Medical Diagnosis Quotes

Stigma against mental illness is a scourge with many faces, and the medical community wears a number of those faces.

People's behaviors are messages, not a diagnosis because I can no longer discern the world's version of insanity.

There are books that are suitable for a million people, others for only a hundred. There are even remedies—I mean books—that were written for one person only… A book is both medic and medicine at once. It makes a diagnosis as well as offering therapy. Putting the right novels to the appropriate ailments: that’s how I sell books.

THE MAXIMS OF MEDICINE Before you examine the body of a patient, Be patient to learn his story. For once you learn his story, You will also come to know His body. Before you diagnose any sickness, Make sure there is no sickness in the mind or heart. For the emotions in a man’s moon or sun, Can point to the sickness in Any one of his other parts. Before you treat a man with a condition, Know that not all cures can heal all people. For the chemistry that works on one patient, May not work for the next, Because even medicine has its own Conditions. Before asserting a prognosis on any patient, Always be objective and never subjective. For telling a man that he will win the treasure of life, But then later discovering that he will lose, Will harm him more than by telling him That he may lose, But then he wins. THE MAXIMS OF MEDICINE by Suzy Kassem

I was once asked if I had any ideas for a really scary reality TV show. I have one reality show that would really make your hair stand on end: "C-Students from Yale." George W. Bush has gathered around him upper-crust C-students who know no history or geography, plus not-so-closeted white supremacists, aka Christians, and plus, most frighteningly, psychopathic personalities, or PPs, the medical term for smart, personable people who have no consciences. To say somebody is a PP is to make a perfectly respectable diagnosis, like saying he or she has appendicitis or athlete's foot . . . PPs are presentable, they know full well the suffering their actions may cause others, but they do not care. They cannot care because they are nuts. They have a screw loose! . . . So many of these heartless PPs now hold big jobs in our federal government, as though they were leaders instead of sick. They have taken charge of communications and the schools, so we might as well be Poland under occupation. They might have felt that taking our country into an endless war was simply something decisive to do. What has allowed so many PPs to rise so high in corporations, and now in government, is that they are so decisive. They are going to do something every fuckin' day and they are not afraid. Unlike normal people, they are never filled with doubts, for the simple reasons that they don't give a fuck what happens next. Simply can't. Do this! Do that! Mobilize the reserves! Privatize the public schools! Attack Iraq! Cut health care! Tap everybody's telephone! Cut taxes on the rich! Build a trillion-dollar missile shield! Fuck habeas corpus and the Sierra Club and In These Times, and kiss my ass! There is a tragic flaw in our precious Constitution, and I don't know what can be done to fix it. This is it: Only nut cases want to be president.

The power to label is the power to destroy.

One of the first things we teach medical students is to listen to the patient by taking a careful medical history. Ninety percent of the time, you can arrive at an uncannily accurate diagnosis by paying close attention, using physical examination and sophisticated lab test to confirm your hunch (and to increase the bill to the insurance company).

The common thread from all those stories was that talking helped, and listening, and time. One day I would find my own place. I couldn't run there, though, because it didn't exist yet; I had to build it myself, out of forgiveness, truth, and terrifying gestures of friendship.

a book is both medic and medicine at once. It makes a diagnosis as well as offering therapy. Putting the right novels to the appropriate ailments: that’s how I sell books.

...sometimes they almost made me feel glad that I had a few extra years to play my depression out with therapy and other means, because I think its useful in youth- unless suicide or drug abuse are the alternatives- to have some faith in the mind to cure itself, to not rush to doctors or diagnosis's...I sometimes worry that part of what creates depression in young people is their own, and their parents, and the whole worlds impatience with allowing the phases of life to run their course. We will very likely soon be living in a society that confuses disease with normal life if the panic and rush to judgment and labeling do not slow down a bit. Somewhere between the unbelievable tardiness that the medical profession was guilty of in administering proper treatment to me and the eagerness to with which practitioners prescribe Ritalin for 8 year old boys and Paxil for 14 year old girls, there is a sane course of action.

Loose diagnosis is causing a national drug overdose of medication. Six percent of our people are addicted to prescription drugs, and there are now more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs.6

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

The great unspoken paradox of the arduous process of psychoanalysis is that the best patients are the ones who never really needed it in the first place. Abnormal

Simply put, diagnosis wields immense power. It can provide us access to vital medical technology or shame us, reveal a path toward less pain or get us locked up. It opens doors and slams them shut.

Speechlessness, however, affirmed in the diagnosis, is carefully based on the facts of the examination, as we see by rendering the statements concerned, just as they stand in examination and diagnosis: "If thou examinest a man having a wound in the temple, ...; if thou ask of him concerning his malady and he speak not to thee; ...; thou shouldst say concerning him, 'One having a wound in his temple, ... (and) he is speechless'.

As one patient with chronic fatigue syndrome put it, 'The difference between a crazed neurotic and a seriously ill person is simply a test.

Again and again, psychiatric labels become vehicles for race- and gender-based harm. The use of diagnosis as a tool of structural oppression is not a new phenomenon.

When using the medical profession, you must remember that it is influenced by many corporations that may not want your health issues to be fully understood and correctly treated.

Taking a pill is passive. In contrast, psychotherapy puts the patient in charge by instilling new coping skills and attitudes toward life.

[W]e have far too much faith in pills, far too little trust in resilience, time, and homeostasis.

A diagnosis is not a prediction. It doesn’t tell you what’s possible. It doesn’t change you, your colleague, your child, or your friend. It just opens up tricks and tools to thrive.

Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.

A lot of the appeal of internal medicine is Sherlockian—solving the case from the clues. We are detectives; we revel in the process of figuring it all out. It’s what doctors most love to do.

(I)f you try to treat the medical problem you *think* you see without fully exploring the differential diagnosis -- call(ed) "speculation on a foundation of assumption" -- you can kill your patient.

