Diagnosis
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Video on Schizophrenia

  Have you ever tried to write a definition of something?  In college, I remember back to Plato's dialogues and his theory of knowledge that were studied in introductory philosophy classes.  One of the dialogues focused on defining a chair.  The focal point was to capture  the essence of the chair.  Each definition was proposed and then tested against the concept of "chairness" and then discarded as too wide or too narrow in its scope.  For example if a chair was defined as something to sit upon, it would be discarded as too broad a definition because clearly there were things that could be sat upon that were not chairs.  If the proposed definition were that the chair had four legs then the definition would be discarded as too narrow because clearly there are chairs that could have less or more than four legs.

Unfortunately, much of the same logic applies to psychological disorders.  While diagnostic criteria are applied most often from the DSM-IV manual in arriving at diagnoses for mental disorders, the overall classification seems to make more people confused than satisfied.

There are many lists of symptoms and explanations of terms all of which are attempts to clarify the diagnostic process and give those who deal with the disorders a framework of reference.  To say that psychosis is difficult to define is an gross understatement.  Add to that the stigma and fear that surround the labels that we use to describe mental illness and psychosis and it becomes easy to understand that in spite of our efforts to clarify the concept of psychological illness, the result is perhaps a state of even greater confusion.

Perhaps this is why we get authors like Pete Earley using the pejorative term "Crazy" as the title for his book about the mental health system.  And even that term is used more appropriately as a label for the treatment and care process than the diseases themselves.

Psychosis, for lack of a better and more precise definition, is then, a syndrome.  It is a collection of symptoms that are associated with a host of different, but some might say related disorders in a diagnostic scheme like the DSM-IV criteria.

Psychosis is not restricted to a single label of a disorder like schizophrenia, but rather it can be a characteristic of a host of psychiatric conditions which include schizoaffective disorder, drug-induced psychotic disorder, delusional disorder, and psychotic disorder due to a medical condition.

Not only is psychosis present in a number of defined disorders, it is further defined as being sub grouped into paranoid, disorganized/excited, or depressive.

Using schizophrenia as an example, the clinical description of schizophrenia is divided into five symptom dimensions, positive, negative, cognitive, aggressive, and affective.  One would think that would help more clearly define the disorder, but it is important to note that not only do some of these symptomatic classifications overlap among themselves, several other illnesses can share some of the same symptom dimensions noted here.  For example, positive symptoms which include such things as delusions, hallucinations, distortions or exaggerations in language and communication, disorganized speech and others are also shared by disorders such as bipolar disorder, Alzheimer's disease, psychotic depression and schizoaffective disorder.  Even that list of disorders is not complete.

The question arises "What am I to make of this?"  The answer to approach it simply, is not much at all.  While it is of little comfort to the lay person who is told that they have a condition that needs help, the reality is that the labels applied serve a greater function for health care and treatment professionals than they do the person who suffers from the disease.  The single most disturbing part for the person with the disorder and their support system is the lack of a tangible label that would give some sense of certainty about what they are facing.  This fact should not be taken lightly, especially by treatment professionals.  While the treatment professionals are far more familiar with symptoms and matching them with medications that have proven more effective at particular types of observed symptoms, the patient is left at the mercy of what seems to be a "trial and error" and "how do I tolerate the side effects of medications" syndrome.

The problems faced by treatment professionals is equally puzzling, but they have two distinct advantages.  They have considerable training in what types of medications are most likely to affect symptoms and familiarity with the entire treatment process.  They also have the distinct disadvantage of not being able to directly feel the results of the treatment.  They must rely upon observations of the patient and evaluation of the observable effects of the treatment.

The ultimate question really becomes not which label applies to the condition, but rather how the therapeutic professionals, support people and patient coordinate and collaborate to achieve the desired results.

Given that the definitions of diagnoses are overlapping, and the diagnoses are defined by observable behaviors and self-reported observations, it is no wonder that many patients are given diagnoses that change over time.  That is not to say that the disease has in fact changed, it is simply due to the methodology that the state of psychiatry uses to define the diseases.  In the future, patients, families and professionals can only hope that better understanding will lead to a better system of categorization of the disorders.  As that happens, the hope for all is that new and more specific treatments will evolve and better identification of specific symptoms and chemical processes will move forward and eliminate a great deal of the pain and suffering that exists today.

 
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Last modified: 07/30/08