Diagnosis vs Formulation

I went to an autoelectrician the other day to get the headlights for my car fixed. He suggested that it was probably the headlight switch in the colum, but wasn’t going to commit to that without checking it out. He also said it could be a fuse, the relay, wiring, a problem with the Earth and a few other possibilities. After looking at it, he gave a positive diagnosis of a damaged switch. He said I might be able to get a second hand one, or I might be able to purchase it first hand from the manufacturer (I have an old car, kind of like me).


I asked him how he knew and he said he tested the inputs and outputs of the switch and could definately say that the switch was not relaying the proper information. This was his test that validated his diagnosis, which was one of the probable expected diagnosies he had formulated in our initial discussion.


Similarly I went to a doctor (general practitioner) with a really sore throught a few years ago. He listened to my symptoms, took a look at my throat and told me I had tonsillitis. He proscribed some antibiotics specific to this kind of infection as my treatment. I asked him how he knew I had tonsillitis and he described the way to tell inflamed tonsils and the low likelihood of it being anything else. I asked him if there was any actual test he could perform to be certain and he offered to take a sample and have a lab test it. This would prove, conclusively, that I had tonsillitis. 


I went to see a psychiatrist many years ago. He listened to my list of symptoms and told me I had cyclothymia. I asked how he knew and he said I fitted enough of the profile of cyclothymia for him to diagnose it as such. I asked if there as any test he could perform to make sure and he said there was not and pointed out that mental health diagnoses do not work that way. He prescribed medication to fix it. I looked up the medication and it’s primary side effect is that if you don’t have cyclothymia before taking the medication, you probably will after taking it. Not a good selling point. I went back to the psychiatrist and asked for another option.


What gets me is, how can they call it a diagnosis when there is no test to actually prove conclusively that their opinion is correct? Isn’t that a formulation, not a diagnosis?


For example, schizophrenia has an interesting diagnostic criteria. The combinations that this “diagnosis” can demonstrate are huge, the causes are varied. You only have to display two of five major categories, each major category has multiple sub categories which you only need one in to make that category count. What conclusive test is there? No blood test, no scan, no reflex or pain test. Nothing.


Schizophrenia is not an isolated mental illness in this respect. Consider borderline personality disorder. It’s diagnostic criteria are also quite strange. One must demonstrate five of a possible nine symptoms for an extended period of time. Again, there is no actual test. 


This blog does not preclude the possibility that either of these, or many other labels, actually exist. The formulation of these theories for a person quite often give added insight for the practitioner to look for specific indicators, history factors and give guidance for proposed treatment and recovery plans. What I object to is the use of the word “diagnosis” without an actual test. Giving such authoritative chronic diagnoses limits people to believing that they are stuck with this illness for the remainder of their lives and thus cannot get better, lessen their symptoms and get back to leading a worthwhile life.


You can change your behaviours. You can thrive.