By James Morrison MD
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Extra resources for Diagnosis Made Easier: Principles and Techniques for Mental Health Clinicians
Personal unhappiness isn’t necessarily abnormal. • At 16, Winnie repeatedly shoplifts from several stores in the mall. She could have kleptomania, but might she be responding to a 46 THE BASICS OF DIAGNOSIS schoolmate’s threats to tell her religiously strict parents that she has had an abortion? Isolated bits of behavior can suggest a diagnosis, but they often don’t constitute one. Gordon wore the colors of his school’s arch-rival team on the day of • the big game. He courted social disapproval and undoubtedly craved attention, but his behavior didn’t qualify him for a diagnosis.
He claimed never to have used alcohol or street drugs intemperately. As a child, Tony was always depressed. Nearly friendless, he had concocted his own playmates, including a rubber lizard he called “Tonto” and a number of imaginary playmates. He had a clubbed foot that was treated with a cast, which he remembered kicking through the boards of his crib, even when he was just a small baby. Analysis Some of Tony’s data conflicted either with one another or with common sense. For example, the repeated suicide attempts that had gone badly (though fortunately) awry seemed exaggerated and possibly insincere.
One example was Tony’s behavior on hearing voices (he turned to confront them every time he heard them). Others would be claims to have schizophrenia characterized by delusions that begin or end suddenly, visual hallucinations of foot-high people, or hallucinations that are continuous rather than intermittent. , delusions that appear full-blown overnight). Symptoms of many disorders at the same time can sometimes be a tip-off. Of course, some patients read enough textbooks to know something about typical presentations of mental illness.