As a retired medical doctor who cared over many years for psychiatric patients in the UK and Africa, I empathise very much with the sentiments expressed by Dr Rebecca Lawrence (As both a psychiatrist and a patient, I know how slippery a diagnosis can be, 30 December). I’ve also suffered from several episodes of depression requiring hospital admission, with the question of whether I also experienced hypomanic episodes at times being a difficult one to answer.
I experienced the introduction of the use of statistical classifications of diseases (ICD and DSM) into day-to-day practice in the late 1970s. When I began psychiatric practice in 1975, we summarised a patient’s condition in a descriptive diagnostic formulation. When I read such descriptions written by a consultant of many years’ standing who was about to retire, it was like reading a description of a character in a novel by a writer such as Dickens or Tolstoy, and one had a clear, realistic, living picture of the patient concerned – a picture that one can never get from an ICD code.
ICD/DSM codes are useful in keeping records and so on, but they don’t help you understand patients and their problems. A patient’s psychology, thinking, feeling and willing, and its disturbances are on a continuously changing spectrum that cannot be defined by a statistical box. If one attempts to do so, one’s patient feels misunderstood.
Dr Susan Arstall
Reading, Berkshire
