A Unifying Premorbid Diagnosis

July 15, 2010
Irwin Feinberg, MD

One cannot but be impressed at the ingenuity of our DSM-5 mavens at conjuring up new diagnostic syndromes.

One cannot but be impressed at the ingenuity of our DSM-5 mavens at conjuring up new diagnostic syndromes. However, they risk unnecessarily fragmenting our nomenclature. To avoid this I propose a new, overarching diagnostic syndrome: LIFE or Living In Forbidding Environments. This is the true premorbid condition; it antecedes (and encompasses) all the other the premorbid states now being considered.  Moreover, it has a virtue that contemplated premorbid conditions sadly lack: perfect inter-rater agreement, which falters in only really extreme environments like committee meetings (all fields) and - - more prominently -- psychiatric conventions.