[{"data":1,"prerenderedAt":315},["ShallowReactive",2],{"blog-transcript-diagnosis":3},{"id":4,"title":5,"body":6,"description":300,"extension":301,"meta":302,"navigation":310,"path":311,"seo":312,"stem":313,"__hash__":314},"blog\u002Fblog\u002Ftranscript-diagnosis.md","Transcript from podcast Episode 5: Diagnosis",{"type":7,"value":8,"toc":296},"minimark",[9,13,16,19,22,24,27,30,33,35,38,41,44,46,49,52,55,57,60,62,65,67,70,72,75,77,80,82,85,87,90,92,95,97,100,102,105,108,111,113,116,118,121,123,126,128,131,133,136,138,141,143,146,148,151,153,156,158,161,163,166,168,171,173,176,178,181,183,186,188,191,193,196,198,201,203,206,208,211,213,216,218,221,223,226,228,231,233,236,238,241,243,246,248,251,253,256,258,261,263,266,268,271,273,276,278,281,283,286,288,291,293],[10,11,12],"p",{},"Razorsmile:",[10,14,15],{},"Okay, welcome to this session of our podcast Conversations About Concepts. Conversation About Concepts is a podcast exploring our experiences and counters with a range of contemporary concepts. We try to listen into the constantly shifting whisperings of language in order to get a sense of how concepts are actually being used in our everyday lives. This is not about defining things or teaching the truth or showing how something should be understood. Rather, it's about assuming that we don't yet know what we mean when we speak.  and that the first task is to open our ears to the world around us. This session, I'm joined by Ed, Laura, Kirsten and Blake, as well as Eric, as usual. And so I'm just going to ask each of you in turn to introduce yourself a little bit, tell us who you are and tell us how you encounter and experience the concept of diagnosis in your life. So can we begin with you, Ed?",[10,17,18],{},"Ed:",[10,20,21],{},"Okay, so my name's Ed, Ed Thornton. My, who am I? My kind of background and the context which put me in contact with Eric and with Matt was in philosophy circles and some kind of psychoanalytic conversations. I did a PhD in philosophy and taught philosophy for a bit.  I then had a career change and I'm now working as a gardener, landscape gardener and otherwise.  What am I thinking about diagnosis? I think a couple things. One thing that's been on my mind a lot recently, and this might sound a bit tangential to diagnosis, but I think it connects, is that I've been thinking a lot about plants and about understanding plants, learning to understand something which is alien to me to start with, and thinking about the ways in which scientific knowledge helps me to understand plants, but also...  sometimes feels kind of hollow. So when I look at a plant and I don't know what it is and then I learn, ⁓ this is a choisea tornata or something, I'm kind of wondering, have I learned anything when I've learned its name or have I learned nothing about it? And the thing that's been going through my head recently is this section, something that Nietzsche says about...  I think it's in an essay called On Truth and Lies in a Non -Moral Sense. And he talks about, he's kind of critiquing science and he says something like, no one's impressed if you hide something behind a bush and then you look there and you find it again. And that's basically what modern science is like. We say, anything with four legs and fur is a mammal. And then we point the camel and say, it's a mammal, as if we've learned something, but we've learned nothing at all.  And it speaks to me, but it also, I feel like it doesn't speak to me because I think actually, if you see something with four legs and fur and you don't know what it is, you can say, it's probably a mammal, which means it probably has live young and it probably breathes oxygen. And you know other things about it because the concept has helped you. So it's a kind of diagnosis. It's a naming of a particular phenomenon. It helps you understand it. And this.  Just to add one other thing there, something which has happened to me in the last month, which has also brought this more alive, is my daughter, who's just a year old, 15 months old, was in hospital last month. She had pneumonia and sepsis and was very ill, and it was scary. And I was also amazed. They take a blood sample. They put that blood sample in a Petri dish. They work out which bacteria it is.  They test different antibiotics against that bacteria and then they work out which one is fighting it best and then they use that antibiotic. That's like a direct diagnosis of what's going on. And it was so powerful. It was amazing to see what that knowledge brought. So that was a kind of like antinitian example of how naming the thing was really helpful. So I don't know. That's where I'm at at the moment. Ambivalence about diagnosis.",[10,23,12],{},[10,25,26],{},"Laura, can I turn to you? Can you tell us who you are and again, how do you encounter the concept of diagnosis in your life?",[10,28,29],{},"Laura Chernaik:",[10,31,32],{},"Hi, I'm Laura. I just got back from New York. I'm American originally, but I've lived here almost all of my life. And I was giving a paper talking to some people about what I feel is the difference between identity or identification, the process rather than the particular being. Because I think that's really important to me. I want to think of whether we're  sort of reflecting and processing or whether we're speaking out of our own identities, where I feel recently people really have been stuck into their own identities and it's troubling me where it's leading because of the battles, the accusations. I gave a paper and I found out quite a while afterwards, though nobody had said something to my face, that people were  wanted to stop me teaching because they said something I'd said disturbed them. But then they just talked to me rather than saying, you know, saying I shouldn't have a platform. So I'm a little uneasy about speaking because I want us to be listening, I hope we'll be listening and conversing rather than...  sort of speaking up for identities in terms of what's our subject position, what flows from that subject position. I want us to be flowing out of our comfortable subject positions. In terms of diagnosis, I've worked with a really wide variety of people as a psychoanalyst. I have right from the beginning. Maybe it's because I've moved countries, so I tend to assume people are...  coming from different places and different points of view, or maybe I'm congratulating myself about some kind of traveling part of my psyche. But in any case, I do work with people who seem to me to be really different