What are psychiatrists? I know the dictionary definition; they’re physicians who treat mental illnesses. But what do they really do? Consider the story of our 11 year-old son John. Psychiatrists have diagnosed him with:
1. ADHD;
2. ADHD with bipolar symptoms;
3. ADHD
4. Bipolar disorder with ADHD;
5. Developmental disorder;
6. Fetal Alcohol Syndrome;
7. Bipolar disorder with ADHD;
8. Bipolar disorder with PDD;
9. Bipolar disorder;
10. And finally, PDD with bipolar symptoms and maybe ADHD.

Notice the list has 10 diagnoses. They cover a span of just four years. Do they sound repetitive and confusing? Well it gets even better. These 10 diagnoses were the work of 5 psychiatrists.

Let’s start at the beginning. During an inpatient hospital stay, Psychiatrist Number 1 made Diagnosis Number 1, ADHD. By the end of John’s three-week stay, Psychiatrist Number 1 modified Diagnosis Number 1 into Diagnosis Number 2, ADHD with bipolar symptoms. Two weeks after his discharge he met his first private psychiatrist, Number 2, who dropped the bipolar symptoms and changed Diagnosis Number 2 into Diagnosis Number 3, ADHD.

After Psychiatrist Number 2 gave us directions to break up time-release capsules for Justin and helped land him in an emergency room, we realized her knowledge of pharmaceuticals was not good for Justin’s health. We searched for and found Psychiatrist Number 3, who said Diagnosis Number 3 was incorrect; John really had what became Diagnosis number 4, bipolar disorder with ADHD.

While under the care of Psychiatrist Number 3 and his Diagnosis Number 4, John still seemed to require a great deal of time in the hospital. During one of these hospitalizations, he was under the care of Psychiatrist Number 4, the attending physician. Number 4 said John was too young to be labeled as bipolar. Instead, he had what became Diagnosis Number 5, developmental disorder.

After his discharge from the hospital, John was in a group home for several weeks. By virtue of being there he was under the care of Psychiatrist Number 5, who was convinced that John’s problem was not ADHD, bipolar disorder, developmental disorder nor any combination of them. All of those were wrong, he said. Psychiatrist Number 5 was certain John had Diagnosis Number 6, fetal alcohol syndrome.

While he was at the group home, we got a tip from people familiar with their modus operandi that the home was planning one of their favorite moves for John, gaining custody of kids in its care. It had nothing to do with providing better care for kids than their parents did; it had everything to do with working the system to collect Medicaid due the kids. We decided they were not terribly concerned about John and brought him home. Now he was back under the care of Psychiatrist Number 3, who reasserted that John had what became Diagnosis Number 7, bipolar with ADHD. Unfortunately, his plan for managing this diagnosis was to sedate John into a state of semi-consciousness. As he so eloquently told us “Would you rather see him violent or semiconscious? I’d rather see him semiconscious.” We thought his management plan was somewhat nauseating and rejected it.

So now we had to find somebody else to care for John, Psychiatrist Number 4. Now Number 4 didn’t think too highly of Number 3. In fact, he said he was an idiot who shouldn’t be a psychiatrist. We certainly agreed with him. Number 4 then made Diagnosis Number 8, bipolar disorder with PDD. In the course of his evaluation of John, he changed and lowered the dosages of John’s medicines. That was a good move; John benefited from these changes. He became more alert and able to function. Unfortunately though, his progress was set back when he was assaulted on the school bus by a fellow student and required emergency room treatment for a broken nose. This fairly traumatic event caused a serious but fortunately, brief relapse that required an emergency room visit and 4 day inpatient stay for John.

The attending doctor, Psychiatrist Number 5, was dumbfounded by Number 4’s diagnosis of bipolar and PDD, and eliminated the PDD portion. Accordingly, he eliminated two medicines and lowered the dosage of a third. The result was Diagnosis Number 9, bipolar disorder.

In a follow up visit after his discharge, John was back under the care of Psychiatrist Number 4, who’s been caring for him now for several months. Number 4 scoffed at Psychiatrist Number 5’s rejection of Diagnosis Number 8 and said Number 5 was an idiot, much like Number 3. He’s now given John Diagnosis Number 10, PDD with bipolar-like symptoms, along with the possibility of ADHD.

There, don't you feel like you know John well now? We didn't think so. Each doctor had full access to John’s medical records. The hospital doctors had signed releases to obtain his records and consult with his private doctors. The private doctors had the records of his hospital visits, both ER and inpatient. Presumably all the doctors used the standard for psychiatric diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, aka DSM-IV-TR.

Maybe Psychiatrist Number 5 or a Number 6 will hit upon the perfect diagnosis and give John the ideal combination of therapy and medicines. But I have a hunch it’s more probable that I’ll bowl a perfect 300 game with a blindfold. I wonder if when they’re by themselves, psychiatrists think “I wish I was a neurologist, then I’d know so much more about how the brain works” or “Why can’t I be a psychologist or social worker? Maybe I’d understand more about behavior”. Probably not, they’re too busy planning the next fight among themselves.