Friday, June 19, 2009

How Do You Know?


ClinkShrink was talking about how it annoys her when a patient says he hears voices, and with no other information, the nurse records a diagnosis of "schizophrenia." One of our readers said they would assume that a prisoner who reported he was hearing voices was seeking specific medications (presumably for reasons other than to stop the voices or directly treat the symptoms of schizophrenia). I read the comment and thought, "Wait, sometimes people hear voices because they have schizophrenia! You can't just assume he's drug-seeking for devious reasons!" Just as one can't assume that hearing voices is 1) an auditory hallucination (it's not if the voices are actually there and the result of real people talking, or if it only occurs in the time right before sleep) or 2) that the voices aren't the result of hallucinogenic drugs or alcohol withdrawal in a prison population, or 3) the result of another psychiatric illness as schizophrenia is not the only psychiatric disorder where people hear voices, well, we can't automatically assume that a patient who hears voices
doesn't have schizophrenia! This is why we take a full history and observe patients over time.

Okay, so I'm sitting with two friends in a restaurant and our waiter is really really skinny. Neither friend is a mental health professional, but we all notice the skinny waiter. One friend says "I wonder if he has anorexia?" The other friend immediately says, "Nah, he's just skinny." I said nothing, but I thought, "How do you know?" He could just be very slim, or he could have an illness (AIDS, cancer, TB, cocaine: they all cause weight loss), or he could have an eating disorder. Really, all we knew was that he was skinny, that he wore a colorful t-shirt, and that he brought us the right food. To figure out any more, about either his medical or psychological state, we'd have to ask questions that just weren't appropriate to the setting. Still, my friend was absolutely certain the waiter didn't have an eating disorder.

Maybe it's human nature that we jump to conclusions, but people do it all the time.