“I don’t diagnose pathology.”
That is the most ridiculous things I’ve ever heard a licensed mental health person say. What do you think the license is for? Honest to god…
Look, seriously, you are a licensed mental health professional who is – licensed – by the state to do exactly that, diagnose and treat pathology. If you don’t diagnose pathology, who does, a plumber?
If so, can you refer me to a plumber to diagnose the pathology because we need a diagnosis. This could be a diagnosis of Child Psychological Abuse (DSM-5 V995.51), i.e., a shared persecutory delusion created in the child by the distorted parenting of the allied parent.
We need to find out if that pathology is present or absent, we need a diagnosis… and if you don’t diagnose pathology… then you’re pretty useless, aren’t you. Who does?
Because if you don’t diagnose pathology then there is absolutely no point in having you involved as a mental health person, because that’s what we need, a diagnosis for the treatment plan.
A plumber doesn’t diagnose pathology, nor does a school teacher. Who does? Hmmm, let me think… a licensed mental health professional? But just not you because you’re pretty useless.
We don’t need a plumber to fix the family conflict either. We need a diagnosis.
Who should I go to for a diagnosis if not a licensed mental health professional? Ask them. If they say this ridiculous thing to you, ask them who you SHOULD go to for a diagnosis, who would that be? I’d be curious what answer they’d give you… maybe they’d respond with just a blank stare.
Early in my training, way early, I was told by my mentor to always-always put a diagnosis.
Even if there is no diagnosis, there’s a diagnostic code for No Diagnosis, V71.09 No Diagnosis on Axis 1, that’s what you put when there is no diagnosis. Always put a diagnosis, even when there’s no diagnosis. Do you know why?
Malpractice. To start treating something before you’ve diagnosed what it is would be malpractice, and to conduct an assessment without a identifying the problem (diagnosing the pathology), even if it’s No Diagnosis (V71.09), would be malpractice.
How do you know what you’re treating if you have no diagnosis? That’s why I was told to always-always give a diagnosis, because otherwise is is automatically a misdiagnosis, which becomes the foundations for the malpractice, i.e., a negligent misdiagnosis because of an inadequate assessment.
There’s a second reason to identify no diagnosis, V71.09 No Diagnosis on Axis 1, it documents that you looked. Without that diagnosis of No Diagnosis, did you even look for a possible psychiatric disorder?
Here’s the rule-of-thumb regarding documentation in a medical record, if it’s not documented it didn’t happen.
Did you assess for a possible Bipolar Disorder, or possible ADHD? Unless you indicate you did, you didn’t. Did you assess for Generalized Anxiety Disorder and for Oppositional Defiant Disorder? Unless you say you did, you didn’t.
If it’s not in the patient’s medical record, it didn’t happen. So… document what you did and the outcome. If I conducted an assessment for possibly the relevant psychiatric disorders and there were no psychiatric disorders present… then I say so, 71.09 No Diagnosis on Axis I.
Otherwise… according to my chart… if I have nothing then I never even assessed for any possible psychiatric disorders. Document, document, document. If it’s not in the medical record, it didn’t happen.
If the patient says they are depressed, document that you asked about suicide. If they report any suicidal ideation, document that you conducted a proper risk assessment for suicide and its outcome.
When I say there is No Diagnosis, I’m saying I looked. But if I never even looked… that could be negligent malpractice.
That’s why I was told by my mentor as I entered clinical training, always-always give a diagnosis – protect yourself.
“I don’t diagnose pathology” is the most ridiculous thing I’ve ever heard from a mental health professional. Who does then? Please tell me because I need a referral to that architect or school teacher, because we need a diagnosis.
“I don’t diagnose pathology.” That is insane.
If I’m a lawyer on TV and this is my episode, I’d get them to say that first thing – “I don’t diagnose pathology” – and they’ll say it all proud like jt’s a good thing – they don’t “pathologize” people. I’d let them swell-up into their delusional beliefs.
They’re the guest star on the episode and I want to give them their moment, before….
Then I’d ask them, “Do you mean like schizophrenia, if one parent had schizophrenia, you wouldn’t diagnose that and wouldn’t tell the judge that one parent was psychotic and had schizophrenia?” I suspect they’ll begin to see the problem and back-track a little,
“Well, something like that I’d definitely diagnose and include it in my report, but there was no schizophrenia.”
What about a delusional disorder, is that a diagnosis you’d diagnose and tell the court about, or is that something you’d ignore and withhold from the court? Ouch, the words are getting sharper.
