The Ethics of Diagnosis from a Distance

[David Baxter PhD]

Doctor, First Diagnose Yourself, and Do No Harm
shrinqueRap
March 17, 2011

You might imagine that Charlie Sheen, given the number of people who have commented upon his recent activities, has a fairly lengthy **** list. But, so far, he’s only publicly challenged one person to a punch-up: Dr. Drew, AKA Drew Pinsky, M.D., addictionologist to the stars. Said Charlie: “I think me and Pinsky should jump in the ring and he can see how unstable these fists of flaming fury really are. I’ll show you how unstable I am. Bring it! Bring it little man!”

So what’s Charlie’s beef? He has taken issue with Dr. Drew’s armchair diagnosis, made on Hollywoodlife.com, that he was in a manic state, and should be hospitalized on an emergency basis.

Dr. Pinsky is not the first physician to draw broad conclusions about a public figure from few established facts. Years ago, psychoanalyst Dr. James Brussel, author of the book, Instant Shrink: How to Become an Expert Psychiatrist in Ten Easy Lessons (take note, Dr. Drew), was asked to profile the notorious “Mad Bomber” who terrorized New York City in the Forties and Fifties.

Dr. Brussel quickly painted a detailed portrait of the Bomber, George Metesky, that included a strong likelihood that he favored double-breasted suits. When apprehended at home, Metesky was wearing pajamas, but, (Aha!) changed into a double-breasted suit for his trip downtown. Dr. Brussel was praised to the heavens.

In a 2007 New Yorker piece on criminal profiling, Malcolm Gladwell wrote: “If you make a great number of predictions, the ones that were wrong will soon be forgotten, and the ones that turn out to be true will make you famous… It’s a party trick”.

My point? Today’s armchair diagnosticians, enabled and empowered by a celebrity-obsessed culture, are, like Dr. Brussel and Dr. Pinsky, performing party tricks. Why not impress and entertain a credulous public with fancy medicalese and psychobabble, while getting to bask in the reflected glow of their celebrity targets?

As a psychiatrist, I am most familiar with the American Psychiatric Association’s position on diagnosis at a distance, although other professional organizations take a similar stance. "It is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement."

Diagnostic labels, particularly in the highly sensitive fields of mental health and chemical dependency, are scarlet letters that stick, and they should not be recklessly applied to public figures by mediagenic, attention-seeking, gossipy types who end up perpetuating negative stereotypes of their chosen professions while serving little constructive purpose.

 

[David Baxter PhD]

Re: The Ethics of Online Diagnosis

More on Dr. Drew: Diagnosing on TV is Easy, Just Like Predicting the Weather
shrinqueRap
April 4, 2011

As a psychiatrist with over 30 years experience, I have a couple of things in common with Dr. Drew. Being a psychiatrist is not one of them. He is an addictionologist. More on that later.

Having been on staff at the same two hospitals in Pasadena, California as Dr. Drew was, albeit well before him, I?m (almost) experiencing a fuzzy sense of kinship with him. In fact, at times, I feel myself basking in a few scattered rays of the good doctor?s starlight just by having shared those experiences with him.

When I saw Dr. Drew explaining to an awestruck CNN interviewer why it?s no big deal diagnosing people via their televised images, I felt like running to the bathroom and yodeling into the old porcelain phone. Had I done so, Dr. Drew would have diagnosed my reaction with 99.99% accuracy as acute nausea. (Nobody?s perfect).

Dr. Drew, Renaissance man that he is, recently gave an addictionologist?s diagnosis of Charlie Sheen?s apparent psychiatric problems based upon his public behavior, and recommended treatment. Immediate hospitalization, no less.

I was gratified to hear from Dr. Pinsky, in the course of the CNN interview, that medicine and, by extension, its subspecialty, psychiatry, are on a par with political and weather commentary in terms of appropriatness for media consumption. Even as a psychiatrist, I could say that a mole-like lesion on someone?s face big enough to show up on TV was probably a mole. Unfortunately, Dr. Pinsky, without further investigation involving not only examining the lesion first-hand, but doing a biopsy, I couldn?t say for certain that it wasn?t a potentially fatal melanoma.

Your smug, shallow response to the interviewer concerning at-a-distance diagnosis, ?It?s pretty easy?, doesn?t apply to the diagnosis of behavioral health problems. They?re much more complex. You may think you?re teaching people something with your armchair diagnoses, but I?ll bet you?re scaring the hell out of plenty of folks who want to hospitalize Aunt Gertrude after watching you pontificate, just because she got a little giddy from some sherry and called herself the Wicked Witch of the West.

Please, Dr. Pinsky, if you want to educate, do so. But I urge you to be wary of the ethical standards that govern many of the health professions. These expressly state that thou shalt not diagnose without thoroughly examining a patient first and making sure that you have his or her permission to share your opinion. No wonder Charlie challenged you to a fistfight.

If, at some time in the future, you had predicted that Sarah Palin would be our next President, and it turned out to be Donald Trump, fine. That?s the way the comb-over blows. If you tell me it?s going to rain tomorrow, and, lo and behold, it?s a blindingly sunny day, well, even Doppler radar makes mistakes. No harm, no foul. But please, please, keep your ego in check. Woody Allen once said that Normal Mailer pledged to donate his ego to the Harvard Medical School. Make sure that yours doesn?t end up sitting in the next jar to the left.