Half of the Patients Diagnosed with Schizophrenia by a Baltimore Clinic Only Have Anxiety Disorders

That isn’t a joke; nor, as far as I can tell, is it because this particular clinic was particularly sloppy in a scandalous everybody-at-this-one-hospital-goes-home-with-the-wrong-leg-cut-off kind of way. As reported:

Mental health researchers discovered that at least half of people diagnosed with schizophrenia at a Baltimore clinic had been misdiagnosed and were suffering only from anxiety. A misdiagnosis can have far reaching implications for a person who could simply undergo the correct treatment for anxiety.

What this new study conducted by experts from the John Hopkins University suggests is that overdiagnosis of a serious mental illness may be a national problem that could be causing inappropriate and delayed treatment.

Central to the study was the method used by general health practitioners to make their diagnoses. According to the Schizophrenia and Related Disorders Alliance of America, there are five common symptoms that need to be present before a person can be diagnosed with schizophrenia. This includes delusions, hallucinations, disorganized speech, disorganized or "catatonic" behavior, and negative symptoms.

However, while many general practitioners were making their diagnoses according to this list, they were not necessarily seeking a second opinion from a psychiatry specialist or clinic. At issue is that, although auditory hallucinations are considered to be one of the symptoms of schizophrenia, symptoms of anxiety and hearing voices were also the most common reasons for misdiagnosis.

This is the mental health equivalent of going to the doctor for a bellyache, being diagnosed with cancer of the stomach lining, and only discovering halfway into your chemo regimen—and only due to the intervention of an independent research body—that you actually have acid reflux. I find the explanation baffling. Yes, general practitioners were making diagnoses without consulting an expert. Yes, certain “extreme symptoms”—mainly auditory hallucinations—aren’t always indicative of a severe psychiatric disorder. But half? How is that possible?

I’m not terribly interested in investigating the particular mechanisms which led to these mistakes. The study itself does a thorough job of that. But the fact that this could happen should be cause to reflect on larger issues in mental health diagnosis and treatment: how even the DSM makes its taxonomies around largely arbitrary symptom clusters, how this kind of sloppiness contributes more to general distrust of psychiatry than any political “stigma”, and how mental illness, even severe mental illness, is not so much a complete departure from ordinary human life as it is the metastatic growth of certain small glitches in ordinary human cognition into immense, life-dominating terrors.

I think of how my own diagnosis keeps shifting between “bipolar disorder type one with psychotic features” and “schizoaffective disorder of the bipolar type” because even the new, medical, and rational schools of psychiatry are clinging on to a century-old axiom that schizophrenia and bipolar disorder are distinct disorders, despite ample evidence that a family member with either is a genetic risk factor for both. I have intense mood episodes, classically bipolar in their presentation and duration, so schizophrenia is ruled out. But I also have psychotic symptoms—persistent delusions and hallucinatory episodes and catatonic lapses — which complicate matters. The difference between “with psychotic features” and “schizoaffective/bipolar type” is, according to the DSM, whether or not I have had psychotic symptoms for at least 14 days of my life in absence of a mood episode. Given that I am rarely certain whether or not I am having a mood episode, and given that a hallmark of psychosis is not knowing that you’re psychotic, and given that the “purest” sample would be from before I was on medication, and therefore from when I was even worse at knowing what kinds of symptoms I was suffering, it is essentially impossible for me to say whether I’ve met that 14 day mark. I think so, but who knows? I might’ve been more manic, or more depressed than I realized. Who cares? Do you, and does anyone really believe that 13 days of a symptom indicates one disorder, while 15 days of the same symptom indicates something else entirely? The punchline is that the medication regimen for “both” disorders, and for almost all cases of bipolar disorder, and for quite a lot of schizophrenics, is the same.

I think of how eager so many people are to believe that psychiatry—and particularly the “pathologizing” of certain abnormal mental and behavioral traits— is horeshit. You have your cranks and scientologists and Freudians, your memelords posting “this is poison” under a picture of a bottle of pills, then “this is medicine” under a picture of a forest, your contrarians yelling “show me a biological test for schizophrenia!”. All of them are delighting in this study. But so, perhaps, are your more serious critics: your rigorous materialists, asking if this isn’t all just ideology (bipolarity feels a bit like the market, after all) and your woke authors wondering if all mental illness is just an adaptation to “trauma”; surely this study lends credence to their skepticism. Throughout the second half of the 20th century, psychiatrists in the United States weaponized diagnoses — conspiracy-minded and justly paranoid Black Panthers were schizophrenics; dissatisfied housewives, oscillating between misery and acting out, were all bipolar — and it helps nobody when the damage done to psychiatry’s credibility by malicious actors is just replaced by damage done out of catastrophic incompetence.

I think of how I’ve come to answer questions about more serious symptoms. What does paranoia feel like? Well, have you ever been afraid? What is a delusion? Well, have you ever believed something that wasn’t true? Imagine that, but you can’t shake it. What is it like when Voices Tell You To Do Something? Has your boss ever told you to do something? Your mom? Sure, of course. It’s like that. I think the reason that a doctor could misdiagnose the emotional imbalance and fleeting hallucinatory quality of serious anxiety with schizophrenia is that all of us suffer emotional imbalance sometimes. Everyone has delusional thoughts. Everybody picks up white noise and over-interprets it; sees patterns where they shouldn’t be; thinks they “hear” something that isn’t there. These experiences aren’t a wholesale break with ordinary life. It’s only that when you’re very ill, you have no defense. The two second fantasy becomes a two year fantasy. The “is someone talking?” becomes “yes, someone is, and I can hear them.” The slip into an irrational mood isn’t shaken off with a cup of coffee and a run; it lasts and lasts and lasts and lasts. As disturbing as it is to think of the mentally ill as somehow alien, it may be more disturbing to see in them only our own faulty, overfiring brains, but in extremis.

Finally, I think of how excited I was to read this story. Among the mentally ill, I can’t imagine that I was alone in that reaction. It is very difficult to accept that you’re sick. More difficult, once you’ve accepted it, to accept that this will persist forever—the diagnosis is a start, not a solution. You spend so much time wondering what doctors are thinking while they examine you and build so much resentment toward friends who wonder if you’re “feeling alright”, you know, mental-illness-wise, whenever you’re frustrated or angry or sad. It is one of my secret fantasies, and I expect among the secret fantasies of many people like me, to be told one day that it was all a mistake. Yes, yes, it was very bad when that first doctor saw you, but it’s just an anxiety disorder. Don’t worry. You’re fine. If half of the people diagnosed by this clinic weren’t as sick as they were led to believe, what are the odds for the rest of us? Surely not half, but better than we thought! It’s like finding out that half the children one street over really were princes and princesses; that just last week, their real parents really did show up and take them away to live in their rightful castles. I don’t think this will happen to me, or to many of us, of course. But I’m terribly happy for the people this study saved. I’m so glad they get to live out my secret wish.