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By A. J Baker

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Medical diagnosis has evolved over the last century, even though the causes of many diseases remain unknown. In the past, physicians classified diseases on the basis of clinical observations. Today diagnosis has come to depend on an understanding of pathological mechanisms. 37 38 Diagnosis Ultimately, categorization has to be rooted in both the causes of disease (etiology) and in the process of disease (pathogenesis). For example, cerebral thrombosis, one of the main types of stroke, has a specific pathogenesis (a clot blocks an artery leading to the brain).

They want to be like other physicians. This helps explain why the profession has taken up diagnosis so enthusiastically. We want to believe we can diagnose patients accurately and prescribe treatment specific to these categories. However, with our present knowledge, these beliefs are unjustified. Although diagnosis is a necessary tool for psychiatry, the categories we use are not as real as those of stroke or tuberculosis. We may be able to establish scientifically valid diagnoses in the future, but our current knowledge is insufficient to allow us to do so.

This validity problem has not prevented some psychiatrists from acting as if their diagnoses describe an ultimate truth. Given the rampant practice of offering drugs to almost all patients, some clinicians favor diagnostic categories that lead to familiar prescriptions. Thus, patients who meet criteria for major depression will be prescribed an antidepressant. Patients who meet criteria for an anxiety disorder may also receive an antidepressant. Patients who have a diagnosis for which there is no specific drug can be fitted into one that leads to the prescription of an antidepressant.

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