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DIAGNOSIS IN
PSYCHIATRY
Adam Blatner
Posted
June 15, 2006 (Several related articles on this website are
linked to below.)
Diagnosis refers to at least two processes. One is the naming of a condition. There is value in doing this, as it can reassure the patient and family that what is being dealt with is recognizable, and that something is known about the condition's natural course, probable outcomes ("prognosis"), what the underlying mechanics or dynamics may be, and how it might best be treated. Yet this naming process is an inexact science. Historically, professionals have sometimes lumped conditions together that later were recognized as having different features. In the early 19th century, "pthisis" referred to a wasting condition that, in retrospect, might have been tuberculosis, cancer, or other type of disease. In the early 20th century, manic-depressive disease and schizophrenia were insufficiently differentiated. Around 1970, when lithium carbonate was approved for the treatment of manic-depressive disorder (and now is often called "bipolar disorder"), it became more apparent that this medicine did not appreciably help people with schizophrenia, while in turn the medicines used for that condition weren't especially helpful for bipolar disorder. For these reasons, it became more important to make a better diagnosis more consistently, and the American Psychiatric Association revised its diagnostic manual to be more "criterion"-based and reliable.
The other process in diagnosis is understanding what's going on, beyond the naming. The word "diagnosis" means to know ( "-gnosis") through (dia-)--as diaphanous, diagram, to clarify, and in this sense, what is needed is a deeper understanding of the relevant dynamics involved. In psychiatry, these dynamics can include not just patients' physical conditions, but their attitudes, basic beliefs, and other psychological patterns; the state of their interpersonal and social networks; their jobs, cultural affiliations and pressures, and many other factors (some of which are described on this website in a paper called factors in psychiatric diagnosis.)
On yet another paper I describe another group of diagnostic variables that are not sufficiently appreciated, in my opinion, and which tend to be most relevant to outcome and treatment planning.
The art of case formulation and (in another webpage article), the art of case presentation also are papers on this website that speak to the complexity of the art of diagnosis.
The key point is that diagnoses are not ultimately real in themselves, but rather verbal tools, categories of thought, which enable psychiatrists and therapists to treat and patients and family members to better understand what's going on. Some terms, such as anxiety and depression, are especially general and don't tell us that much about what's happening. My point here is to get beyond the feeling that if your doctor uses such a term, or prescribes medicine for it, that the problem is thereby solved. It's generally important to find out what's really going on, why these symptoms emerged, so that even if the medicines work, the stresses that triggered the problem have been more clearly addressed.
Can relationships be sick? In another paper on this website I comment on a controversy a few years back about whether or not it was wise or useful to diagnose relationships!
Some seemingly diagnostic labels thrown around in psychology and psychiatry are generally unhelpful and often make things worse. I write about this in a paper on unhelpful overgeneralizations.
Browse among my other papers and you may find still more that can be useful to you. Feel free to email me with questions. (I don't do personal consultations, but specific questions about aspects of psychology might be interesting for me to address.) Email to adam@blatner.com
Diagnosis refers to at least two processes. One is the naming of a condition. There is value in doing this, as it can reassure the patient and family that what is being dealt with is recognizable, and that something is known about the condition's natural course, probable outcomes ("prognosis"), what the underlying mechanics or dynamics may be, and how it might best be treated. Yet this naming process is an inexact science. Historically, professionals have sometimes lumped conditions together that later were recognized as having different features. In the early 19th century, "pthisis" referred to a wasting condition that, in retrospect, might have been tuberculosis, cancer, or other type of disease. In the early 20th century, manic-depressive disease and schizophrenia were insufficiently differentiated. Around 1970, when lithium carbonate was approved for the treatment of manic-depressive disorder (and now is often called "bipolar disorder"), it became more apparent that this medicine did not appreciably help people with schizophrenia, while in turn the medicines used for that condition weren't especially helpful for bipolar disorder. For these reasons, it became more important to make a better diagnosis more consistently, and the American Psychiatric Association revised its diagnostic manual to be more "criterion"-based and reliable.
The other process in diagnosis is understanding what's going on, beyond the naming. The word "diagnosis" means to know ( "-gnosis") through (dia-)--as diaphanous, diagram, to clarify, and in this sense, what is needed is a deeper understanding of the relevant dynamics involved. In psychiatry, these dynamics can include not just patients' physical conditions, but their attitudes, basic beliefs, and other psychological patterns; the state of their interpersonal and social networks; their jobs, cultural affiliations and pressures, and many other factors (some of which are described on this website in a paper called factors in psychiatric diagnosis.)
On yet another paper I describe another group of diagnostic variables that are not sufficiently appreciated, in my opinion, and which tend to be most relevant to outcome and treatment planning.
The art of case formulation and (in another webpage article), the art of case presentation also are papers on this website that speak to the complexity of the art of diagnosis.
The key point is that diagnoses are not ultimately real in themselves, but rather verbal tools, categories of thought, which enable psychiatrists and therapists to treat and patients and family members to better understand what's going on. Some terms, such as anxiety and depression, are especially general and don't tell us that much about what's happening. My point here is to get beyond the feeling that if your doctor uses such a term, or prescribes medicine for it, that the problem is thereby solved. It's generally important to find out what's really going on, why these symptoms emerged, so that even if the medicines work, the stresses that triggered the problem have been more clearly addressed.
Can relationships be sick? In another paper on this website I comment on a controversy a few years back about whether or not it was wise or useful to diagnose relationships!
Some seemingly diagnostic labels thrown around in psychology and psychiatry are generally unhelpful and often make things worse. I write about this in a paper on unhelpful overgeneralizations.
Browse among my other papers and you may find still more that can be useful to you. Feel free to email me with questions. (I don't do personal consultations, but specific questions about aspects of psychology might be interesting for me to address.) Email to adam@blatner.com