Gerry Klerman, my mentor, referred to the Washington University approach to psychiatric diagnosis (and the DSM-III that it spawned) as a “Chinese-menu:” one from column A, 2 two from column B. We have lived with this descriptive focus for several decades, and truly, psychiatrists must be competent in reliable diagnosis. But there’s undoubtedly more to our art and science.
A few days ago I admitted a 50-something gentleman to our in-patient hospital. He came with a long-standing diagnosis of schizophrenia. I always bring a critical eye to psychiatric diagnoses of patients I am newly meeting. But in his case, the diagnosis fit well. The history was totally consistent, and with his blunted affect and ongoing paranoid and odd delusions, the diagnosis of schizophrenia was pretty well established.
I completed our interview, then explained to the patient that I was going to spend a few minutes entering his information into a computer terminal. (It was my first experience with our new electronic medical record.) While I was busily typing away, he leaned over to read my ID badge. “Alan,” he said. I was surprised to hear my first name and looked up. “You’re a snappy dresser.” My face broke into a broad, spontaneous grin. “Thanks,” I responded. “I really appreciate your saying that.”
I do my best to teach our students and residents what I struggle to remember myself. There’s the Axis-I diagnosis. Sometimes it’s a severe one, like schizophrenia—which robs people of much of their human ability to connect with others. But beyond the multiple axes of DSM-IV, there are human strengths, talents, likes and dislikes. And as this man showed me, the ability to reach out and relate at a person-to-person level often persists.
- Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry