During these pandemic times, the importance of diagnosis is strongly emphasized. Being diagnosed with COVID provides insight into the symptoms, determines what to do about it, and shapes our collective responsibility to the community.
Making a diagnosis seems to be a fairly simple matter. You have symptoms, the doctor examines or tests you, you are given a name for what ails you.
But the reality is much more complex. Diagnoses are actually social agreements about what counts as a disease.
Of course, there is some dysfunction in the beginning, but not all dysfunctions are given diagnostic status, some diagnoses shift over time from one category to another and different diagnoses will have different connotations.
Even a seemingly straightforward diagnosis like COVID is more than just a label on a virus. You may have suspected COVID, historical COVID, alpha, delta, or omicron. You can have COVID for a long time.
The latter is diagnosed as COVID, even if the virus is long gone and it could in fact be something else: chronic fatigue syndrome or fibromyalgia. Long COVID can be a particularly visible form of post-viral fatigue. That would require another diagnosis.
Read more: COVID testing led to new disease diagnosis techniques: progress must not stop now
Diagnosis as storytelling
Diagnosis is so important to understanding our lives and those around us that it is often applied outside of the health setting.
“Diagnosing” has become a popular form of entertainment. TV shows like House use diagnostic mysteries to underpin plots – less Whodunit and more Whatisit.
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Does Donald Trump have a narcissistic personality? Was Joan of Arc schizophrenic? What Caused Richard III’s Hunchback? And even, does Winnie the Pooh have obsessive-compulsive disorder?
What’s interesting about this fascination with Trump’s supposed narcissism, or even Jesus’ mental health, isn’t so much whether these diagnoses are valid and explanatory, but rather how diagnostic frameworks have become dominant ways of telling stories.
A diagnosis is a story in itself. When a doctor says “you have pneumonia,” they’ve actually said:
You have an infection of your lungs, probably caused by a bacteria or virus and possibly caused by the cold you had last week. It will disable you, but will likely be self-limiting if all goes well. Stay home and take your antibiotics.
You can repeat that story by saying the same thing to your employer or your friends. They will know the storyline.
Stories and anomalies
Diagnostic stories are explanations of abnormal behavior. By “deviation” we mean the sociological meaning of the term: an inability to conform to social expectations of behavior, belief, or experience.
To explain deviance, we often assume a diagnosis. Having visions, having an inflated self-esteem, being lethargic, and being unable to keep up with others’ pace are all somehow beyond normal expectations. Diagnosing it as psychosis, narcissism, or depression is one way to understand it.
Diagnosis is also used as a storytelling technique for deceased people, fictional characters and politicians. For example, Vincent van Gogh, who died of a self-inflicted gunshot, has received retrospective diagnoses ranging from depression to bipolar disorder, temporal lobe epilepsy and acute intermittent porphyria.
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More than 150 scientific authors have devoted themselves to finding a diagnosis to explain his abnormality. Each diagnostic statement is an example of the desire to understand Van Gogh.
In the same vein, Arthur Fleck’s analysis in the movie Joker is full of learned specialists picking up on what the movie did wrong, what diagnosis he might have or what the impact of his candidate diagnoses might be on patients in the real world.
Read more: The Joker’s origin story comes at a perfect time: clowns define our times
The diagnoses proposed for Joker include psychopathy, pseudobulbar affect, schizotypal personal disorder, and many more. But Fleck doesn’t exist, and the cinematic goal of suspending disbelief constructs a character, not a patient.
Likewise, Winnie the Pooh does not have obsessive-compulsive disorder, Roo is not autistic, and Tigger does not have ADHD. They are appearances. While you could argue that these stories serve as ways to help children see themselves, sometimes stories are just stories. Not everything is a cautionary tale, an educational tool, or a self-reflexive device.
Medicalizing experiences
The social practice of diagnosis as a way of talking about characters reflects our contemporary understanding of illness and disease as the main narrative to explain deviant behavior and to legitimize the diagnoses themselves.
These stories say more about us, the diagnosticians, and our contemporary attitudes than about the lives of those they try to describe. But this practice is not without its drawbacks.
By using diagnosis to explain people, we medicalize our experience of the world and shut down other modes of explanation. Calling someone a narcissist to explain political behavior means we have given up on politics. We see pathology as the underlying explanation for unsavory policies, rather than structural failure.
Just as explaining an imaginary character through a diagnosis means we have lost faith in stories. Winnie the Pooh is just a kid’s toy “with very little brain”.