to each other. And occasionally diagnosis helps to figure out what not to say until you've done a lot of listening. Because some things you say can really  disturb somebody and make it much harder for you to listen to each other. And also in terms of my own diagnosis, I've suffered from migraine all of my life and often it's been horrifically disempowering and I've just had to take to my bed for days and draw the curtains, try to block out all sound and it's a real form of...  of suffering that stops me being able to think and live in the world and then I feel I'm able to go out, go for a walk, talk to people and so I found that time back in the world connecting with people is really important to me because of the need sometimes to protect myself. But I've never found that there's an identity of people who...  suffer from migraine. I think it's more that we find it hard to hold down nine to five jobs where you can't say, I'm not feeling well. I need a bit of time. Or, sorry, I'm standing up and stretching, but I need a bit of space. So I think it's something to do with our different neurologies.  separating us rather than I haven't found that my different neurology helps me relate to people in the community. I think it silences me, throws me into my body but not being able to think while I'm in bodily pain. Maybe that's helped me be a psychoanalyst or maybe it's hindered me, I really don't know. But it is part of me.  experience that pain sometimes stops you thinking. Literally. It can overwhelm.",[10,34,12],{},[10,36,37],{},"Can I turn to you Blake and again same thing how do you encounter diagnosis in your everyday life and first of all tell us a little bit about yourself and who you are.",[10,39,40],{},"Blake:",[10,42,43],{},"Yeah, thanks. Thanks for having me. My name is Blake. I'm a MA student with Eric. That's how I came to this podcast.  I came to think about diagnosis in my undergraduate. I was at Goldsmiths, I was doing psychosocial studies and so I'm doing it as a mature student and I was really struck by hitting this kind of psychic wall of my focus and my motivation. I found it really challenging to do this work, like work I had...  the work and a space I'd never really been in in my adult life. I'd always kind of done random jobs like film and television, musician, working on vans. And yeah, it wasn't until I was sitting down in these classrooms and having to take in a lot of reading and writing, procrastinating on both.  I was talking to some of my peers and they had been tested for ADHD and they recommended I do that and I was interested in it but at the same time was a bit ambivalent like Ed was saying in that undergraduate course, you know, we'd been learning about social construction and things like that, you know, the laying in kind of thinking around madness and so I was interested but yeah, I was a bit cautious.  The process was really interesting when I was being asked questions by doctors and things like that because I realized that in my childhood we never went to doctors a lot and really thought about stuff like this. I grew up Christian and so there was this kind of thing about putting curses on yourself by like saying these kind of giving yourself these kind of labels. And so yeah, it kind of just struck me how I'd never really thought about that stuff.  But then as I started looking into it, and like from a psychosocial perspective, I kind of thought about how I'd never really put myself in that situation and I wondered like if that was a conscious thing or an unconscious thing, you know, the situation of where I'm challenged by those things. And then from a generational perspective, I thought, well, neither of my parents or my grandparents and...  Yeah, so that kind of nature nurture conversation came up for me, which I just thought was really interesting. And so, yeah, so I've kind of been diagnosed with some things and some things I thought I had I didn't and yeah, a bit of ambivalence and I don't want to like be identified or characterized by these things, but I do think that they are useful points of reflection.  And I think about like in our line of work, like I'm training to be a psychotherapist, like in my personal therapy and also the people who I'm working with, I feel like there's quite a bit of the workers about the capacity, your capacity to be and how we've perhaps been limited by that, by what we've been told we can and can't do, or then we've internalized that what we can and can't do. And so, yeah, I...  I think that's where my ambivalence lies with diagnosis because it can be a useful signpost but equally I don't want it to define me. I want it to just be a point of reflection. And speaking of reflection, I was thinking just on the weekend actually, I was in a really playful space with other kind of like -minded people.  and kind of doing a bit of social dreaming together and I thought about how a lot of the time I find it quite difficult to communicate and in fact that's one of the reasons why I do these podcasts is it's a useful way to pull those thoughts out through my mouth. Yeah often I find it like a stumbling block for me but on reflection...  doing psychodynamic work with the free association and the reverie. Being in multiple streams at once can actually kind of be a bit of a useful tool. So yeah, to think of the decades I've spent in the wilderness thinking about what I'm gonna do, I find it interesting that I've landed here. Yeah, and that's where I'm at with my journey with diagnosis at the moment.",[10,45,12],{},[10,47,48],{},"And can I turn to you Kirsten? Same sort of thing, if you can tell us a little bit about yourself and your encounters and experiences with diagnosis.",[10,50,51],{},"Kirsten Shirke:",[10,53,54],{},"Sure. So I have been a GP in the East End of London for the last 21 years now. So diagnosis is something that I come across every day as part of my work as a GP. I've also been working as a psychotherapist for a while and I work a lot around drug and alcohol misuse. And I also work with  doctors  who've experienced problems with addiction and poor mental health. So I was thinking about diagnosis and what that means in the different areas of my work. And I do think it's complex. Physical health diagnosis is complex, although sometimes there can be biochemical or physiological markers and signs and tests that we can do.  but nonetheless it's complex and multifaceted and even more so in mental health. But I think the other thing about diagnosis is the power that it can have both in terms of being a liberating force but also can sometimes be quite imprisoning as well and the kind of responsibility when using diagnosis.  