A very useful saying in psychiatry is “diagnosis comes last”. This of course is ridiculous if you take it to mean that diagnosis is unimportant.

A very useful saying in psychiatry is “diagnosis comes last.” This of course is ridiculous if you take it to mean that diagnosis is unimportant. A better way of stating it would be “diagnosis comes last, but it is still essential!” A diagnosis tells us what symptoms this person has in common with all other people who share the diagnosis. It is useful in a broad sense. However, it doesn’t tell us anything at all about what makes this particular person’s situation unique. It doesn’t tell us who this person is.

In order to provide sophisticated treatment, we need to understand what makes this person who they are, and what has contributed to the difficulties they present with at this particular time and in this specific way.

An understanding of the complex interplay between biological, psychological, social and developmental factors ensures that treatment is not solely focussed on managing symptoms alone. Rather, there should be a focus on treating the individual’s condition as a whole and in an appropriately sophisticated way.