Mental disorders should be diagnosed only when the presentation is clear-cut, severe, and clearly not going away on its own. The best way to deal with the everyday problems of living is to solve them directly or to wait them out, not to medicalize them with a psychiatric diagnosis or treat them with a pill.

Mental illness is no different than a heart condition. In the same way a faulty valve can cause harm to the body and require medication and care, so does a malfunctioning brain. Insanity is a crude, culturally loaded term setting the sufferer apart in a way which will not aid the patient’s recovery. The way we regard those whose brains hinder them with fault or injury is a prejudice, not a diagnosis.” Dr. North

..I don't count Jennifer among my mistakes. She had a severe infection and precious little reserve. Nevertheless, I think of her often. Those minutes of terror and confusion I felt standing powerless in her room served as a visceral reminder throughout my training... that the big picture isn't enough in medicine...

Like so many other high school discipline cases, he'd probably been given some hybrid cockamamie ADHD- bipolar diagnosis at a very young age and been medicated into submission for the benefit of his homeroom teacher. We've all read about them in the paper, the problem kids who get slapped with five disorders by the time they're twelve, and horse-pilled by a culture that has pathologized everything from PMS to teen angst.

[W]ay too much treatment is given to the normal "worried well" who are harmed by it; far too little help is available for those who are really ill and desperately need it. Two thirds of people with severe depression don't get treated for it, and many suffering with schizophrenia wind up in prisons. The writing is on the wall.

Be aware of the whole domain of sickness - be aware of its implications in human life - be aware of its farthest reach in the life of the patient as well as the lives of the next of kin - be aware of its deepest roots, for that very awareness is the very foundation of true diagnosis, which automatically brings along the awareness of wellness.

Scholars in other disciplines found it useful, and the ideas of heuristics and biases have been used productively in many fields, including medical diagnosis, legal judgment, intelligence analysis, philosophy, finance, statistics, and military strategy.

It is unsettling to find how little it takes to defeat success in medicine. You come as a professional equipped with expertise and technology. You do not imagine that a mere matter of etiquette could foil you. But the social dimension turns out to be as essential as the scientific--matters of how casual you should be, how formal, how reticent, how forthright. Also: how apologetic, how self-confident, how money-minded. In this work against sickness, we begin not with genetic or cellular interactions, but with human ones. They are what make medicine so complex and fascinating. How each interaction is negotiated can determine whether a doctor is trusted, whether a patient is heard, whether the right diagnosis is made, the right treatment given. But in this realm there are no perfect formulas.

President Barack Obama The White House 1600 Pennsylvania Avenue NW Washington, DC 20500 November 29, 2016 Dear President Obama, We are writing to express our grave concern regarding the mental stability of our President-Elect. Professional standards do not permit us to venture a diagnosis for a public figure whom we have not evaluated personally. Nevertheless, his widely reported symptoms of mental instability — including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality — lead us to question his fitness for the immense responsibilities of the office. We strongly recommend that, in preparation for assuming these responsibilities, he receive a full medical and neuropsychiatric evaluation by an impartial team of investigators. Sincerely, Judith Herman, M.D. Professor of Psychiatry Harvard Medical School Nanette Gartrell, M.D. Dee Mosbacher, M.D.

Overcoming problems on your own normalizes the situation, teaches new skills, and brings you closer to the people who were helpful. Taking a pill labels you as different and sick, even if you really aren't. Medication is essential when needed to reestablish homeostasis for those who are suffering from real psychiatric disorder. Medication interferes with homeostasis for those who are suffering from the problems of everyday life.

As I have already argued, research on tool AI—those specific, innocuous applications such as game playing, medical diagnosis, and travel planning—often leads to progress on general-purpose techniques that are applicable to a wide range of other problems and move us closer to human-level AI.

Fortunately, the clinical diagnosis “ADD” didn’t exist when I was a child, and restless children were not medicated, or I might have been narcotized at an early age, and my brain affected. (No one can tell me that dosing young children with such powerful drugs will have no long-term effect upon them.)

When the injured humerus is accompanied by a serious rupture of the overlying soft tissue the injury is regarded as fatal.

In medicine, uncertainty is the water we swim in.

I tried to self-medicate without knowing the proper diagnosis. I didn’t have any problems and that became the problem.

A journey into self diagnosis and treatment was required when the medical profession left me suffering for years with mental illness and chronic fatigue.

After many years of using the medical profession, I concluded that it is infested with blatant incompetence.

Patienthood can become a way of life and rationale for people who are struggling for other reasons.

Whatever the mind believes, the body has a better chance of becoming. An absolute diagnosis is therefore not only false, but also unhelpful.

Time heals so well because many of our ills are short-term, situational, and self-limited - our bodies and our minds are programmed to be resilient without any active effort on our part.

It is equally dangerous at either extreme - to have either an expanding concept of mental disorder that eliminates normal or to have an expanding concept of normal that eliminates mental disorder.

It was my experience with the medical profession that had years of experience treating me and knew that I was displaying symptoms that matched B12 deficiency, that they were unable to make that diagnosis.

The tendency to assume that women can’t be trusted to accurately convey their symptoms comes from the historical diagnosis of “hysteria,” which was once thought to be a medical condition said to only affect women.

DSM definitions do not include personal and contextual factors such as whether the depressive symptoms are an understandable response to loss, a terrible life situation, psychological conflict or personality factors.

The anti-psychiatrists held various, sometimes conflicting views but one particular line of reasoning is attributable to all of them—they all pitched their arguments against the power of the psychiatric establishment. They argued that the psychiatric diagnosis is scientifically meaningless. It is a way of labeling undesirable behaviour, under the guise of medical intervention. Those who are diagnosed ill are subjected to treatment which is a violation of human rights and dignity. The situation amounts to psychiatry having a mandate to declare some citizens unfit to live in an ‘ordinary’ community. It claims to cure but the supposed beneficiaries of that cure are often held in hospitals against their will. Within a structure like this it is impossible to understand the real nature of mental suffering and it is just as impossible to develop a coherent system of help.