to be collaborative about it. And I was thinking just this week, actually, among the patients I've seen, I saw someone who came into the surgery, a young single mother in temporary accommodation with a life -threatening asthma attack. So making the diagnosis was essential to giving her  life -saving treatment in that moment. But the diagnosis of a life -threatening asthma attack was only part of the much bigger story, and the story was that of her life. It had taken her so long to get medical help because she was a single parent in temporary accommodation miles away from the friends and family who could have helped her and looked after her children while she got help for herself. But also,  the accommodation she's living in with her children, which is not fit for any human being to live in. It's damp and mouldy and is making the whole family sick. So diagnosis is part of the problem, but it doesn't tell us about the cause of the problem. And in her case, the cause of the problem is the environment that she's living in and a society and a culture that allows people to live in those conditions.  So diagnosis for her meant treatment that could allow her to carry on living and looking after her family, but also tells us something about the society we live in. And then quite on a very different end of the spectrum, I was working with a doctor who's just returned from Gaza doing humanitarian work.  there, who's come back completely burnt out and exhausted and traumatized by what he's seen and had to be involved with while he was there, which has led to any number of symptoms that you could categorize and put into diagnostic labels, but actually,  what he's experiencing is a kind of moral injury or a moral trauma. And this is something that I've seen a lot with the doctors I've seen recently who work in A &E departments where the care they're giving is way, way beneath the kind of care that people deserve and the impact that has on them as carers. So I think...  Diagnosis can be part of the story, but it's only one piece in a puzzle. And I think we have to be really careful that we don't see it in a kind of limiting, straightforward way.  I don't know if that makes any sense.",[10,56,12],{},[10,58,59],{},"That's great. Thanks, Kirsten. OK, I mean, one of the first things then, I mean, a couple of you talked about it and kind of have like bumped into it. But there's this relationship that we perhaps notice at the moment between diagnosis and identity, Laura in particular, you seem to be mentioning this. And that obviously is closely connected to sometimes relationships of power and relationships of access to social goods in one form or another.  I know my own experience is of my son has a thing called Sturge -Weber syndrome and this is a long -standing medical condition that causes sort of brain damage and so he has a learning disability and one of the things that's I've had strange relationships with diagnosis because his diagnosis enables him to get disability benefits in a very clear and simple way. He doesn't have any, there's no real questioning.  of his diagnosis. It's a medical diagnosis. He's got a birthmark that's down his face. It has brain injury effects. And so, you know, he simply puts it down on the form and he is immediately given this back in a kind of simplistic and simple way where things kind of working, you know, someone needs some help. It's clear that they have something that needs help with and so they're given some help. But he is supported, his social support network.  primarily social support network is people with schizophrenia and very, very severe ADHD who have a continual process of struggle to get exactly the same process. And this is in UK called the personal independence payment process. And so there's this constant kind of relationship differential that you witness where essentially the medical seems to be in many ways.  not completely, but in many ways a cleaner and simpler relationship to diagnosis. But as soon as we enter anything that's not, as it were, simply medical or has wider ranging dynamics, wider ranging involvements, I don't want to just refer to sort of mental health in a broad sense, but there are because there are other things. So is the with the problem or the difficulty of diagnosis primarily in your eyes?  arise in that realm where it's not simply a medical relationship or I mean, Ed, you referred earlier to the, you know, to the sepsis diagnosis. And that again is a kind of straightforwardly medical identification action process. So one thing that we're interested in is, is it primarily in this realm of what broadly we might call mental health, but you know, that outside, that less medicalized version?  of diagnosis where difficulties arise or is that too simplistic? Anyone have any thoughts on that?",[10,61,29],{},[10,63,64],{},"Well, my experience with migraine, which is a neurological condition, is very hard to get support from your employer or to get benefits if you're unable to work because it affects you differently day to day. And a lot of, I mean, I found out after years of working, just assuming that my...  Colleagues and employees in the university would have my back because we were in the educational realm. I found out they assumed I was lying because they couldn't understand that a condition like migraine could be a physical condition and yet some days I would take the medication and have to take days off work. Other days I would be able to go into work. I ended up going into work.  when I was basically unable to see because I was suffering from tunnel vision and acute pain. So I was unable to see and unable really to think to say anything other than dialogues I'd memorized before. And clearly it was a hysterical thing to get myself in that stage where I was sort of being hysterically defiant and trying to prove that I could cope with something. And...  misunderstanding their reactions, but at the same time it was something to do with having a neurological condition that manifests intermittently rather than the same way hour by hour and day by day. And so it's not simply a difference between mental health and physical health. I think it's a lot more complicated. And there are some...  