Diagnosis: Same as It Never Was
A Harvard psychiatrist tracks the evolution of his discipline's 'bible.'
By Michael Craig Miller, M.D. | NEWSWEEK
Dec 10, 2007 Issue
The word "diagnosis" comes from the Greek "to recognize" or "to know." The
concept is an ideal in medicine, where to recognize and understand a
disease is a prerequisite to treating it properly. Despite advances in
science, history teaches that we usually know less than we'd like to about
the causes of illness. This is particularly true when it comes to mental
health.
Today's promise is that science will lead us out of the thicket.
Researchers are decoding the genome, sorting out the functions of brain
regions and mapping neural pathways. They'll be able to tell us what goes
wrong, where it goes wrong and—eventually—how to fix it. Having reduced
human experience to its fundamental biological elements, psychiatric
diagnosis will finally be definitive and treatment choices will be
precise.
Not so fast.
As the American Psychiatric Association ramps up to revise its Diagnostic
and Statistical Manual (DSM), with a target publication date of 2012,
signs are that the diagnostic system will improve. But no one doubts that
the next edition will be the same as prior versions in one important
respect—a work in progress.
Despite what the word means in Greek, "diagnosis" has a less lofty, more
practical meaning in English. A diagnosis is a label, one that comes to
represent a disease or a syndrome that is maladaptive or causes distress.
Diagnoses are part of professional language. When a mental-health
professional describes someone as having a "generalized anxiety disorder,"
another professional across town or across the country will have a good
idea of how that term is being used.
The politics of psychiatric diagnosis, however, are not so
straightforward. For one thing, people cherish their individuality and
resist being labeled. Also, the power to name is significant. Diagnostic
labels, when misapplied, can establish people as deviant, deprive them of
rights or heap upon them a burden of shame or stigma. Even when intentions
are good, diagnostic systems—like the science they are rooted in—are
inevitably constrained by the intellectual, ethical and political trends
of the era.
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