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The Institutional Status of Medical and Psychiatric Diagnoses

This post is by Richard Hassall.


Richard Hassall

Diagnosis, as the identification of the disease afflicting the patient, is a central element in modern medicine. However, a diagnosis is more than just a statement defining a disease and aiming to guide treatment. It can also have other important social and other consequences for its recipient, beyond acting as a hypothesis for the purpose of treatment. Thus, sociologists of medicine have observed that diagnoses can function to define the sick role in social contexts and authorise medical social control in various ways (e.g. Jutel, 2017; McGann, 2011).

In a paper forthcoming in Journal of Medicine and Philosophy, I argue that the act of delivering a medical diagnosis creates an institutional fact. I make use of Austin's (1962) speech act theory to argue that the statement of a diagnosis is both an illocutionary and a perlocutionary speech act. The announcement by the physician of a diagnosis is not simply a factual statement about the illness. It is also intended to persuade the recipient and other people in the healthcare system that something important about the patient has been established and is expected to have relevant consequences. It achieves certain effects by virtue of its pronouncement.

I then argue that the statement of a diagnosis creates what Searle (2010), in his account of the construction of social reality, calls an institutional fact. To constitute an institutional fact, the diagnosis has to be given by the relevant specialist, in the appropriate medical context and following the specified diagnostic process appropriate to the illness in question. Searle states that a test for an institutional fact is whether its existence entails certain deontic powers such as rights, obligations, and authorisations. Medicine, along with its associated institutions, is a field that confers such powers. It is characterised by a high degree of epistemic authority.

A diagnosis is recorded as a fact in the patient’s case notes and thus acquires the status of an institutional fact. Even an incorrect diagnosis can have this status. If a patient wishes to challenge their diagnosis, it can be difficult to do so. A diagnosis given within a formal medical context carries with it a socially recognised status which may have an important impact on the recipient's subsequent experiences. For example, it may enable the recipient to claim welfare benefits. In some cases, relevant diagnoses have to be declared on applications for insurance policies. They can also entail legally enforceable restrictions on the patient’s activity for certain notifiable diseases.

Since psychiatry is a branch of medicine, the same set of features apply to a psychiatric diagnosis. In the case of psychiatry, a diagnosis may be one factor used to justify compulsory detention of the patient in hospital. The diagnosis can also contribute to stigma, including internalised stigma, experienced by the patient. However, it can also be helpful to the recipients in allowing them to access welfare benefits.


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