Mental Health Diagnosis: More of an Art Than a Science

A commenter writes:

How can they be “pretty damn good” and “wrong”?

Because diagnosis of mental illness is much more of an art than a science, that’s why. It’s almost impossible to get it right every time. It’s not uncommon for people to have maybe 10-15 different diagnoses. This is because psychiatric diagnosis is murderously hard. I don’t blame most clinicians for getting it wrong. It’s nothing like the diagnosis of physical illness at all.

I see a number of people with OCD who got misdiagnosed as psychotic, but that’s actually pretty common, and looking at their symptoms, I don’t blame the clinician for dx’ing them as psychotic.

When OCD is very bad, they appear psychotic, and the people I am thinking of have symptoms that appear exactly like psychotic symptoms, except they are not. They have what I call “fake delusions”, “fake illusions”, “fake hallucinations”, along with a lot of derealization and depersonalization, etc. Sometimes they can even get actual perceptual distortions, which makes things even stranger.

These people who have a form of health anxiety where they worry that they are going psychotic, and then they develop a lot of “fake psychotic” symptoms psychosomatically in the same way that patients develop fake physical symptoms psychosomatically as part of some hypochondriasis.

I know more about this stuff than the vast majority of clinicians, and I have seen more people with this problem than most clinicians will ever see. I have seen scores of people with this problem, maybe 50-75. I have gotten to the point where I can tell “Schiz OCD” (OCD with the fear of schizophrenia/psychosis theme) apart from true psychosis, but it’s not clear or easy at all if you haven’t dealt with a lot of these people. Actually it is not even easy for me sometimes.

Furthermore, in the course of diagnosing these people, you will get a few people who are actually psychotic, and you have to tell them apart from the Schiz O’ers. They are much more ill than the Schiz O’ers, but their symptoms are extremely confusing and they seem to have OCD going along concurrently with some sort of psychotic process. They are very confusing.

I don’t think mental health workers are inept, and I work in the field myself. And I do not think they are crazy at all. Most of the ones I have dealt with were amazingly sane.

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Filed under Anxiety Disorders, Mental Illness, OCD, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders

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