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Diagnostic Conclusions

All of us draw conclusions based upon our prior experiences. In fact, this is essential in order to bring some predictability to our lives. We say that if it looks like a duck, quacks like a duck and walks like a duck it is a duck. Seems logical.

The ethics involved in the field of psychiatry precludes psychiatrists from diagnosing any particular individual without having completed a direct thorough evaluation.

By and large I agree that this is a fine policy, although I have read, for example, many statements about Lincoln’s clinical depression rendered by individuals who never had any sort of personal contact with him. Even psychiatry, a profession in which I have been a member for many years, is capable of making extremely stupid and even dangerous conclusions.

I believe that most of these have been based, at least in the most egregious examples, by accepting societal norms rather than by attempting to accumulate bias free scientific data.

If you think that this is wrong, explore the history of the euthanasia movement and its acceptance in the psychiatric field. Think also of the children with Downs Syndrome. Do we forget that children with this syndrome were once clinically diagnosed as “Mongolian Idiots?”  Parents who were presented with an infant with this diagnosis at birth were most frequently advised to immediately institutionalize them, usually in grossly inadequate circumstances with almost no stimulation. This treatment precluded intellectual development. In fact, we now know that many of these children are capable of being employed and living satisfactory lives in society.  The two examples, euthanasia and Downs Syndrome, are good reasons to be cautious in diagnosis.

I apologize for the digression but now we get to the meat of the subject.  There have been a number of recent conversations in which the diagnosis “Narcissistic Personality Disorder” has been bandied about, particularly in relation to a specific individual.  All psychiatric disorders are named, along with the diagnostic criteria, in the so-called DSM (i.e. the Diagnostic and Statistical Manual of the American Psychiatric Association).

If one simply Googles the DSM Criteria For Narcissistic Personality Disorder, a series of statements will appear. This list provides the entire criteria for Narcissistic Personality Disorder; there are no laboratory, genetic or other tests for this disorder.  In making any diagnosis a psychiatrist will gather as much information from available sources, interview the patient a variable number of times, and may request psychological testing. All of these are then compared with the DSM statements and a judgment tendered as to whether the diagnosis is correct or whether some other resolution is appropriate.  I urge you to Google the list.

My personal ethics preclude my coming to a diagnostic conclusion regarding a person I have not personally evaluated. However, I do believe, in my heart of hearts, without doubt, that there is a person who is extremely well known and appears to fit this diagnosis in exquisite detail. My ethics preclude naming a name.

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