I find, in the same way Marx found that the wealth of capitalist societies are an immense accumulation of commodities, medicine and treatment contains their own collection of commodities in the form of diagnoses. Recognized by Marx as being a unity of use value and exchange value, diagnoses reflect this feature of a commodity. This isn't to say that diagnoses are meaningless, they do contain use value and meet some need "whether from the stomach or imagination." However, effective Marxist critique of market economics has always been in the illusory nature of social exchange value. Diagnosis adhering to this definition, bear social exchange value in the form of what sickness they are meant to convey to the outside world (and even to ourselves.) This exchangability is felt in the deterritorialized way that 9 different types of doctors with different fields of study treat my "Gender Dysphoria DSM-5 302.85". In the process of being treated, none of them rely on any of the others' test results or lab notes, or therapy sessions. I mean, why would they? what does a cranial facial surgeon need to know about my relationship with my father? what does a therapist need to know about my blood levels? This central exchangeability of a symbol in the form of a diagnosis that means practically nothing moves it from being a mere commodity to one as universal as money itself that we trade for treatment.
I've had people insist that, because dysphoria or other 'illnesses' can be located in the form of symptoms that it does indeed exist in the concrete sense. That mistakenly places a lot of imagined shared properties of the illness onto the patients mind. There's hardly any solid evidence what "Gender Dysphoria DSM-5 302.85" looks like in a psychological or even distinct taxonomic form. It's practically up to your therapist to decide if you're "fucked up" enough to be treated. Despite the readily available multitude of treatments and things that you can exchange this diagnosis for there is no central value to the diagnosis itself. We can only say that certain forms of 'fucked upedness' look like other forms of 'fucked upedness' and then create the label relatively speaking. This obviously fails to question what an ideal case of mental health looks like, or why it is ideal, and whether or not providing this "treatment" instead enacting the notion of sickness to begin with?
I don't mean to suggest that as commodities this means that all diagnosis are "fake" many commodities have varying levels of use-value; Cancer will obviously kill you if left untreated, I probably wouldn't want to have a necrotic lung inside me. This still leaves us to figure out how to cope with wellness at it's most abstract, and figure out what parts of this mirror theory of wellness actually exist. I think a useful way to view it is in relation to production. I am not transgender because I have a brain disease that makes me want to shoot estrogen in my leg every week and wear dresses that don't fit me, nor is a commodity like gold valuable because you can look and see it's exchange value under a microscope. I am transgender because the way I like to present myself for whatever reasons, a priori or post-priori to any gender socialization, don't gel perfectly with the labor and it's divisions. In the same way laborers are in a dialectical relationship with the capital form that's detrimental to their own existence.
Much like abolishing the commodity form in an economic sense, I don’t hold much hope that contradictions in care like these will be resolved in my lifetime, but I do think a critical analysis of mental health operates like a currency in many scenarios is a good way to begin to create a model of mental health that doesn’t end in reifying my own diagnoses’ value much in the same way that certain economists reject any implication that at least some of it’s conventions are wrapped up in the cargo cult of sign value and cannot be scrutinized. You can turn back to use value however, and following that advice I think we should explore a less deterritorialized version of mental health and refocus on how we can consolidate our understanding of these things into what’s useful.