And also it would have a mental health impact on me as well as a neurological impact. And it took years before I recovered enough to think, well, what do I actually want to do with my life? I want to be a psychoanalyst and to think of the reasons why I hadn't trained before and then to find myself in a profession that I love. But where I do rely on some sorts of  tentative diagnoses to start off with, where I might think, I wonder if the person is schizophrenic, or I wonder if the person has multi -generations of trauma in their family, and so forth. And I don't know how much of that is defensive, because you, so many...  people who are so different come into my consulting room that sometimes I take a step back from the individual. Or how much of it is something I've learned that you can't respond just the same to everybody. You have to have a sense of human diversity, which isn't the same as diagnosis, but does overlap a bit with it. Because the kind of diagnosis that I'm thinking about and thinking...  of what I use in my own work is diagnosis that indicates that we're not all the same as each other. We're of equal value, which is not recognized, but we're not identical to each other.",[10,66,12],{},[10,68,69],{},"Ed, you need to come at me soon.",[10,71,18],{},[10,73,74],{},"Hearing Laura talk about migraine made me think of something that happened to me and which relates maybe to this question of the map what you're asking about the medical versus the non -medical. I was thinking about maybe a different distinction than that which is between whether a diagnosis names the cause or whether the diagnosis names a symptom.  which makes quite a lot of difference, I think. So I remember reading about the DSM, the Diagnostic and Statistical Manual of, I guess, psychiatric disorders. And I was very surprised when I read it that each diagnosis doesn't say what the condition is. It says,  what collection of symptoms are required to be diagnosed with it, which is quite a different thing. So it says, are you, do you find these situations difficult and, ⁓ Kirsten maybe wants to clarify, maybe I've got something wrong there, but I was intrigued about the kind of discovering that maybe it was in a certain sense for certain medical purposes.  diagnose something without actually saying what was causing it, but just to say we recognize a collective set of symptoms which are shared across different cases. And I had this experience when I was diagnosed with having a migraine. I had a strange moment when I lost all my language processing. I suddenly couldn't read and I couldn't speak and I didn't know what was going on. And I had some tests and they said, ⁓ we thought it could be a stroke, but it's not a stroke. And we think probably it was a migraine.",[10,76,29],{},[10,78,79],{},"Mm.",[10,81,18],{},[10,83,84],{},"I felt a sense of relief. I thought, okay, good. Okay, now I know what it is. I said to the doctor, so what is a migraine? And they said, well, we don't really know. I was like, okay, so you've told me what it is, but really what you're saying is we've seen this pattern before in other people and we've collectively called that a migraine. We're not telling you what's really caused it, but we are saying maybe you don't need to be worried about certain kinds of effects because we've seen this before. So I just think there was...  Some diagnoses are helpful even if they don't tell you the cause, but that also opens up lots of other problems because then you have multiple different causes. Some may be social causes, some may be more kind of biological personal causes. Might be causing the same thing. And then the diagnosis can be confusing because it's as if you've grouped all those people together with having the same condition, but not necessarily for the same reason. I was thinking about that when Kirsten was saying,  you know, you might have a diagnosis on with asthma, but that's not telling you anything about the cause of where that came from.",[10,86,12],{},[10,88,89],{},"Yeah, Kirsten, you want to come in?",[10,91,51],{},[10,93,94],{},"Yeah, so I was thinking as well about cause and in particular that certain diagnoses have a stigma attached to them and that goes for certain physical health conditions as well as certain mental health diagnoses and particularly if people are seen as having in some way caused their illness, for example by drug or alcohol use or lifestyle choices and I use that word very carefully.  You know, in terms of people's diet, exercise, any other of their so -called lifestyle choices, which of course are very much easier if you live in an environment where you've got access to good food and education and fresh air and all the rest of those things that support a healthy lifestyle. But I suppose there is this stigmatizing effect  of  categorizing the sort of deserving sick and the undeserving sick. And I think that's again sort of comes back to the kind of power of diagnosis and the reasons why it has to be used very carefully and some of the problems associated with the labeling and the kind of stereotyping of diagnosis as well.",[10,96,29],{},[10,98,99],{},"I was thinking also it's not just questions about causes. It's also questions about what doesn't map onto what, even though each of these different discourses or ways of thinking about something are incredibly informative. I remember at one point I went to see a particular neurologist a lot and he ended up talking to me a lot about his research, which  partly infuriated me because I, at that point in my life, I was having so many migraines, I wanted to see a really well -known, famous neurologist and have him give me the right medication. And he kept saying, well, what we know about the neurology is fascinating and I can tell you about it and I can urge you since the software doesn't know you're not a medical doctor, you're a PhD doctor.  log on to the online programs that you could log on to as Dr. Cernak and do my module for junior doctors. You'll learn a lot that way and you'll also get a sense of what the doctors you go to see will have learned. And so I read his publications about the neurology of migraine and how he'd shown that the earlier...  model of migraine, which was the theory that it was a vascular condition, were wrong. And that's why the vascular treatments didn't work. But even after all of his fascinating research on the neurology and the way different parts of the brain are involved and the different kinds of imaging showed different things, I learned a lot. But I still...  