Why a Psychiatric Diagnosis Is an Agreement, Not a Measurement

To understand what a diagnosis means in psychiatry, it helps to see how it is actually built. The mainstream is linear: diagnosis first, then treatment. But behind this lies something rarely explained to the patient — the diagnosis is subjective. There is no thermometer here; there is a subjective reading of symptoms, which can be turned one way or another.

No Thermometer — Only Conventions

Psychiatry has no objective measuring instrument. Neither DSM nor ICD-11 — take whichever system you like — has double-blind, randomized observation behind it. What exists are conventions, not even contracts: “let’s agree to count it this way.” In each association, in each country, there is a separate “we’ll still count it this way.”

This is not a reason to condemn psychiatry. As a branch of medicine it handles very delicate matters — forensic assessment, legal capacity — and in disputes the expert needs something to stand on. So tools are necessary. But these tools are subjective: they give an “average temperature across the ward.”

Where the System Works, and Where It Doesn’t

With gross disorders — epilepsy, schizophrenia (hebephrenic, simple, catatonic) — it is clinically “more ill than well,” and the system works. But everything we interpret around the word “depression,” the neuroses and similar states — here it all “sticks” to a core, yet nothing can be measured. The symptoms are there; the measurement is not.

Questionnaires and Scales

Questionnaires raise particular doubt. Handing a person in a psychiatric state a scale, then drawing conclusions from how they fill it in — this strikes me as a kind of mockery. How is a person in a given state to determine for themselves what is happening? And yet some system of objectification is needed — which is why the world remains at this level of understanding mental disorders.

Why It Falls on the Individual

All these systems are aimed at society: reducing depression, accidents, suicides. They are not radically aimed at the specific person. From this comes the risk of stigma — the diagnosis turns into a stamp that society pins on you.

The VitaModo Approach: Describing the Process, Not Stamping

Here lies the cardinal difference. We do not care about your nationality, religion, sex, or views — we hold a purely professional niche: mental disorders, addictions, psycho-neurology, that is, real illnesses. For us a diagnosis is not a “yellow star” or a brand, but a description of understanding the process: why a person experiences these particular symptoms.

Only if the person asks — so it can be passed on to colleagues — do we describe it and align it with the official DSM or ICD-11 wording. I took the basis of this approach about ten years ago from one of the best American clinics: there the patient was seen not only by a psychiatrist but by an endocrinologist, a neurologist — several specialists — who together drew the conclusion. What mattered: with each prescription they wrote why, and what effect was expected. That comprehensive, multi-professional view is the model I saw.

Practice: How to Read Your Diagnosis

1. Remember: a diagnosis is a convention and an interpretation, not a “thermometer” reading.
2. Ask (yourself or the specialist): does it describe the process — why the symptoms arise — or is it only a label?
3. Distinguish: for gross disorders the diagnosis is more informative; for “blurred” states around depression and neurosis it is a frame, not a measurement.
4. Treat questionnaires and scales as a rough guide, not a verdict.
5. Value the comprehensive view: the process is clearer when the whole person is considered, not a single diagnostic line.