Theraverse . May 29, 2025

When  we  start  training  as  residents  in  psychiatry,  it  can  be  a  bit  disconcerting  as  to  how  medicine  is  practiced  here  as  compared  to  all  other  branches.

While  a  general  physician, orthopaedic surgeon or  cardiologist  can  confidently  display  an  array  of  scans,  images,  deranged  values,  supporting  the  diagnostic  conclusion,  we  are  left  grappling  with  an  abstract  entity, the mind, the symptoms and complaints of which are often not explained  by  corresponding  brain  or  other  physiological  correlates.  We  have  to  rely  on  clinical  features, MSE, history (the  elucidation  of  which  can  often  be  sketchy and varying) and on  diagnostic  guidelines  hoping  privately  that  the  patient  would  reliably  fit  into  one  box  of  guidelines  or  the  other  while  striving  to  keep  subjectivity  to  a  minimum.

As per ICD, “disorder” is  not  an  exact  term,  but  it  is  used  here  to  imply  the  existence  of  a  clinically  recognizable  set  of  symptoms  or  behaviors  associated  in  most  cases  with  distress  and  with  interference  with personal  functions.  Notably  and  thankfully,  it  mentions  social  deviance  or  conflict  alone  without  personal  dysfunction  should  not  be  included  in  mental  disorder  as  defined  here.

While  it  is  important  that  provisional,  differential  and  definitive  diagnosis  be  made  for  the  sake  of  communication  and  treatment,  we  need  to  reiterate  to  ourselves,  clients  and  their  concerned  others  that  it  should  be  viewed  in  the  same  light  as  a  guidepost to treatment and recovery, rather  than  a  life  sentence or a limiting and definitive box encompassing the entirety of  personhood.

I have  heard  it  remarked  that  a  psychiatric  diagnosis  is  predominantly  a  social  diagnosis  and  we  as  a  society  have  not  yet  progressed  to  the  point  where  a  mental  health  condition  is  not  viewed  an excuse, inconvenience or a  threat.  As Viktor Frankl famously said, “An abnormal reaction to an abnormal situation is normal human behaviour”. While classification is intended to help understand and help heal individuals, the outcomes of frameworks inevitably depend on the people using them. The medicalisation of mental health conditions also runs the risk of being used for coercive social control and the pressure to conform. This has also been one of the concerns of the anti-psychiatry movement.  Let  us  not  forget  that  earlier  versions  of  the  DSM  classified  homosexuality  as  a  disorder  and  with  each  subsequent  revision, nosological classifications  and  terminologies  also  keep  changing  whether  the condition changes or not.

To conclude it  is  important  for  a  practitioner’s  patients  and  their  caregivers  to  constantly approach  the  issue  of  psychiatric  diagnosis  with  a  fresh,  open, holistic and  non-judgmental  perspective, to be wary of pathologising what may be normal given the context and to make mindful efforts to remain collaborative and never coercive.

In brief, a psychiatric diagnosis is made on the basis of an established set of guidelines (such as that in the DSM or ICD) being fulfilled by presenting symptoms.
-it should be made only after detailed assessment and adequate history taking from the client and ideally one or more care-givers
-is not ironclad and unchanging
-is not a label
-should not be considered a life sentence even if chronic
-should be revisited, reassessed and revised from time to time as required
-is subject to the confidentiality clause
-may have legal, social or job-related repercussions
-should not be used to discriminate against
-may consist of more than one diagnosis such as dual diagnosis
-does not define the person
-is something the person has and not something the person is

by,

Dr Navina Suresh MD

Consultant Psychiatrist, Theraverse