A Physician's Forecast

William Todd Schultz on diagnostication:
Let me begin by saying this: No, I don't believe every artistic genius is mad. Nor do I believe that every mad person is secretly (or not-so-secretly) artistic. Both are statistical outliers, the two do intersect occasionally in enormously interesting ways that I plan to talk about a lot, but they are not one and the same. There is no essential connection. A tendency that does seem to be increasing in frequency, however, and it's a tendency I generally deplore, is the diagnosing of artists as a means of explaining their art. The process usually goes something like this: Sylvia Plath was consumed by the idea of killing herself, she was emotionally erratic, her moods were labile, she was occasionally full of rage, her interpersonal dynamics were complex, so she must have suffered from borderline personality disorder. "Shazam," the interpreter declares, popping the champagne cork. "I have explained Sylvia Plath."

But a diagnosis is not an explanation. It is merely a description, a name for a set of thoughts, feelings, and behaviors, not a real answer. What we want to know is how someone became who she is, not what her DSM-derived "disease" might be. I talk a lot about this subject in chapter one of my Handbook of Psychobiography. You can check that out for more detail.
  Here's a little illustration I use in my psychobiography courses. Say a mother tells a psychiatrist, "My son hears voices. Why?" The psychiatrist answers, "Well, sorry to say this, but it's because he's a schizophrenic." Mom replies: "Oh. Well, how do you know he's a schizophrenic?" Psychiatrist says, "Because he hears voices." See how, in fact, we get nowhere?
In this post, Schultz promotes his field of study, psychobiography. But he purposefully does so at the expense of psychological diagnostication. Other academics have done this and I find it maddening.

What's their beef? Criticism of diagnostication usually falls into one of three categories. First, making a diagnosis is incomplete in terms of treatment. Second, having a diagnosis incurs social stigma. And, finally, particular diagnoses include too many or not enough symptoms.

Now, it is true that treatment of a psychological condition should always be more than diagnosis and prescription. You have to be low on the brain scale to think otherwise. Furthermore, the researchers who study the symptom clusters are the ones who should decide what symptoms are included and excluded and they should not be criticized for what are predominantly media-fueled hysterics.

Here's what the critics fail to understand:  Diagnostication is a way for care providers to succinctly share patient information and is the most adequate method to dictate treatment. It is not a sacred ritual and a diagnosis is never carved into stone. It is simply asinine for Schultz to assert that anyone with half the intelligence needed to graduate graduate school believes that, after a diagnosis is made, additionaly understanding of a patient magically becomes unnecessary.


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