realized as he was talking to me, he kept saying, but what we know about neurology doesn't really map directly into treatment because the medicine doesn't address the very particular parts of the brain we want to address. And that's why the studies just say that this particular medicine, which is licensed, will reduce the frequency of migraine X number of times.  So you will get a bit of help from medication. But that's really all I could offer is a bit of help. And it wasn't until years later when I found that my being in psychoanalysis reduced the frequency and severity of migraine, that I began to realize something about the psychoanalytic arguments about agency and passivity.  not just the political arguments, but the individual ones as well. And ways in which I could, after various treatments to stop some of the physical triggers, I could manage my migraine differently, which led to me changing career and making a lot of changes in the way I live my life, which becomes part of...  being part of the world, which is something philosophically I find very important, but I found I was doing it literally, like going for walks for a certain number of hours every day and making sure I lived in the part of East London where I could do that. And doing things like if I was training and frustrated, I'd spend the rest of the day after the training walking for miles across London to get home, rather than sitting on a bus and feeling frustrated then.  I had to commute or I had to sit quietly in a class to undergo a certain number of years of training, some of which was wonderful and some of which wasn't. And it's the individual relation to that that I think makes a change. And that took me away from some political discourses about working collectively or thinking the ways in which work  oppressed as people who don't fit in in different ways. To think about agency rather than oppression. And more than just the rather weak sense where we talk about we don't want to victim shame and so forth. But more in terms of the being in the world and realizing that and realizing what little actions I can take for myself and for other people.  which maybe takes us away from diagnosis, but I think it's important.",[10,101,12],{},[10,103,104],{},"Yeah, I mean, I think actually that might be adding something interesting there because people often have a kind of a curious relationship to getting a diagnosis. It often is not simply, I think, about identity, particularly perhaps even more so when it's a more medical diagnosis. There's a reclaiming of a sense of control or a sense of capacity, even if the diagnosis is extremely negative, that kind of relationship of agency often, I think, it seems to be tied into, you know,  solving a problem. The diagnosis is a problem, an answer to a problem or a solution or offers a solution to a problem in that sense. Eric, you want to come in?",[10,106,107],{},"Eric:",[10,109,110],{},"I wanted to bring in a class, economic dimensions into the discussion because a lot of people I used to work with in the homeless sector and just people I know they desperately want a diagnosis because it opens certain doors.  and they can get housing benefit or they can seem to have some legitimacy that they wouldn't normally have. In a sense it's almost like it provides some sort of cultural capital that people from other classes don't have to worry about and that this diagnosis can open doors. But I think it's a complicated issue because if I think about my mom and  My mom was from a working class background but the context was in South Africa and she was ostensibly a single mom. For the first six years of my brother's life she didn't know what was wrong with him and she was frantically trying to find out what the issue was because he wasn't speaking and all kinds of issues and then one day she was given this diagnosis of cerebral palsy.  which brought a great sense of relief to her. But she then started to call him retarded. It was the term at the time. And my brother took this on and it kind of became part of the currency in the house. You know, when I went to university I learnt a learning disability and I tried to change the discourse. But my brother now walks around with this internalised sense of self -oppression.  or sees himself as being retarded and hates himself for his sense of this being retarded, not being the same as other people and it really haunts him, it haunts him in his daily living. So I'm really not too sure whether it was helpful or unhelpful. And I just want to throw one last thing into the discussion in terms of a...  Western and non -western perspective because I remember when I was in Maputo and I was speaking to the doctor in the for Maputo the district doctors and he was talking was telling me about someone who had come to see him and he gave him the diagnosis of HIV and the person shrugged their shoulders and said well If it's not HIV, it's gonna kill me then it's gonna be poverty and if it's not poverty, it's gonna be the violence  So in that sense, and this was a context where the life expectancy at that point was around 40 years of age. So having this diagnosis in that context took on a whole different meaning for someone who's...  didn't really have a life expectancy and yet within a British context for someone who is working class being given a certain diagnosis means that maybe they can get housing benefits they can get certain benefits they can get certain cultural capital they wouldn't normally have",[10,112,12],{},[10,114,115],{},"Blake, you want to come in?",[10,117,40],{},[10,119,120],{},"Yeah, I was just thinking about both the political utility of diagnosis that both you and Eric have talked about and the moral aspect that Kirsten and Laura have mentioned. And Eric's telling of his brother's experience just makes me think about something that's been going on in New Zealand at the moment. So I'm from New Zealand and I'm part Maori. And so in Maori,  like from after like European contact, a lot of modern Maori words were loan words, you know, so like English words passed through the Maori alphabet, motoka for example, or kofi for coffee. But in recent years they've started to...  do away with that and kind of come up with new words that reflect the knowledge and philosophy of Māori pre -contact. And one example for that is autism. So autism was recently given the name Takiwatanga, which translates to in his or her own time and space. And I really love that idea, you know, to contrast it with Eric's brother's experience.  