One of the interesting problems in psychiatry, that I will have to bug my teachers about when I go to residency, is the issue of dealing with the consequences of a diagnostic error. How do you get rid of a person’s diagnosis if you think that its application had been unjustified?

The currently accepted definition of major psychiatric disturbances like schizophrenia implies the impossibility of being cured from them, and describes someone who has had symptoms in the past but is completely asymptomatic now as being in a state of persistent remission. In other words, a schizophrenic once diagnosed is a schizophrenic for life, even if he fails to produce а single symptom over the last decade or two. The truthfulness of this concept is questionable, but at least its reasoning seems non-contradictory. However, it can only be applied if we believe in the validity of the original diagnosis.

Given the ease with which psychiatric diagnoses are nowadays affixed to people, I feel compelled to question this belief in many cases. It is a known fact that in modern psychiatric institutions a diagnosis is often made in a hurry, with a certain degree of superficiality, and in an atmosphere of financial pressure that makes it necessary to use bold and definitive diagnostic labels instead of vague and temporary ones in order for the treatment to be reimbursed. In such circumstances, it seems quite plausible to suggest that at least in some cases the primary diagnosis had been made incorrectly, and therefore the asymptomatic patient in question is not in “remission”, but actually does not have this particular disease, and have never had it!

So what do I do with such a patient? How do I “take him off” of his diagnosis? The answer is not immediately clear.