Of course that diagnosis was never made official because my mother refused to get professional help. Instead, she lived her life with her fingers in her ears, as though the truth would not exist if she never heard the words spoken aloud. Add to that cauldron an ever increasing measure of cheap vodka—a form of self-medication that quelled the inner scream but amplified the outer crazy—and you get a picture of the mother I left behind. She

Many doctors focus almost exclusively on processing information: they absorb medical data, analyze it, and produce a diagnosis. Nurses, in contrast, need good motor and emotional skills in order to give a painful injection, replace a bandage, or restrain a violent patient. Therefore we will probably have an AI family doctor on our smartphone decades before we have a reliable nurse robot.9 The human care industry—which takes care of the sick, the young, and the elderly—is likely to remain a human bastion for a long time. Indeed, as people live longer and have fewer children, care of the elderly will probably be one of the fastest-growing sectors in the human labor market.

Telehealth will have the ability to extend the reach of care from the traditional face-to-face interaction between patient and clinician whether it’s to obtain a diagnosis, collect medication, or receive treatment, even surgery.

I have another scan this week," I say lightly, hoping to reassure my loved ones that it is safe to rejoin my orbit. There is always another scan, because this is my reality. But the people I know are often busy contending with mildly painful ambition and the possibility of reward. I try to begrudge them nothing, except I'm not alongside them anymore. In the meantime, I have been hunkering down with old medical supplies and swelling resentment. I tried— haven't I tried? — to avoid fights and remember birthdays. I showed up for dance recitals and listened to weight-loss dreams and kept the granularity of my medical treatments in soft focus. A person like that would be easier to love, I reasoned. I try a small experiment and stop calling my regular rotation of friends and family, hoping that they will call me back on their own. _This is not a test. This is not a test._ The phone goes quiet, except for a handful of calls. I feel heavy with strange new grief. Is it bitter or unkind to want everyone to remember what I can't forget? Who wants to be confronted with the reality that we are all a breath away from a problem that could alter our lives completely? A friend with a very sick child said it best: I'm everyone's inspiration and and no one's friend. I am asked all the time to say that, given what I've gained in perspective, I would never go back. Who would want to know the truth? Before was better.

Some parents resist the idea of ADD for fear of seeing their children labeled and categorized. They do not like the idea of pinning a medical diagnosis on a child who, except in certain areas of functioning, seems quite well. Such fears are not baseless. Too often ADD seems no more than a judgment that characterizes a child as a problem student, incapable of normal activity. How people use language is quite revealing. People commonly say that this adult or that child “is ADD.” That, indeed, is labeling, identifying the whole person with an area of weakness or impairment. No one is ADD, and no one should be defined or categorized in terms of it or any other particular problem. Recognizing a child’s ADD should be simply a way of understanding that helping him calls for some knowledgeable and creative approaches, not a judgment that there is anything fundamentally or irretrievably wrong with him. This recognition should enable us to support the child in fullfilling his potential, not to further limit him. That even open-minded people may have difficulty coming to terms with this diagnosis is only to be expected. Our usual mode of thinking about illness (or anything else, for that matter) is not comfortable with ambiguity. A patient either has pneumonia or does not; she either has some illness affecting the mind or does not. There is a popular discomfort with any condition of the mind perceived as “abnormal.” But what if illness is not a separate category, if there is no line of distinction between the “healthy” and the “nonheaithy,” if the “abnormality” is just a greater concentration in an individual of disturbed brain processes found in everyone? Then perhaps there are no fixed, immutable brain disorders, and we could all be vulnerable to mental breakdowns or malfunctions under the pressure of stressful circumstances. We could all go crazy. Maybe we already have.

Many parents have experienced this with their kids. They get referred for testing, and the first psychologist says the child has ADD. But then another round of tests with the next shrink points to PDD-NOS. More tests and more doctors take us back to ADHD, then Asperger’s. They bounce from one diagnosis to another, never really knowing what to do or where they stand. In some cases, kids are given medications, and a medicine that’s good for one thing can be bad for another.

but it’s not the only diagnosis. Other diagnoses include: hormonal birth control with a “high androgen index” some types of psychiatric medications high prolactin hypothyroidism rare pituitary or adrenal diseases congenital adrenal hyperplasia.

Understanding sickness in its whole form, reach and impact, automatically brings along the insight into wellness, just like understanding chaos with all its nuances brings along the true practical perception of harmony and the means to achieve it.

It must be noted that there is no proof that it is justified to apply the label somatisation to such conditions as chronic fatigue syndrome and several more illnesses that established medicine has so for failed to explain scientifically. ……Don't hesitate to ask questions about scientific evidence behind this talk about somatisation. Be persistent, because a diagnosis of somatisation is definitely not an innocuous label. It will close various doors and lead (to) treatments that usually get nowhere.

Stigma takes many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the extrusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt a child or pilot a plane. But it is also the reduced expectation, the helping hand when none is needed or wanted, the solicitous sympathy that one cannot really be expected to measure up. And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of the trouble comes from the change in how you see yourself: the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of the group. It is bad enough that stigma is so often associated with having a mental disorder, but the stigma that comes from being mislabeled with a fake diagnosis is a dead loss with absolutely no redeeming features.

Hippocrates argued that the causes of disease were physical, and that they could be divined by observing a patient’s symptoms. He and his disciples introduced a system for classifying diseases, which is why he is often referred to as the father of western medicine: he was responsible for the notions of diagnosis and treatment that still underpin medicine today (he also left us with a code of medical ethics, the Hippocratic Oath, from which we have the promise made by newly qualified doctors to ‘do no harm’).

