In brief, most diagnostic processes (at least in the field of mental health) are output and outcome oriented. Diagnosis is all about “honing-in” (a process of convergence). There is a clear decisional-orientation: we need to make a judgment regarding how to proceed—that is what’s most important. As an aside, we might conjecture that those who are supportive of diagnostic processes (based on DSM) score high on Carl Jung’s “judging” function—or at least the system in which they operate is saturated with Jung’ judging function (it is important, when engaging Jung’s typology, to look not only at individual personalities, but also the environments in which one is operating.
Our colleagues in the growing field of behavioral economics (e.g. Kahneman, Ariely, Thayer) offer some insights regarding decision-making processes that are relevant to our reflections on diagnostic processes. There is a tendency to rely on “fast thinking” and simple heuristics (widely-shared assumptions about the world and ways in which to live and work in this world) when confronted with conditions of stress and when there are not clear indicators of what the world now looks like or how it might react to our interventions in this world.
This fast thinking certainly operates in a warzone hospital unit or when a pandemic produces an overwhelming population of men, women and children needing treatment. This is the classic triaging that occurs when decisions must quickly be made about which patients to treat and which must be left to die. Which patients do we treat first (because they are in critical condition) and which do we try to comfort (and perhaps medicate) while they await later treatment? This fast thinking makes sense and can be quite successful, if there is a strong background among those making the decisions—so that they can rely on their “old-brain” intuitions (Lehrer, 2009).
What about under “normal conditions” when the stress is not great (though any patient/client presenting dysfunctional behavior creates stress for all involved)? What about conditions when the issue(s) being considered and decision to be made do not have to be rushed. Is there still a reliance on heuristics, instinct, and fast thinking? When a clinical psychologist has a daily quota to reach, will this professional be inclined to slap a hastily reached diagnosis on the eighth or tenth patient being seen in the late afternoon?
