The Politics of Diagnosis – A Glimpse

Why diagnose?

In most of medicine – people go to doctors when something is wrong.  Something about them is not “normal” and they want to know what it is, what caused it, and how to fix it.

SO – as “diagnosticians,” doctors over the centuries have observed patients.  We find a group of symptoms that usually seem to go together.  We call that a disease.  We try to find a cause, we try to find a cure, and the purpose behind all of it is to make sick people better, and keep healthy people from getting sick.

We don’t always know what causes disease.  We don’t always have a way to fix it.  But we try.  Sometimes we can diagnose it, fix the problem, and it’s gone forever.  Sometimes we can’t fix the problem, but we can treat the symptoms to make life better.  Sometimes we don’t know the cause of the disease, but we have a lot of educated guesses about stuff that might be causing it – so we try to prevent that. 

And sometimes we really have no idea - so we try everything in the book because we hate the thought of being powerless and being able to do nothing – so we try everything.

Mental illness diagnosis is the same.  Sometimes we know exactly what caused a disease.  We know how to treat it, and it’s fixed.  Often we don’t know the cause, but we know the symptoms, and we know what helps.  

So why does diagnosis matter?  Usually the answer is “Diagnosis dictates Treatment.”  All treatment research is based on diagnosis, so if you don’t know what a person has – there is no research as to how you should treat it.

Unfortunately – “type of treatment” is not always the answer but rather “ability to treat.”  

Example: After Vietnam and Korea, the VA ignored vets with PTSD.  Why???  The diagnosis didn’t exist yet.  Some Physicians saw the symptoms, some wanted to treat them, but they couldn’t.  These soldiers were in the VA system, and as a VA Psychiatrist, you could only treat veterans for a listed number of problems…PTSD as a diagnosis did not exist..so they had to be released to “deal with it.”  The doctor could not get paid, and the patient could not be treated because it was not a diagnosable condition.

Sometimes diagnosis matters because diagnosis opens the door to services, to insurance, to disability, to what the patient needs.

Example: Parents of an autistic child can often find great educational assistance and community programs for their child.  But what if the child doesn’t have “Autism” but rather has “Asperger’s Disorder,” “Childhood Disintegrative Disorder” or “Pervasive Developmental Disorder.”  These children have similar symptoms, but they have no access because the funding and programs are for “autism.”

How do we get help for those kids?  Do we pass new funding bills through Congress to fund every diagnosis?  Do we talk with city councils, schools, and donors to get money for each different disorder?  Or do we just call them all "Autistic" and we’re done?

Next year the new edition of the “Diagnostic Manual” for psychiatry comes out.  The plan is to eliminate all these different names and diagnoses -  and call them all “Autism Spectrum Disorders.”

 
WHY?  

It could be that they should have been called that in the first place.  They really are one disease with different levels of severity.  Or it could be that we just have a bunch of kids that need help and since nothing else has worked, we’re just going to change the label so they can all get assistance.

Is this a slippery slope?  Are we “fudging the numbers”, or changing the labels to fit programs, and insurance plans?

That’s a discussion for another day (or the comments section).