Diagnosis is not Reality. Beware!

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(Quick post I might flesh out later: the Muses offer what they offer, on their own inexplicable schedule…)

alien7I often counsel patients not to take psychiatric diagnoses quite so seriously as they do.

These scientific pronouncements sound so definitive and absolute, don’t they? All vetted by top men: top men. They’re even in a book. Written by top experts, no less!

Yet all diagnoses, throughout medicine, remain nothing more than ideas. The best we have in many cases, yet works in progress, all.

We know high blood pressure is bad, say, and we know some things that might (or might not) cause it, and some treatments that might (or might not) alleviate it. Such is medicine: we know much, yet it all adds up to a thin, VERY thin slice of the whole of reality.

Blood pressure amounts to pressure in pipes, rather simple stuff really. The brain is the most complex and mysterious entity humans have yet to meet in the entire universe. We know far more than we used to, yet it all remains a paper-thin slice of reality. Much of our knowledge will likely turn out to be not quite true in time: such is the nature of progress.

So our diagnoses by expert committee have far more in common with the expert past ‘certain knowledge’ about leaches, and blood-letting, and medieval humors, and so on, than most care to admit. Science is a process, not a fact. So it goes.

It’s comforting – SO comforting! – to revel in our knowledge and confidence and power. Yet wisdom, clearly, amounts to noticing how much delusion and fiction such confidence requires. True understanding requires much uncertainty.

I’d be the last to throw out all of Western medical knowledge. In quite a few situations, it’s far and away the best we’ve got and getting better over time. I see it help people every day.

But don’t worship it or take it too seriously. It’s all remains a work in progress, imperfect, subject to revision.

Every diagnosis remains an idea, imperfect and often enough inaccurate in a given case.

Even the most brilliant ideas fall prey to messy reality, and often.

Let the buyer beware…


  1. Great article and very true.
    Sometimes people tend to put doctors in place of God and that is just not fair to them. Doctors and psychiatrists are people who’ve studied to attain some knowledge in a particular area and as such can often help, but they are far from infallible (even assuming the data they are basing their conclusions on is correct). I generally find it tends to be about 50/50 if they can help or not but hey that’s a lot better than nothing!
    I must be the most dificult patient ever as I invariably go home and research the doctors diagnosis and thoroughly check any medication for side effects etc. It’s just as well I’m hardly ever sick or my poor doc would need a psychiatrist! lol!


  2. oooooo, I so agree with this. I figure that allopathic medicine is wrong at least 25% of the time, but I don’t know which 25%. Sometimes I suspect and become very conservative in an area. For example, I have been very careful about prescribing opiates my entire career and always say they are addictive. Now Washington State law has caught up to me! and about time, too.


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