that we're not prescribing something onto a person, but we're just, we're kind of showing their place, like within society, but like it's dynamic, like they can make of it what they will. It makes me think of an essay I wrote on disability a while ago, and I hope I get it right, but it was about the kind of difference between the medical model of disability versus the social model of disability.  And then I was talking about a different one called the predicament model, which is like if you have two people who might have the same diagnosis, let's say limb difference is like a state that someone might be in, they could experience it completely differently or chronic fatigue syndrome, for example, like...  One person might not even consider it a disability. It's just, but it's up to the person to how they experience it in their life. Chronic fatigue syndrome actually makes me think about what Laura was saying about migraine and that really murky area about how do you, how are you unified as a group when people experience it in so many different ways. And that takes me back to that moral aspect of diagnosis.  There's almost this really weird thing about the Protestant work ethic comes up where certain people's lived experiences seem to be work shy or lazy or unmotivated. And so, yeah, in some ways getting a diagnosis could help because it kind of takes some of that burden off of the people to say, it's not those things, I have something going on.  But yeah, it takes me back to this thing about the predicament model, about putting it back to the person and their agency and what they do with it.",[10,122,12],{},[10,124,125],{},"Kirsten, you went to come in.",[10,127,51],{},[10,129,130],{},"I was thinking after what you were saying Laura,  we can sometimes create a sort of perhaps false dichotomy between body and mind. And in my experience, most physical health diagnoses have a psychological component and vice versa as well. And it made me think about something we did in the practice where I work about 10 years ago. So I work in Tower Hamlets in East London and we have a large Bangladeshi population.  And we noticed, myself and one of the interpreters, advocates that I have worked very closely with for many years, that lots of women in their 40s and 50s would come in with physical health symptoms that were very difficult to, they weren't explained medically. And it could be quite  difficult for people with those symptoms to get any effective treatment through the traditional medical model, which led to frustration both for them and for the doctors treating them. And what we tried to do was set up a yoga class for these women, mostly women and a few men.  And it worked fantastically well because there was no differentiation between physical pain and psychological pain. We just started from where people were. And the yoga helped them as whole people. And I've, you know, those women gave such positive feedback about the yoga treatment they'd had. And it had a huge impact on their health.  and we learnt a lot through that process as well.",[10,132,12],{},[10,134,135],{},"Ed, you wanted to come in, I believe.",[10,137,18],{},[10,139,140],{},"I'm still just processing what Kirsten just said. But I think, Matt, when you were talking a moment ago, you said in some context, diagnosis can kind of be a solution to a problem or people can relate to it as if it's a solution to a problem. And Eric was adding, and I think Eric, one thing I understood from what you were saying was that the diagnosis in a way for your brother solved the problem for your mum.  but didn't solve the problem or maybe even created a problem for your brother. So it made me think about, well, like solving a problem for whom? And sometimes it might be the case that diagnoses solve problems for some people and create problems for other people in the same case as it were, like one diagnosis kind of, and in some ways then that can kind of map what's going on in that moment between those different groups.  I was also thinking again of the DSM because I remember thinking about how, in my understanding, especially in the US, for example, if you have private healthcare and you want to access some kind of support, ⁓ I'm just getting a bit of sound there.  You want to access some kind of support for your mental health condition. You need to have a diagnosis and it needs to be a diagnosis that's in the DSM. Which means you might even start to characterize your own condition under those kind of names in order to access healthcare. The DSM starts to actually affect how people experience their own condition. Similarly, if you want to do any medical research in the US,  on these conditions, you need to do research on recognized DSM conditions. So then the research material all kind of spirals around these same terms. So I was just thinking about how in those situations, like having a diagnosis maybe solve the problem for the insurer who needs to know how much to pay out in different cases, but creates a problem for other people who maybe find themselves with a diagnosis which...  doesn't exactly fit them, but it's what's required in order to access the healthcare. So, I don't know, that kind of question of for whom was always coming up for me.",[10,142,12],{},[10,144,145],{},"Yeah, I like that question. I think as I listen to what you're talking about, the thing that comes to mind is difficulties that often exist around diagnosis, particularly political economic difficulties, seem to be more often actually difficulties of bureaucracy, difficulties of access and gatekeeping and passing someone through a system of processes in a way that is acceptable and so you know you have...  a selection dynamic in which you can, we've mentioned the deserving and the undeserving sick, but you know, you have a selection dynamic in which the processes of bureaucracy, particularly amongst kind of welfare states, social democratic states, you know, you have a selection process to select out those who are gaming the system because we're going to assume that there's already somebody that's gaming the system. We assume somebody is lying. We assume somebody is going to be kind of trying to take us for a ride, the freeloader problematic.  