Disability scholars Andrienne Asch and Erik Parens, in their seminal discussion of the problem, wrote,'Pre-natal diagnosis reinforces the medical model that disability itself, not societal discrimination against people with disabilities, is the problem to be solved.

Much of the education doctors get in their four years of medical school and subsequent years of apprenticeship training is focused on teaching this skill of identifying and shaping those aspects of a patient’s life and symptoms, exams and investigations that contribute to the creation of a version of the patient’s story that makes a diagnosis possible. Indeed, the ability to create this spare and impersonal version of the patient’s story is THE essential skill in diagnosis. It’s also one of the aspects of medicine that can seem the most dehumanizing.

The basic sciences of anatomy, physiology, biology, and chemistry are linked to a patient at the bedside through very specific stories that doctors learn and eventually create. These stories, what researchers now call illness scripts, contain key characteristics of a disease to form an iconic version, an idealized model of that particular disease. … It is the story that every doctor puts together for herself with the knowledge she gains from books and patients. The more experience a doctor has with any of these illnesses, the richer and more detailed the illness script she has of the disease becomes.

attention deficit disorder in his own son. “I had worked in an ADHD clinic during my residency, and had strong feelings that this was overdiagnosed,” he said. “That it was a ‘savior’ diagnosis for too many kids whose parents wanted a medical reason to drug their children, or to explain their kids’ bad behavior.

If a doctor has worked through the problem well, there’s a very good chance that one of these possible diagnoses will be right. The rest though, by definition, will be wrong. We are regularly wrong in the pursuit of being right. … The question we are taught to ask ourselves is, if it isn’t that, what else could it be?

Trump received five deferments: four for education, one for medical reasons. The excuse? “Bone spurs” in his feet. The injury was concocted, according to the daughters of the podiatrist who made the diagnosis, as well as the president’s former lawyer, who recounted Trump saying, “You think I’m stupid? I wasn’t going to Vietnam.

A similar concern about using the web to provide just-in-time information shows up among physicians arguing the future of medical education. Increasingly, and particularly while making a first diagnosis, physicians rely on handheld databases, what one philosopher calls “E-memory.” The physicians type in symptoms and the digital tool recommends a potential diagnosis and suggested course of treatment. Eighty-nine percent of medical residents regard one of these E-memory tools, UpToDate, as their first choice for answering clinical questions. But will this “just-in-time” and “just enough” information teach young doctors to organize their own ideas and draw their own conclusions?

ADHD is spreading like wildfire. It used to be confined to a small percentage of kids who had clear-cut problems that started at a very early age and caused them unmistakable difficulties in many situations. Then all manner of classroom disruption was medicalized and ADHD was applied so promiscuously that an amazing 10 percent of kids now qualify.

...Why is it, that from the moment you enter medical school to the moment you retire, that the only disorder you will ever diagnosis with a physics book - is obesity? This is biology folks, it's endocrinology, it's physiology - physics has nothing to do with it. The law of thermodynamics is always true, [but] the energy balance equation is irrelevant...

That question became even more salient to me as I began my clinical work with troubled children. I soon found that the vast majority of my patients had lives filled with chaos, neglect and/or violence. Clearly, these children weren’t “bouncing back”—otherwise they wouldn’t have been taken to a child psychiatry clinic! They’d suffered trauma—such as being raped or witnessing murder—that would have had most psychiatrists considering the diagnosis of post-traumatic stress disorder (PTSD), had they been adults with psychiatric problems. And yet these children were being treated as though their histories of trauma were irrelevant, and they’d “coincidentally” developed symptoms, such as depression or attention problems, that often required medication.

What makes our contemporary neurobiological concepts different is the extent to which they have been promoted by pharmaceutical marketers. You are not shy; you have social anxiety disorder. You are not absentminded, dreamy, or fidgety; you have ADHD. You are not moody; you are bipolar. Each diagnosis comes with a prescription. Your need for medication becomes part of your identity.

I don't know. It kind of sucks not knowing for sure, because when I explain it to people, they just look at me like I'm making it up. But if someone has a diagnosis and medication? Then it's 'legitimate'. And don't get me wrong, those things are super important for a lot of people. But I feel like associating legitimacy with a formal diagnosis sometimes leaves people behind--people like me, whose families really frown on anything to do with therapy and meds, or people who have found their own ways of coping with it, or people who can't afford it. It doesn't mean they don't still feel what they feel--they just don't have the privilege of being told by someone with a degree what they're allowed to call it. Shouldn't the focus be on what we're feeling rather than what box we can neatly fit ourselves into?

The DSMs have a mixed record. They have served an extremely valuable function in improving the reliability of psychiatric diagnosis and in encouraging a revolution in psychiatric research. But they have also had the very harmful unintended consequence of triggering and helping to maintain a runaway diagnostic inflation that threatens normal and results in massive overtreatment with psychiatric medication.

Take healthcare, for example. Many doctors focus almost exclusively on processing information: they absorb medical data, analyze it, and produce a diagnosis. Nurses, in contrast, need good motor and emotional skills in order to give a painful injection, replace a bandage, or restrain a violent patient. Therefore we will probably have an AI family doctor on our smartphone decades before we have a reliable nurse robot.

That woman had doubted that his weak sperm might had been a reason for her physical impairment, and that thought had left an indelible mark on her memory as the words of medical judgement had carried a weight far beyond a diagnosis, far beyond their coldly clinical indication, far beyond their biological implications; from that day onwards, the phrase rather became a seed of bitterness growing into a rift that no one could bridge, a lasting emotional fracture.

