Thanks for this thoughtful essay. One reaction (among many others, unspoken!) from my own experience: Some years ago, after a few months of back and forth with my psychiatrist, I convinced him (or at least, I convinced him to say—but I believe he was being genuine and honest) that being diagnosed with schizophrenia means nothing more than exhibiting some disjunctively specified set of experiences or behaviors. Once we agreed on that basic point, *both* of us began to think about treatment differently, and I'd say for the better. (For my part, it was really just a matter of now being willing to work with him.) In particular, he stopped worrying about treating some underlying 'disease' or 'condition' or whatever (called ‘schizophrenia’, or is it ‘really’ ‘schizoaffective disorder’ or..., or…, or does the name really matter?) and we focused on what could be achieved with regard to living well with those experiences and behaviors, or perhaps altering them where that’s helpful and possible.
In other words, if you take DSM/ICD for what they (mostly) are—disjunctive lists of ‘symptoms’ to which certain names are attached—then it is easy to stop worrying about the names and focus on the ‘symptoms’ (a misnomer in this case, but no further comment on that point here). And then an ‘incorrect’ diagnosis starts to matter a lot less because one is not asking “how do we ‘deal with’ this schizophrenia?” but “how do we cope with these experiences?” (regardless of what we might call them, taken collectively).
This is a great article, and great comment above. I almost always have one or more diagnoses that I’m using for insurance purposes and a completely different picture in my head. We are so concerned about being more specific and getting it right.
I wonder if it’s better to acknowledge the ambiguity of psychiatric diagnosis, if there’s value in having a diagnosis that just allows you a lot of wiggle room as a Dr or a patient. It’s counter to science and medicine, it might make us embarrassed. But I personally would sort of prefer to not be described exactly. I’d prefer to think that I can’t be captured by a
code.
We might instead say to patients, “Our diagnoses are quite overlapping and connected. I’m going to suggest this medication because I think it targets your main issue or targets the overlap.”
Thanks for this thoughtful essay. One reaction (among many others, unspoken!) from my own experience: Some years ago, after a few months of back and forth with my psychiatrist, I convinced him (or at least, I convinced him to say—but I believe he was being genuine and honest) that being diagnosed with schizophrenia means nothing more than exhibiting some disjunctively specified set of experiences or behaviors. Once we agreed on that basic point, *both* of us began to think about treatment differently, and I'd say for the better. (For my part, it was really just a matter of now being willing to work with him.) In particular, he stopped worrying about treating some underlying 'disease' or 'condition' or whatever (called ‘schizophrenia’, or is it ‘really’ ‘schizoaffective disorder’ or..., or…, or does the name really matter?) and we focused on what could be achieved with regard to living well with those experiences and behaviors, or perhaps altering them where that’s helpful and possible.
In other words, if you take DSM/ICD for what they (mostly) are—disjunctive lists of ‘symptoms’ to which certain names are attached—then it is easy to stop worrying about the names and focus on the ‘symptoms’ (a misnomer in this case, but no further comment on that point here). And then an ‘incorrect’ diagnosis starts to matter a lot less because one is not asking “how do we ‘deal with’ this schizophrenia?” but “how do we cope with these experiences?” (regardless of what we might call them, taken collectively).
A wonderful illustration from your experience, Michael! Thank you
This is a great article, and great comment above. I almost always have one or more diagnoses that I’m using for insurance purposes and a completely different picture in my head. We are so concerned about being more specific and getting it right.
I wonder if it’s better to acknowledge the ambiguity of psychiatric diagnosis, if there’s value in having a diagnosis that just allows you a lot of wiggle room as a Dr or a patient. It’s counter to science and medicine, it might make us embarrassed. But I personally would sort of prefer to not be described exactly. I’d prefer to think that I can’t be captured by a
code.
We might instead say to patients, “Our diagnoses are quite overlapping and connected. I’m going to suggest this medication because I think it targets your main issue or targets the overlap.”