Demystifying Psychiatry for the Church – Part 4
Parsimony
Let me address a few of the myths and misperceptions that I encounter in my practice.
A patient said, “I have depression, bipolar illness, and schizophrenia. Now I am told I don’t have schizophrenia. What should I believe?”
Psychiatry uses standard criteria which we use to diagnose a patient’s condition. A basic principle that is used is called parsimony. Parsimony dictates that you can only diagnose what is in front of you now. So, depending upon how symptoms present in an individual, their diagnosis may change. Although an individual may have been diagnosed with depression, schizophrenia, or bipolar illness in the past, that reflects history of presentation, not necessarily what is currently occurring.
A thorough psychiatric evaluation will likely include looking at blood work to ascertain if there is a thyroid issue, a vitamin deficiency, or hormone imbalance.
At times imaging such as an MRI or CT scan can prove beneficial to rule out a mass or tumor that is impacting the brain and the individual’s personality.
The Diagnostic and Statistical Manual Fifth Edition (DSM5) lists the criteria by which psychiatric illness are defined.
A diagnosis serves a few purposes:
1. Requirement of insurance to bill for services
2. Provides a base from which treatment is initiated. The diagnosis reflects to what medication or therapy modalities the diagnosis is amenable.
3. It names “the enemy”. In many cultures when you can name the enemy it empowers people to act against it. This is all part of our need to understand something as we are not comfortable with that which we cannot define.
As a practice, I don’t focus on calling the client by the disease lest he/she find an identify in it. We say “I have cancer” but “I am bipolar.” This implies that cancer is something I experience and fight, but bipolar is who I am, my identity. Since I cannot divorce myself from my identity, this does not enable me to separate myself from the mental illness. So, I chose to challenge clients to see their illness as something separate from them which they are experiencing and not as their identity.