I am constantly asked: What can you, with your cold rationalism, offer to the seeker after salvation that is comparable to the cozy homelike comfort of a fenced-in dogmatic creed? To this the answer is many-sided. First, I do not say that I can offer as much happiness as is to be obtained by the abdication of reason. I do not say that I can offer as much happiness as is to be obtained from drink or drugs or amassing great wealth by swindling widows and orphans. It is not the happiness of the individual convert that concerns me; it is the happiness of mankind. If you genuinely desire the happiness of mankind, certain forms of ignoble personal happiness are not open to you. If your child is ill, and you are a conscientious parent, you accept medical diagnosis, however doubtful and discouraging; if you accept the cheerful opinion of a quack and your child consequently dies, you are not excused by the pleasantness of belief in the quack while it lasted.

Distraction leaches the authenticity out of our communications. When we are not emotionally present, we are gliding over the surface of our interactions and we never tangle in the depths where the nuances of our skills are tested and refined. A medical professor describes the easy familiarity with which her digital-native resident students master medical electronic records—but is troubled by the fact that they enter data with their eyes focused on their digital devices, not on the patient in the room with them. Preoccupation with technology acts as a screen between the student and the patient’s real emotion, real fear, and real concern. It may also prevent these residents from noticing physical symptoms that the patient fails to mention. The easy busyness of medical record entry is a way to sidestep the more challenging dynamics of human connection. But experienced physicians know that interpersonal skills are essential to mastering the art and science of medical diagnosis.

Multiple blows to the head, whether in football, soccer, boxing, hockey, or other activity, can sometimes cause permanent brain damage accompanied by changes in personality, memory, and thinking. Chronic traumatic encephalopathy, or CTE, is the medical term for the damage caused by these repeated concussions. Standard MRIs cannot detect it, so a diagnosis of CTE usually cannot be made with certainty until after a person has died. Only on autopsy can a pathologist see the damaged brain tissue.

But no matter how carefully we schedule our days, master our emotions, and try to wring our best life now from our better selves, we cannot solve the problem of finitude. We will always want more. We need more. We are carrying the weight of caregiving and addiction, chronic pain and uncertain diagnosis, struggling teenagers and kids with learning disabilities, mental illness and abusive relationships. A grandmother has been sheltering without a visitor for months, and a friend's business closed its doors. Doctors, nurses, and frontline workers are acting as levees, feeling each surge of the disease crash against them. My former students, now serving as pastors and chaplains, are in hospitals giving last rites in hazmat suits. They volunteer to be the last person to hold his hand. To smooth her hair. The truth if the pandemic is the truth of all suffering: that it is unjustly distributed. Who bears the brunt? The homeless and the prisoners. The elderly and the children. The sick and the uninsured. Immigrants and people needing social services. People of color and LGBTQ people. The burdens of ordinary evils— descriminations, brutality, predatory lending, illegal evictions, and medical exploitation— roll back on the vulnerable like a heavy stone. All of us struggle against the constraints places on our bodies, our commitments, our ambitions, and our resources, even as we're saddled with inflated expectations of invincibility. This is the strange cruelty of suffering in America, its insistence that everything is still possible.

Because now mental health disorders have gone “mainstream”. And for all the good it’s brought people like me who have been given therapy and stuff, there’s a lot of bad it’s brought too. Because now people use the phrase OCD to describe minor personality quirks. “Oooh, I like my pens in a line, I’m so OCD.” NO YOU’RE FUCKING NOT. “Oh my God, I was so nervous about that presentation, I literally had a panic attack.” NO YOU FUCKING DIDN’T. “I’m so hormonal today. I just feel totally bipolar.” SHUT UP, YOU IGNORANT BUMFACE. Told you I got angry. These words – words like OCD and bipolar – are not words to use lightly. And yet now they’re everywhere. There are TV programmes that actually pun on them. People smile and use them, proud of themselves for learning them, like they should get a sticker or something. Not realizing that if those words are said to you by a medical health professional, as a diagnosis of something you’ll probably have for ever, they’re words you don’t appreciate being misused every single day by someone who likes to keep their house quite clean. People actually die of bipolar, you know? They jump in front of trains and tip down bottles of paracetamol and leave letters behind to their devastated families because their bullying brains just won’t let them be for five minutes and they can’t bear to live with that any more. People also die of cancer. You don’t hear people going around saying: “Oh my God, my headache is so, like, tumoury today.” Yet it’s apparently okay to make light of the language of people’s internal hell

But then there are other cases… Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must don her deerstalker cap and unravel the mystery. It is in these instances where medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patient in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, "what is wrong with me?" They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar a place a name, to know it - on some level - restores a measure of control, independent of whether or not that diagnosis comes attached to a cure.

I believe the perception of what people think about DID is I might be crazy, unstable, and low functioning. After my diagnosis, I took a risk by sharing my story with a few friends. It was quite upsetting to lose a long term relationship with a friend because she could not accept my diagnosis. But it spurred me to take action. I wanted people to be informed that anyone can have DID and achieve highly functioning lives. I was successful in a career, I was married with children, and very active in numerous activities. I was highly functioning because I could dissociate the trauma from my life through my alters. Essentially, I survived because of DID. That's not to say I didn't fall down along the way. There were long term therapy visits, and plenty of hospitalizations for depression, medication adjustments, and suicide attempts. After a year, it became evident I was truly a patient with the diagnosis of DID from my therapist and psychiatrist. I had two choices. First, I could accept it and make choices about how I was going to deal with it. My therapist told me when faced with DID, a patient can learn to live with the live with the alters and make them part of one's life. Or, perhaps, the patient would like to have the alters integrate into one person, the host, so there are no more alters. Everyone is different. The patient and the therapist need to decide which is best for the patient. Secondly, the other choice was to resist having alters all together and be miserable, stuck in an existence that would continue to be crippling. Most people with DID are cognizant something is not right with themselves even if they are not properly diagnosed. My therapist was trustworthy, honest, and compassionate. Never for a moment did I believe she would steer me in the wrong direction. With her help and guidance, I chose to learn and understand my disorder. It was a turning point.

