals be addressed without losing sight of the wider symbolic drama in which it is entangled.

Endnotes

1. Jaspers, K. (1963). General Psychopathology. (original 1913). English trans. Manchester University Press.
2. Stanghellini, G. & Fuchs, T. (2025). “Karl Jaspers as Psychiatrist.” In The Anthem Companion to Karl Jaspers. Anthem Press. See also Editorial, British Journal of Psychiatry (2025), describing Jaspers’ phenomenological psychiatry as a resource for contemporary practice.
3. Freud, S. (1917). Introductory Lectures on Psychoanalysis. Jung, C. G. (1959). The Archetypes and the Collective Unconscious. Collected Works, Vol. 9. Princeton University Press.
4. Healy, D. (1997). The Suspended Revolution: Psychiatry and Psychotherapy Re-examined. Faber & Faber. See also Hilary Cass (2024). Independent Review of Gender Identity Services for Children and Young People. NHS England.
5. Jung, C. G. (2009). The Red Book: Liber Novus. Philemon Foundation / W. W. Norton. See reflections on anima/animus and symbolic individuation.
6. Souza, R. C. (2023). “Karl Jaspers and the Dialectics of Psychopathology.” Revista Latinoamericana de Psicopatologia Fundamental, 26(4).
7. Kim, H. (2019). “Phenomenological Psychopathology Today.” Psychiatry Investigation, 16(2), 93–101.