Diagnosis

There are times when, no matter how well versed one may be in one’s native language, no matter how many educational degrees one has earned, one still has to expend mental energy to figure out what some people are saying. (I am talking about people, not cats; I will never understand what Alex is saying).

The year was 1972 or maybe ’73. I was attending my first case conference at a major hospital as a relatively new social worker employed by the Commonwealth of Kentucky. Being from field services, I had never before attended a conference with so many psychiatrists and psychologists with “Dr.” before their names. I didn’t realize that the primary function of social workers—at least female social workers—at such conferences was to go get the coffee and doughnuts for the attendees. As a male social worker representing another agency, I was just basically ignored.

My client was a 14-year-old boy who lived with his mother and three younger siblings. My own diagnosis of the mother was simple and non-professional: she was wacky. But it was the boy we were there to discuss and, as the primary case manager, I hopefully awaited the diagnosis of these doctors. When the verdict came out of the mouth of one of the psychiatrists, I must have done a double take: she said the kid was “a Pseudoneurotic Schizophrenic.” What the hell does that mean? I asked myself.

I would have consulted the DSM (Diagnostic and Statistical Manual of Mental Disorders) whatever volume was out in those days (DSM-II, I think), but it wouldn’t have helped. If this blog were a scientific paper, I would refer to the 1938 work of Stern[1] regarding the borderline between neuroses and psychoses and possibly the description of Deutsch[2] of a group of patients who lacked a consistent sense of identity and source of inner direction. The event took place a few years before Kernberg[3] conceptualized borderline personality disorder (BPD) as a diagnosis, so that wouldn't have helped me. As it was, I was left on my own, and I had no idea what the psychiatrist meant. Thus, I asked her what in the name of Freud she just said.

What she replied was something like this, “The young man evinces the behaviors of one who is neurotic but he is really psychotic.” I still had no idea what she was saying, so I’ll not go into how this diagnosis affected the treatment plan I wrote. Actually, it didn’t affect it at all. I will say that, by the time I left the case to attend graduate school a couple of years later, the four kids were doing fine and their mom was still, uh, wacky.

P.S.~ If you get a lot of gobbledygook around those pseudo foot notes, it has to do with the browser you are using: Microsoft Explorer. If you look at them with another browser, such a Netscape or Mozilla Foxfire or even Opera, they look just fine!

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[1] No, I ain’t listing footnotes or even hyperlinks. If you want the technical stuff you can Google it yourself!

[2] See above.

[3] Why do you keep looking down here? See footnote #1.