I for many years after my initial diagnosis was reluctant to take my medications as prescribed. Why was I so unwilling? Why did it take having to go through more episodes of mania, followed by long suicidal depressions, before I would take lithium in a medically sensible way? Some of my reluctance, no doubt, stemmed from a fundamental denial that what I had was a real disease. This is a common reaction that follows, rather counter-intuitively, in the wake of early episodes of manic-depressive illness. Moods are such an essential part of the substance of life, of one’s notion of oneself, that even psychotic extremes in mood and behavior somehow can be seen as temporary, even understandable, reactions to what life has dealt.

Given the central place that technology holds in our lives, it is astonishing that technology companies have not put more resources into fixing this global problem. Advanced computer systems and artificial intelligence (AI) could play a much bigger role in shaping diagnosis and prescription. While the up-front costs of using such technology may be sizeable, the long-term benefits to the health-care system need to be factored into value assessments. We believe that AI platforms could improve on the empirical prescription approach. Physicians work long hours under stressful conditions and have to keep up to date on the latest medical research. To make this work more manageable, the health-care system encourages doctors to specialize. However, the vast majority of antibiotics are prescribed either by generalists (e.g., general practitioners or emergency physicians) or by specialists in fields other than infectious disease, largely because of the need to treat infections quickly. An AI system can process far more information than a single human, and, even more important, it can remember everything with perfect accuracy. Such a system could theoretically enable a generalist doctor to be as effective as, or even superior to, a specialist at prescribing. The system would guide doctors and patients to different treatment options, assigning each a probability of success based on real-world data. The physician could then consider which treatment was most appropriate.

There was a time when the public had an unquestionable faith in biomedicine and the practitioners who translated it into everyday patient care—and physicians believed that the public's trust was justified based on their educational qualifications and training. But today, many patients believe that individual clinicians must earn their trust, just as a close relative has earned it through shared experience. ...Gallop polling over the last several decades that demonstrates how much the public's confidence in most US institutions has deteriorated. Confidence in the medical system in particular fell from 80% in 1975 to 37% in 2015. Statistics from the General Social Survey confirm this troubling trend. Baron and Berinsky explain the historical reasons for this shift in attitudes, but the more pressing question is: How can individual clinicians, and the profession as a whole, regain the patients' trust? 

Dr. Kary Mullis, who won the Nobel Prize in Chemistry for inventing PCR, stated publicly numerous times that his invention should never be used for the diagnosis of infectious diseases. In July of 1997, during an event called Corporate Greed and AIDS in Santa Monica CA, Dr. Mullis explained on video, “With PCR you can find almost anything in anybody. It starts making you believe in the sort of Buddhist notion that everything is contained in everything else, right? I mean, because if you can model amplify one single molecule up to something that you can really measure, which PCR can do, then there’s just very few molecules that you don’t have at least one single one of them in your body. Okay? So that could be thought of as a misuse of it, just to claim that it’s meaningful.” Mikki explained, “The major issue with PCR is that it’s easily manipulated. It functions through a cyclical process whereby each revolution amplifies magnification. On a molecular level, most of us already have trace amounts of genetic fragments similar to coronavirus within us. By simply over-cycling the process, a negative result can be flipped to a positive. Governing bodies such as the CDC and the WHO can control the number of cases by simply advising the medical industry to increase or decrease the cycle threshold (CT).” In August of 2020, the New York Times reported that “a CT beyond 34 revolutions very rarely detect live virus, but most often, dead nucleotides that are not even contagious. In compliance with guidance from the CDC and the WHO, many top US labs have been conducting tests at cycle thresholds of 40 or more. NYT examined data from Massachusetts, New York, and Nevada and determined that up to 90 percent of the individuals who tested positive carried barely any virus.”17 90 percent! In May of 2021, CDC changed the PCR cycle threshold from 40 to 28 or lower for those who have been vaccinated. This one adjustment of the numbers allowed the vaccine pushers to praise the vaccines as a big success.

Was it real? Well, of course not, not in any meaningful sense of the word "real." But did it stay with me? Absolutely. Long after my psychosis cleared, and the medications took hold, it became part of what one remembers forever, surrounded by an almost Proustian melancholy. Long since that voyage of my mind and soul, Saturn and its icy rings took on an elegiac beauty, and I don't see Saturn's image now without feeling an acute sadness at its being so far away from me. So unobtainable in so many ways. the intensity, glory, and absolute assuredness of my mind's flight made it very difficult for me to believe, once I was better, that the illness was one I should willingly give up. Even though I was a clinician and a scientist, and even though I could read the research literature and see the inevitable, bleak consequences of not taking lithium, I for many years after my initial diagnosis was reluctant to take my medications as prescribed." An Unquiet Mind by Kay Redfield Jamison Pages 90 - 91, 2nd paragraph.

ADHD Prescriptions: Diagnosis rates of Attention Deficit Hyperactivity Disorder (ADHD) have skyrocketed 500 percent since 1991, according to the Drug Enforcement Administration. An estimated 7 million schoolchildren are being treated with stimulants for ADHD, including ten percent of all ten-year-old American boys, according to an article published in the Journal of the American Medical Association. A 1998 study by researchers Adrian Angold and E. Jane Costello found that the majority of children and adolescents who receive stimulants for ADHD do not fully meet the criteria for ADHD. The efforts of neurologist Dr. Fred Baughman, ADHD diagnosis critic, led to admissions from the FDA, DEA, Novartis (manufacturers of Ritalin), and top ADHD researchers around the country that “no objective validation of the diagnosis of ADHD exists.” A Maryland Department of Education study found that white, suburban elementary school children are using medication for ADHD at more than twice the rate of African American students.