And so in the relationship between diagnosis and bureaucracy, there are kind of deep social political difficulties. But yeah, the way in which diagnosis can map two different directions. I mean, I experienced this precisely with my own son when he was diagnosed with Sturge -Faber at a very young age. I mean, he was basically diagnosed when he was born because it's a very, very telltale birthmark. It's a very straight line birthmark down.  down the face and it's a very common and easy test in some medical doctors' exams apparently to have someone in there. He used to in fact be paid a certain amount of money to go into medical doctors' exams regularly so they could sort of go up and see him and they were meant to be able to instantly recognise it. And obviously as a child he had no impact on him. He didn't have any awareness of this. But for me and my young wife, we were 22 at the time, it was a catastrophe. It was a kind of...  And it was a huge trauma that had longstanding impacts, particularly when it actually began to play out in its effects when we had to deal with that. And now he talks about himself, he refuses the concept of learning disabled. He doesn't mind the medical things, but he talks about himself as a mutant. Specifically, he's very into comic strips and he's very into games and he identifies very strongly with mutation and difference in that form. And so he won't call himself disabled. He says, no, I'm just a mutant.  And I kind of love that relationship of how he's mapped that through his relationship to the culture that he enjoys and he's mapped a positive relationship to that. But yeah, the impact on the parent and the impact on the child in that childhood diagnosis was utterly different and quite catastrophically different in many ways. Blake, did I see you wanting to come in there? No? Okay. Eric, Eric, you want to come in?",[10,147,107],{},[10,149,150],{},"It might be a bit of a tangent but as we've been speaking I started to think about the Renaissance and the whole game of mapping the world from a very particular Western perspective and this moment in the Renaissance where those were seen as the masters who had this...  higher perspective from which things could be seen. So that would be considered art and that would be considered arts and crafts. And then this distinction happens and it happens at the same time that there's this mapping onto plants and it also happens at the same time in terms of colonial mapping. And it privileges a particular way of ordering things.  which is intimately linked to a certain global process, globalization, which is slowly starting to happen in this process. And I was thinking how, in a sense, so when the European or the colonizer goes to Africa,  There was a time that someone in Africa was not seen as to have a history because the history wasn't, in certain parts of Africa, wasn't a written history. It was an oral history. It was a history which was performed in a different way. And it was a history which privileged the senses and the expression of the senses and the way of experiencing the world in a different kind of way. But that was then seen as not.  was seen as an empty space it was seen as being without history so that a certain privileging and a certain way of reinforcing a particular game gets played over and over and I wondered to how much to if at all diagnosis fits into this game that began with the whole mapping of  the globe, species, categorizations and it's a Western game so I just wanted to throw that out I may be going off on a tangent",[10,152,12],{},[10,154,155],{},"Laura, did you want to come back on that?",[10,157,29],{},[10,159,160],{},"Yeah,  yeah, I think it's, I find it useful to think in local global terms, movement back and forth between the two. And if I think of my practice as a psychoanalyst and how some of my patients spend a lot of time talking about their difficulties getting PIP or getting a diagnosis for their child so the child can have a...  a person working with them in school. And, you know, the real financial constraints, the poverty that some of my patients are living through, and how they need the diagnosis to get the funding, to get the support, to be able to live in the world. And other patients of mine who have very well -paid jobs with health insurance and  I have to play the game and diagnose them according to the particular handbook that they use. It's not the DSM, which is the American one, it's the British version. But you can look it up. It's just like the physician's handbook, which you can look up. Here's the mental health handbook. So you write a diagnosis based on these criteria. You find some general category that you think,  fits the patients in some way like complex PTSD, because you want them to get continuing funding to carry on with their therapy, to work on their intergenerational trauma. And you know their GP is just going to say, trauma, and the insurer will think they'll get six weeks of CBT. And you say, no, this is also treatable by psychoanalysis over a three to five year period.  And you know, I'll have to, I, as long as my patient has this well -paid job, I'll be filling in a form, jumping through hoops on my patient's benefit, to my patient's benefit, so they can stay in therapy. Because I don't know, if I say, no, you've got the money to pay, so, and we don't want to be linked to this political system, they might leave. So I play the game. And,  I translate the general, what I might say to a patient who says, can we have a review every three months? I would have a short conversation with them if they asked me to do that. I have to translate that into the forms for the handbook. And you can either believe in them, believe in the list of symptoms, which a lot of people I know.  who are supporting family members who need some support because of some physical or mental health thing that, where after the initial period where the NHS pays, then they say, no, it's social care. So you have to learn to fill in a form. So you're going to claim some sort of medical diagnosis for them, or one of the very few mental health diagnoses that they will accept in these categories. So you do that.  Do you play the game in order to get support for people who need it? Or do you say no? You don't want to collude with a system in which you have to think about lists of symptoms rather than dynamic change over time. We may want people to change and be able to live their, choose life is what I say to my patients. Don't choose death, choose life.  