What is psychological diagnosis?
Psychological diagnosis is frequently confused with medical diagnosis of an organic condition, so we will begin by differentiating them in order to have a clearer vision of the field.
Medical diagnosis of an organic condition, in the great majority of cases, refers to a condition that can be observed directly with specialized instruments. For instance: the pathogenic agent of an infection can be detected; the uncontrolled proliferation of cells can be observed; the obstruction of a blood vessel by a thrombus can be seen; the fibrosis of a liver can be examined, etc. It is for this reason that it is appropriate to say that someone “has” the flu, cancer, a heart-attack o cirrhosis.
Psychological diagnosis, however, refers to symptoms or mental-emotional functioning that do not have an observable organic base ––the diagnosis is inferred from patients’ behavior and what they report about themselves. Despite considerable progress in the neurosciences, we are still light-years away from understanding the complexity of the brain enough to be able to say, with a degree of exactness comparable to medical organic diagnosis, what brain structure is responsible for a specific mental-emotional state in that moment.
Therefore, to say that someone is depressed because they are lacking serotonin (a neurotransmitter) in their brain, is like saying that a country’s economy is plunging because its citizens buy foreign cars. That may have something to do with it, yes, but the answer is infinitely more complex.
Thus we must be careful not to reify (make something intangible into something tangible and observable) psychological diagnoses as if they were things that you could observe directly and that you “have”. You do not “have” sexual difficulties or a depression, for instance, in the same way that you have a heart-attack. Everyone who has suffered a heart-attack will have an obstruction in one of the blood vessels that provides the heart with blood. People with sexual difficulties or a depression will be suffering from them due to an infinity of different reasons.
Kinds of psychological diagnosis
Once that is clarified, we can go on to describe psychological diagnosis and say that, by and large, there are two different kinds: symptomatic psychological diagnosis and structural psychological diagnosis.
Symptomatic psychological diagnosis
Symptomatic psychological diagnosis consists in grouping together a certain number of symptoms ––this is called a syndrome–– in function of the frequency, duration and etiology of their apparition, and giving them a name so they can be easily recognized. This is useful because it is common that certain groups of symptoms appear together and form a clinical picture that is familiar to mental health professionals. It allows us to quickly convey to other professionals what the patient is manifestly suffering from.
However, this form of diagnosis does not tell us much about the person that is suffering from those symptoms: it does not allow us to create an idea of what kind of person he/she is, nor what their personality is, nor what their patterns of feeling, thinking and acting are. It is a descriptive, but shallow, form of diagnosis since similar symptoms can be produced by very different people, for different reasons.
Structural psychological diagnosis
Structural psychological diagnosis consists in trying to discover what the patient’s personality structure is ––although this is always subject to revision based on new data–– in order to understand him/her as a complete and complex person. Personality structure consists in what kinds of bonds that person establishes with others, what the quality and the intensity of his/her drives and affects is, what defense and adaptive mechanisms he/she uses, what self-image he/she has, what symptoms are present and how did he/she arrive there.
The goal is to be able to create a three-dimensional image of the individual and try to understand how that concrete person functions. This allows us to have a clearer idea of what kind of treatment would be beneficial for that person and how to approach those difficulties for which they consult. It is important to remember, however, that a structural psychological diagnosis is always approximate and never completely belongs to one single category; mental functioning is complex and can change over the course of a life or as a consequence of psychological treatment.
During the initial interviews, psychologists will try to reach a an approximate structural diagnosis in order to try understand the underlying structure that causes the patient's suffering and be able to indicate the most appropriate treatment.
Since the technical words used by psychologists to talk about structural diagnosis are frequently reified, and made into reductionist labels, psychologists will avoid using them with patients given that they tend to limit their freedom to think about themselves and form their own personal idea of what their specific difficulties are.
It is more important for patients to be able to create a nuanced, intimate and deep image of themselves, than it is for them to know that what they suffer from is called “X”. Therefore, when it is time to make a therapeutic indication, psychologists will use plain, comprehensible, language to convey to the patient what they perceive to be the fundamental problems, and will indicate what measures are best suited to help him/her.
This is perfect. Thank you for giving a clear and concise voice to these ideas.