Guest Post by Annemarie Goldstein Jutel
Putting a name to an illness is as much a social task as it is a medical one. The pursuit of diagnosis is often the reason we choose to seek medical attention (“What’s wrong with me, doctor?”). It separates the lay person from the professional (doctors diagnose, lay people don’t), differentiates different specialists from one another (this diagnosis to the rheumatologist, that one to the gastroenterologist), and provides a kind of organization to a physical complaint. A cough on its own is just a cough. Pneumonia, on the other hand, puts the cough and the fever into a structure: one with sick leave, a prescription, and a particular prognosis.
Diagnoses have incredible power to structure our lives. Getting a bad diagnosis from the doctor, for example, divides life forevermore into “before” and “after.” It gives rise to “bucket lists” and religious conversions; it is the subject of memoirs and of creative writing. The description of diagnosis in poetry and prose is a rich source of information about popular understandings of diagnosis and the drama of the doctor-patient relationship. Not just the focus of creative expression, diagnosis is also one of medicine’s most powerful tools. It is why patients go to the doctor; its pronouncements makes sense of symptoms, dictating the treatment and outcomes, defining the future, and in some cases, describing the pathway towards death. Diagnosis also pervades popular culture: it is the topic of TV series, movies, and even greeting cards.
Some diagnoses are welcome, as they help us make sense of what ails us: “Whew! I was beginning to think it was just me!” Having a diagnosis legitimizes our complaints, and allows us to some social leeway (like not going to work, or having someone else look after the kids). But a diagnosis can also be stigmatizing: think of syphilis, HIV, and even gout! Diagnoses often guard the boundaries between normality and deviance. Fringe behaviors may shift between being seen as moral depravity or disease. Addiction, sexuality, and even violence can be forgiven when viewed as diseases.
What’s really important as we strive for good health outcomes (in any society!) is to recognize that diagnosis is a social activity with social consequences. The diagnoses that we use—be they contested psychiatric labels, or material, physical disorders—all have the potential to shift how we think about ourselves and others. The wise clinician considers the social as well as the medical when diagnosing.
Annemarie Goldstein Jutel is the director of research at the Graduate School of Nursing, Midwifery, and Health at Victoria University of Wellington, New Zealand. Her latest book is Social Issues in Diagnosis: An Introduction for Students and Clinicians. She is also the author of Putting a Name to It: Diagnosing in Contemporary Society, both are published by Johns Hopkins University Press.