Saturday, September 20, 2008

What's In A Name?

My favorite commenter, Anonymous, asks:
Once a person is diagnosed as, say Bipolar II, do they keep that designation for the rest of their lives?

Oh, gosh, I think we all wished we knew more about the exact course these illnesses would take and that we could tell each individual what to expect. We don't. I like the part of the question that asks if one keeps a diagnosis for life.

It left me thinking about what a diagnosis actually is. I know what a piece of chocolate cake is, and I could give a pretty good guess as to the fate of that cake if it's put near me. I know what a diamond is and that it is likely to last for a very long time.

Unlike a piece of chocolate cake or a diamond ring, a diagnosis is a hypothetical construct. It isn't a real thing, it isn't tangible, and the only meaning it has is the meaning we give it. Diagnosis isn't even an illness, which is slightly more concrete for certain diseases (say broken bones or the presence of a tumor) because one can have an illness without ever having a diagnosis simply by avoiding contact with physicians. While mostly we agree that certain symptoms (for example, having hallucinations or delusions) are likely the cause of a yet-to-be-fully-elucidated pathological process, some diagnoses are a matter of spectrum-- the somewhat random designation of when sadness or grief is "depression," when personality is disordered, or the precise reading at which we deem blood pressure to be "hypertensive."

The meaning of diagnosis is left to each person. Some people advertise their diagnoses, others live in fear of stigma. Sometimes, diagnosis is used to protect a member of society from suffering from the consequences of their behavior ("not criminally responsible") or to justify financial support from the government ("disabled"). In the negative, diagnosis alone seems to be held in the greatest regard by insurance companies. The implications for a diagnosis of AIDS are profound when one wants insurance. The same person, undiagnosed and
undesignated, might find it easier to get insurance. There's a blood test for AIDS, there isn't one for Schizophrenia.

We talk about "carrying a diagnosis." Whatever that means. I think, if one suffered from episodes of an illness many years ago, and one has remained symptom-free for a long time with no treatment, the issue of designation (-- for purposes of a medical history, or perhaps for government security clearance when applying for the Vice-Presidency in any party)... is best left to an honest recount of history. If it were cancer, one might say they were diagnosed with cancer 20 years ago, treated for a period of time, and have been disease-free since.... I'm not sure
psychiatric illnesses are any different.