Is there a diagnosis of V995.51 Child Psychological Abuse on page 719 of the DSM-5? Is that a diagnosis you would diagnose, or is that a diagnosis you would ignore and withhold from the court?
So you do diagnose pathology sometimes, but you don’t diagnose pathology other times, sometimes you report relevant diagnostic information to the courts and sometimes you withhold relevant diagnostic information from the courts, based on how you feel, is that what you’re saying?
Oh, I see, if it’s relevant you’ll make the diagnosis and tell the court, but if you believe it’s not relevant then you withhold the diagnostic information from the courts, is that what you’re saying? That you decide what is relevant and non-relevant information for the court’s consideration, and then you tell the court what you think is important for the court to hear, and you withhold information that you decide is not important?
Is a diagnosis of a shared persecutory delusion relevant for the court’s consideration? Is a diagnosis of Child Psychological Abuse relevant to the court’s consideration?
“I don’t diagnose pathology.” That’s the most ridiculous thing I’ve ever heard. Too bad I only play a lawyer on TV, just lemme at that nonsense. Then how do you know what you’re treating if you don’t make a diagnosis – is it cancer or diabetes?
“I don’t diagnose pathology” from a mental health professional… if you hear that, just start laughing, just laugh, and laugh, and laugh as you turn around and walk out the door.
Go find yourself a good plumber or school teacher to diagnose what’s going on, because we need a diagnosis. Is it child abuse? Is there a shared persecutory delusion?
Please, someone… is there a doctor in the house? A rodeo clown? A lawyer? Who diagnoses pathology? Because whoever that profession is, that’s who we need and it’s obviously not you… so that makes you’re pretty pointless, doesn’t it.
Frontal lobe deficits in linear-logical reasoning, they actually say this stuff with a straight face. That’s where my TV lawyer guy would let the forensic mental health person swell on their first answer -“I don’t diagnose pathology” – all proud of themselves like that’s a good thing. Give the week’s guest star their moment before the dramatic collapse on the witness stand.
Okay then… would you diagnose schizophrenia if a parent had schizophenia, do you think the court should know that a parent has schizophrenia? How about a delusional disorder? What is a persecutory delusion? What is a shared persecutory delusion? Would creating a shared persecutory delusion in the child that then destroyed the child’s attachment bond to the other parent be a diagnosis of Child Psychological Abuse?
Would that be relevant for the court to know?
TV-lawyer: Hypothetically speaking, just a hypothetical question, doctor, purely hypothetical not related to this case at all… if… IF… a psychologist missed making a child abuse diagnosis because they failed to conduct a proper risk assessment, could that become negligent malpractice?
I’d use “could” if I was the TV-lawyer guy because of course it “could”, it’s a less strict word as “would” – could it? Yes, of course it could. But what do I know about asking questions, I’m just a psychologist. I’m not a real TV-lawyer guy.
“Did you order the Code Red! Did you order the Code Red?” – looks fun.
Honest to god, stupid pathogen. It comes from an inhibition to the frontal lobe executive function systems for linear-logical reasoning, along with deficits in foresight and planning ahead, and in self-reflective insight.
Linear-logical reasoning – find the point of illogic and stay linear on the question line with yes-no questions. The pathogen will want to escape into associational-emotional thinking, don’t let it, remain on yes-no questions – linear and logical. This will tie it up in knots when it reaches the thought-diorder part of the illogic.
Foresight and planning ahead – The pathogen doesn’t., they are very now-reactive. They won’t know the package is arriving until it’s at their doorstep, no foresight.
Because they are entirely now-reactive with no forsight, they will say what seems best in the moment. This will lead them into making contradictory statements in different contexts. Once they start contradicting themselves, put their own statements side-by-side and ask them to reconclie the contradiction.
Self-reflective insight – they have none. They are arrogant and overly inflated with the self-importance of their opinions. They think they’re important… just because. Everytime you expose them, you create a narcsisistic injury.
Be careful, they may try to retaliate using their power. That should never-never happen. But it does. Be careful.
They can’t because it’s illogical. The licensed mental health person who says, “I don’t diagnose pathology” is illogical – of course you do, that’s your training, that’s what the license is for. Honest to god…
They have to testify and testimony is all about linear lines of questions. They could be in trouble if their thinking isn’t as linear-and-logical as the line of questions.
They don’t diagnose pathology… well, that makes you pretty irrelevant then, doesn’t it, because that’s what we need. If we need our Tarot cards read, we’ll be sure to think of you.
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857