Although there are no set methods to test for psychiatric disorders like psychopathy, we can determine some facets of a patient’s mental state by studying his brain with imaging techniques like PET (positron emission tomography) and fMRI (functional magnetic resonance imaging) scanning, as well as genetics, behavioral and psychometric testing, and other pieces of information gathered from a full medical and psychiatric workup. Taken together, these tests can reveal symptoms that might indicate a psychiatric disorder. Since psychiatric disorders are often characterized by more than one symptom, a patient will be diagnosed based on the number and severity of various symptoms. For most disorders, a diagnosis is also classified on a sliding scale—more often called a spectrum—that indicates whether the patient’s case is mild, moderate, or severe. The most common spectrum associated with such disorders is the autism spectrum. At the low end are delayed language learning and narrow interests, and at the high end are strongly repetitive behaviors and an inability to communicate.

In studies of first-episode bipolar patients, investigators at McLean Hospital, the University of Pittsburgh, and the University of Cincinnati Hospital found that at least one-third had used marijuana or some other illegal drug prior to their first manic or psychotic episode.10 This substance abuse, the University of Cincinnati investigators concluded, may “initiate progressively more severe affective responses, culminating in manic or depressive episodes, that then become self-perpetuating.”11 Even the one-third figure may be low; in 2008, researchers at Mt. Sinai Medical School reported that nearly two-thirds of the bipolar patients hospitalized at Silver Hill Hospital in Connecticut in 2005 and 2006 experienced their first bout of “mood instability” after they had abused illicit drugs.12 Stimulants, cocaine, marijuana, and hallucinogens were common culprits. In 2007, Dutch investigators reported that marijuana use “is associated with a fivefold increase in the risk of a first diagnosis of bipolar disorder” and that one-third of new bipolar cases in the Netherlands resulted from it.13

If two people with no symptoms in common can both receive the same diagnosis of schizophrenia, then what is the value of that label in describing their symptoms, deciding their treatment, or predicting their outcome, and would it not be more useful simply to describe their problems as they actually are? And if schizophrenia does not exist in nature, then how can researchers possibly find its cause or correlates? If psychiatric research has made so little progress in recent decades, it is in large part because everyone has been barking up the wrong tree. It is not a question of getting a bigger and better scanner, but of going right back to the drawing board. What’s more, medical-type labels can be as harmful as they are hollow. By reducing rich, varied, and complex human experiences to nothing more than a mental disorder, they not only sideline and trivialize those experiences but also imply an underlying defect that then serves as a pseudo-explanation for the person’s disturbed behaviour. This demeans and disempowers the person, who is deterred from identifying and addressing the important life problems that underlie his distress.

Western medicine’s love of drawing people into diagnostic categories and applying disease names to small differences and minor bodily changes is not specific to functional disorders – it is a general trend. Pre-diabetes, polycystic ovaries, some cancers and many more conditions have all been subject to the problem of over-inclusive diagnosis. My biggest concern in this regard is the degree to which many people are wholly unaware of the subjective nature of the medical classification of disease. If a person is told they have this or that disorder, they assume it must be right. The Latin names we give to things and the shiny scanning machines make it look as if there is more authority than actually exists. To a certain extent, Sienna pursued each diagnosis she was given, but other people have diagnoses thrust upon them, having no idea that there might be anything controversial about it – and having no idea that they have a choice. Western medicine’s hold on people, and its sense of being systematic and accurate, makes it a powerful force in the transmission of cultural concepts of what constitutes wellness or ill health. But Western medicine is just as enslaved to fads and trends as any other tradition of medicine.

As many speakers noted, this tool wasn’t particularly well suited for assessing outcomes of a psychiatric drug. How could a study of a neuroleptic possibly be “double-blind”? The psychiatrist would quickly see who was on the drug and who was not, and any patient given Thorazine would know he was on a medication as well. Then there was the problem of diagnosis: How would a researcher know if the patients randomized into a trial really had “schizophrenia”? The diagnostic boundaries of mental disorders were forever changing. Equally problematic, what defined a “good outcome”? Psychiatrists and hospital staff might want to see drug-induced behavioral changes that made the patient “more socially acceptable” but weren’t to the “ultimate benefit of the patient,” said one conference speaker.11 And how could outcomes be measured? In a study of a drug for a known disease, mortality rates or laboratory results could serve as objective measures of whether a treatment worked. For instance, to test whether a drug for tuberculosis was effective, an X-ray of the lung could show whether the bacillus that caused the disease was gone. What would be the measurable endpoint in a trial of a drug for schizophrenia? The problem, said NIMH physician Edward Evarts at the conference, was that “the goals of therapy in schizophrenia, short of getting the patient ‘well,’ have not been clearly defined.

When we go to the doctor, he or she will not begin to treat us without taking our history—and not just our history but that of our parents and grandparents before us. The doctor will not see us until we have filled out many pages on a clipboard that is handed to us upon arrival. The doctor will not hazard a diagnosis until he or she knows the history going back generations. As we fill out the pages of our medical past and our current complaints, what our bodies have been exposed to and what they have survived, it does us no good to pretend that certain ailments have not beset us, to deny the full truths of what brought us to this moment. Few problems have ever been solved by ignoring them. Looking beneath the history of one’s country is like learning that alcoholism or depression runs in one’s family or that suicide has occurred more often than might be usual or, with the advances in medical genetics, discovering that one has inherited the markers of a BRCA mutation for breast cancer. You don’t ball up in a corner with guilt or shame at these discoveries. You don’t, if you are wise, forbid any mention of them. In fact, you do the opposite. You educate yourself. You talk to people who have been through it and to specialists who have researched it. You learn the consequences and obstacles, the options and treatment. You may pray over it and meditate over it. Then you take precautions to protect yourself and succeeding generations and work to ensure that these things, whatever they are, don’t happen again.

