Monday, January 26, 2009
You are depressed. The DSM checklist reveals you have nine depression symptoms out of nine. Question: Is your condition diagnosable as a depressive episode?
Not necessarily. "Checklist psychiatry" tends to influence how we view ourselves, but beneath the symptom menu to every Axis I DSM entry we find other qualifying criteria, such as a time period (two weeks for a major depressive episode). Also, before a diagnosis can be made, other possible causes (such as bereavement or a general medical condition) need to be ruled out.
The most intriguing qualifier, though, concerns functionality. With regard to depression, the episode must be severe enough to cause "significant distress or impairment in social, occupational, or other important areas of functioning."
Virtually identical wording appears across the Axis I panoply of episodes and disorders, including mania, anxiety, and schizophrenia. The prominent exception is hypomania.
So, in theory, it is possible to walk into a psychiatrist's office looking like a DSM basket case and yet obtain a clean bill of health. In practice, this is unlikely to happen. But suppose, just suppose, that we could have depression and not be depressed, that we could have a panic attack and not panic. And so on and so on.
Wait! I know what you are about to say. But before you call me crazy, I ask you to indulge me for a moment or two. Just suppose ...