Introduction: At the end of clinical examination, do Psychiatrists diagnose ‘brain dysfunctions’ or ‘mind dysfunctions’?

At the end of clinical examination, do psychiatrists say, “This patient has dysfunction in median raphe nucleus, increased levels of glutamate in hippocampus and mPFC, LTP of Mesolimbic pathway and abnormal modulation of parabrachioamygdaloid pathway by noradrenaline”? This would be a neurobiological dysfunction-based diagnosis.

To make a complete neurobiological diagnosis, it is necessary to know the status of all such parameters of the brain in every patient who attends the psychiatric clinic. This is impractical as of now. It is practically impossible to just know the levels of even ten important neurotransmitters in vivo in every patient at the time of diagnosis – and at the time of every follow up! So, it is impossible to make a ‘neurotransmitter dysfunction diagnosis’, let alone make a complete ‘neurobiological dysfunction diagnosis’ that also describes the status of epigenetic changes, neuroplasticity and glia in various brain parts.

However, it is practically possible to make mind-dysfunction based diagnoses such as ‘intense wish to consume increasing quantities of alcohol and much reduced intensities of wishes to maintain health, career and relationships’.

Thus, at the end of clinical examination, Psychiatrists do not make ‘brain dysfunction diagnosis’, but make ‘mind dysfunction diagnosis’.

Diagnosing dysfunctions and making a diagnosis using a theoretical framework that describes the ‘organ of interest’

A Cardiologist has learned the anatomy, physiology, pathology, clinical features of the ‘organ of interest’ i.e. heart. The Cardiologist is aware of the various anatomical and functional systems of the heart: the contractile system, the vascular system, the valvular system, the excitatory and conducting system, the pericardium. So, when a Cardiologist is examining the patient, he or she has this theoretical framework in mind while drawing inferences during the clinical examination. The Cardiologist endeavours to know where the dysfunctions are, in these systems. Because of this framework, the evaluation of the patient becomes comprehensive and systematic. For example, the diagnosis of ‘Anteroseptal Myocardial Infarction due to LAD artery block with Left Ventricular Failure and Ventricular Tachycardia’ describes specific dysfunctions in specific systems of the heart.

           The ‘organ of interest’ for Psychiatry is mind. Hence, we need a theoretical framework that describes the mind comprehensively and systematically. The 4-Level, 5-Part Framework (4L5PF) provides such a framework for describing the mind and its dysfunctions during the clinical examination. Hence, a diagnosis based on this framework becomes systematic and comprehensive.