Diagnosis: Same as It Never Was

The word "diagnosis" comes from the Greek "to recognize" or "to know." The concept is an ideal in medicine, where to recognize and understand a disease is a prerequisite to treating it properly. Despite advances in science, history teaches that we usually know less than we'd like to about the causes of illness. This is particularly true when it comes to mental health.

Today's promise is that science will lead us out of the thicket. Researchers are decoding the genome, sorting out the functions of brain regions and mapping neural pathways. They'll be able to tell us what goes wrong, where it goes wrong and—eventually—how to fix it. Having reduced human experience to its fundamental biological elements, psychiatric diagnosis will finally be definitive and treatment choices will be precise.

Not so fast.

As the American Psychiatric Association ramps up to revise its Diagnostic and Statistical Manual (DSM), with a target publication date of 2012, signs are that the diagnostic system will improve. But no one doubts that the next edition will be the same as prior versions in one important respect—a work in progress.

Despite what the word means in Greek, "diagnosis" has a less lofty, more practical meaning in English. A diagnosis is a label, one that comes to represent a disease or a syndrome that is maladaptive or causes distress. Diagnoses are part of professional language. When a mental-health professional describes someone as having a "generalized anxiety disorder," another professional across town or across the country will have a good idea of how that term is being used.

The politics of psychiatric diagnosis, however, are not so straightforward. For one thing, people cherish their individuality and resist being labeled. Also, the power to name is significant. Diagnostic labels, when misapplied, can establish people as deviant, deprive them of rights or heap upon them a burden of shame or stigma. Even when intentions are good, diagnostic systems—like the science they are rooted in—are inevitably constrained by the intellectual, ethical and political trends of the era.