ABSTRACT
However much psychiatric diagnosis may share the language of medicine, it is a completely different, if not alien, form of classification. All medical diagnoses begin with a hypothesis, based on the physician’s observations of signs of possible illness, displayed by the body, and symptoms reported by the person. The formal diagnosis – especially where the condition is severe or life-threatening – is dependent on pathological corroboration. After examining me, the physician may believe that I have swine flu (H1N1) but would need the results of a laboratory test of a viral culture to confirm this. If my condition appears related to a more complex, or rare disorder, the physician might need to call on the support of radiographers, toxicologists, pathologists or other medical scientists, to confirm the diagnosis. By contrast, if I go (or am sent) to a psychiatrist complaining of troubling thoughts, feelings
or patterns of behaviour – or indeed if a member of my family views any of these as troublesome – a psychiatrist may decide, on the basis of an interview, that I have a psychiatric disorder. None of the blood tests, urine tests, X-rays, biopsies or computerised body scans, commonly used to confirm a medical diagnosis, will be used to help confirm the presence of my ‘illness’. Although I may be interviewed several times, in principle a single conversation with a single psychiatrist is all that is necessary to judge whether or not I am ‘mentally ill’. However odious the comparison might seem to psychiatrists – if not other mental health
professionals – all psychiatric diagnosis is mere opinion, based on the professional’s ‘powers of observation’. These are the same ‘tools’ used by the art or theatre critic, or the judges in boxing or gymnastics. Of course, these critics and judges might be described as experts, having witnessed hundreds if not thousands of ‘performances’, and their judgement might carry considerable authority. However, the audience, the general public and the performers are free to disagree. Indeed, time will tell whether these opinions were flawed if not actually ‘fixed’. However, because a psychiatric diagnosis is made by a doctor it is assumed to relate to an
actual illness.1 In that sense, it is nothing like judging the results of a boxing match. If those judges make errors of judgement, or even ‘fix the fight’, the loser can still fight again later for another title. By contrast, if I am judged to have a psychiatric disorder, this may (indeed likely will) affect, among other things: my freedom to travel internationally; my career opportunities; my chances of adopting or fostering a child; or even my right to cast my vote in an election. Unlike sports, making a comeback from a psychiatric diagnosis is fraught with many more complications.