Until recently, three unspoken principles have guided the arena of genetic diagnosis and intervention. First, diagnostic tests have largely been restricted to gene variants that are singularly powerful determinants of illness—i.e., highly penetrant mutations, where the likelihood of developing the disease is close to 100 percent (Down syndrome, cystic fibrosis, Tay-Sachs disease). Second, the diseases caused by these mutations have generally involved extraordinary suffering or fundamental incompatibilities with “normal” life. Third, justifiable interventions—the decision to abort a child with Down syndrome, say, or intervene surgically on a woman with a BRCA1 mutation—have been defined through social and medical consensus, and all interventions have been governed by complete freedom of choice. The three sides of the triangle can be envisioned as moral lines that most cultures have been unwilling to transgress. The abortion of an embryo carrying a gene with, say, only a ten percent chance of developing cancer in the future violates the injunction against intervening on low-penetrance mutations. Similarly, a state-mandated medical procedure on a genetically ill person without the subject’s consent (or parental consent in the case of a fetus) crosses the boundaries of freedom and noncoercion. Yet it can hardly escape our attention that these parameters are inherently susceptible to the logic of self-reinforcement. We determine the definition of “extraordinary suffering.” We demarcate the boundaries of “normalcy” versus “abnormalcy.” We make the medical choices to intervene. We determine the nature of “justifiable interventions.” Humans endowed with certain genomes are responsible for defining the criteria to define, intervene on, or even eliminate other humans endowed with other genomes. “Choice,” in short, seems like an illusion devised by genes to propagate the selection of similar genes.

Read the following chain of events and see whether a similar pattern might apply to other toxic products that were reported in the news during your lifetime: 1. Workers were told that the paint was nontoxic, although there was no factual basis for this declaration. The employers discounted scientists. The workers believed their superiors. 2. Health complaints were made in ever-increasing frequency. It became obvious that something was seriously wrong. 3. U.S. Radium and other watch-dial companies began a campaign of disinformation and bogus medical tests - some of which involved X-rays and may even have made the condition worse. 4. Doctors, dentists, and researchers complied with U.S. Radium's and other companies' requests and refused to release their data to the public. 5. Medical professionals also aided the companies by attributing worker deaths to other causes. Syphilis was often cited as the diagnosis, which had the added benefit to management of being a smear on the victims' reputations. 6. One worker, Grace Fryer, decided to sue U.S. Radium. It took Fryer two years to find a lawyer who was willing to take on U.S. Radium. Only four other workers joined her suit; they became known as the "Radium Girls." 7. In 1928, the case was settled in the middle of the trial before it went to the jury for deliberation. The settlement for each of the five "Radium Girls" was $10,000 (the equivalent of $124,000 in 2009 dollars), plus $600 a year while the victim lived and all medical expenses. Remember the general outline of this scenario because you will see it over and over again: The company denies everything while the doctors and researchers (and even the industrial hygienists) in the company's employ support the company's distorted version of the facts. Perhaps one worker in a hundred will finally pursue justice, one lawyer out of the hundreds of thousands in the United States will finally step up to the plate, and the case will be settled for chump change.

On the one hand, I recognize the power of the placebo effect: if you believe it’s working, it may well work. If you think an object brings you luck, you are more confident. And yet what the Italian students in the “lucky” seats showed wasn’t confidence; it was overconfidence. They thought they were doing better, but the evidence didn’t actually back them up. And then there’s the flip side of the placebo, the nocebo effect: the belief in evil signs or bad luck. It turns out people can literally scare themselves to death. If you think you’ve been cursed or otherwise made ill, you may end up actually getting sick, failing to improve poor health, or, yes, dying altogether. In one medically documented instance, a man was given three months to live after a diagnosis of metastatic cancer of the esophagus. He died shortly after. When his body was autopsied, doctors realized that he had been misdiagnosed: he did indeed have cancer, but a tiny, non-metastatic tumor on his liver. Clinically speaking, it could not have killed him. But, it seems, being told he was dying of a fatal illness brought about that very outcome. In another case, a man thought he was hexed by a voodoo priest. He came close to death, only to recover miraculously after an enterprising doctor “reversed” the curse through a series of made-up words. In yet a third, a man almost died in the emergency room after overdosing on pills. He’d been in a drug trial for depression and decided to end his life with the antidepressants he’d been prescribed. His vitals were so bad when he was admitted that doctors didn’t think he would make it—until they discovered his blood was completely clear of any drugs. He’d been taking a placebo. Once he found out he had not in fact taken a life-threatening quantity of pills, he recovered quickly. The effect our mind has on our body makes for a scary proposition. Belief is a powerful thing. Our mental state is crucial to our performance. And ultimately, while some superstitions may give you a veneer of false confidence, they also have the power to destroy your mental equilibrium. I like to think of this as the black cat effect. You see one cross the parking lot as you walk to a tournament. You brood about the bad luck. Your game is thrown off. You blame the cat. You bust. You feel validated. Superstitions are false attributions, so they give you a false sense of your own abilities and in the end, impede learning.

It is easier to say that AS best describes my differences. It makes people more comfortable to have a scientific-sounding term. But actually, I feel dishonest when I say I have AS because the negative effects of my differences on my life are so slight compared to other kids who have AS or other forms of autism and truly suffer. I always feel like I'm doing the people who have these conditions a disservice when I use the medical term, because then people say, "Oh, that doesn't seem so bad. What's all the fuss about?

episodes are due to psychiatric illness, and the nature of the episodes is often embarrassing. A potentially violent or injurious episode often leads to evaluation. Yet effective medical treatments are now available—actually a number of them—such as medication and hypnosis. The key is finding a sleep medicine professional experienced in the diagnosis and management of sleepwalking and sleep terrors. Sleepwalking and sleep terrors affected every part of Ms. Frazier’s life. They put her safety, her very life, at risk and threatened the safety of those close to her. Sleepwalker: The Mysterious Makings and Recovery of a Somnambulist is an accurate