It occurs to me that in medicine (and medical psychiatry) we aspire to make a diagnosis first, then deliver a treatment. But due to our persistent ignorance of the real causes of mental illness, we are pretty much reduced to trying out different treatments and often arrive at a diagnosis as a result of the response to those treatments. The distinction between treatment and diagnostic test in psychiatry is pretty flimsy.
After I see someone once or twice, how certain am I of a diagnosis? Often not very. But after I've seen someone a few years and can review how things have gone, things look a lot clearer (even if, due to the shortcomings of our treatments, I still can't make a huge difference).
arspsychiatrica.blogspot.com
After about 8 sessions, my T asked "Did I ever tell you what diagnosis I came up with?" The psychiatrist had given a diagnosis over a year before, when I was interested in medication. Now that I have been doing therapy, I found myself feeling defensive about getting a "diagnonsense" from him. Quickly I told him what *I* perceived as my diagnosis. He had reached the same conclusion. This actually served to strengthen my faith in him, that we agreed.
This is because the DSM is limited, despite it's length - it does not have a category for "anxious type-A overcompensating career woman with 2 kids and mother issues".
Because I do not accept payment from 3rd parties, the whole diagnosis a la DSM IV is not pat of what I do. I don't "assign" a diagnosis at all. I am working from a different notion of diagnosis which is more about the defenses I see than a label. And most of the people I see frankly do not fit any of the DSM categories.
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