And that's not a diagnosis. So I try to help them move towards the question of life, which we do try to put into pigeon holes and classify with all the ways in which we get interested in classifying plants and animals and so forth.",[10,162,12],{},[10,164,165],{},"Ed, you wait to come in.",[10,167,18],{},[10,169,170],{},"I was thinking about, when Laura was talking, she talked about translating one thing she's seeing into terms that maybe the insurer will understand. And I was thinking before about how sometimes maybe the translation that's going on is not necessarily between two people, but between two different, maybe two different scales of operation. And I was thinking before about,  I know that the kind of larger project of the Freudian spaceship that this podcast made part of involves thinking about things at different scales simultaneously. I was wondering whether there are these institutional scales, bureaucratic scales of operation, thinking about the management of mental health care at a kind of national level, say.  And then there's a different thing happening at the scale of the lived experience of the individual or of the family or of the relationship. And often the diagnosis is specifically the thing which kind of mediates or translates between those two scales. It's like, it's a term which operates in both of the two scales at the same time and like allows them to try to get them to marry up. So to be able to say, okay, this is my diagnosis and to understand it for yourself.  It means something to you, but it also then means something maybe similar or slightly different at this other scale of operation. And maybe sometimes then the kind of tension that exists and the difficulty around diagnosis is exactly about the tension between those two different scales mapping onto one another. When Eric was talking about mapping, I also thought the same thing. There are these kind of large scale mappings going on, mapping the globe, and that are maybe...  oppressive of or are kind of erasing certain things in the lived experience underneath in order to map efficiently. But the directions also goes two ways. So thinking about the diagnosis might be thought of as something which mediates between different scales. The scale of the big logistical medical healthcare and the lived experience. And that maybe some of the tensions we're talking about are tensions about how those different scales rub against one another.",[10,172,12],{},[10,174,175],{},"Blake, you'd like to come in?",[10,177,40],{},[10,179,180],{},"Yeah, just a few of these things flying around, I've kind of, I can't help but associate them with something I was thinking about with PTSD. So like the mapping of the world, I was thinking about, and insurance, I was thinking about the railways and how railway spine was kind of like a precursor to PTSD and shell shock. All the kind of injuries, a horrific kind of life to be building the railways and the somatic effects were.  recorded you know headaches and that type of thing where I think Britain came up with this act where people could sue the railway companies for some of these injuries and the railways were so unpopular that they lost a lot of them and so that kind of had to they had to kind of start reassessing what the causes of these things were yeah  and then it developed with World War I, Shellshock, and then with Vietnam. That also makes me think about Ed's question of, who is it for? Who does it serve? And it makes me think about a blog post I read in my undergraduate degree about a Vietnam vet who...  I felt like it was really offended by the idea of PTSD, how it was individualized rather than society just not accepting the fact that they could send people away to war and the soldiers could just reintegrate back into society after experiencing the horrors of war. And he proposed an alternative to PTSD called CRAS or CRAS, Citizen Reality Avoidance.  syndrome which took it from an individual pathology to like a societal one.",[10,182,12],{},[10,184,185],{},"I want to thinking about those levels, those different levels, because you're right, in the Fordian Spaceship Project, we kind of have this sort of basic, very basic framework of one -to -one group and community levels. We try and think in at least three different levels of this kind of way in which...  people often have at least three of these different and there's obviously often more but there's often at least three of these different levels in their lives nested inside them and pulling sometimes in the same direction and sometimes in different directions, sometimes with different levels of intensity, different levels of like impact on them and obviously making them into different bodies as they do that. In each of these different levels they're a kind of different body you know in our community level we're often data bodies now, we're often demographic, we're often bodies of big numbers.  and treated by Facebook in a different form in the way in which we're treated by social media and Facebook and social medias, but our bodies are still connected in that sort of relationship. And diagnosis is a kind of, as I said earlier, I think it's got something to do with problems for me, but that's partly because I come from a philosophical background. So one of the ways in which, outside of the kind of medical and personal ways I encountered diagnosis was when I first read Wittgenstein.  So I'd read a whole series of philosophers who were trying to answer problems and truths and then along came this philosopher who basically went no actually the the way of dealing with this is to diagnose the problem and your main problem is you know what you're doing is you know you're an engine idling that's that's one of his big phrases you know when you're doing philosophy you're doing you're an engine idling and you're not actually putting your your understanding to work and this is why you end up with these kind of strange dynamics and these strange  issues arising because it's a bit like sitting in your car and just putting your foot to the floor without ever putting it into gear, you know, and then wondering why the engine sounds weird. I mean, it's like, yeah, obviously it's going to sound weird because you're not really, you're not really doing, not really engaging in the process that that engine is kind of part of that wider dynamic. But I want to kind of, if I can push a little bit to that larger scale and from South of the Second World War, Auden talked about and diagnosed society.  in the West as the age of anxiety. And it was a kind of diagnosis. It was a relationship to the community as a whole that he diagnosed. And more recently, we've seen Mark Fisher diagnose in capitalist realism as a kind of dynamic that's present. And you're never quite sure whether this is a kind of ideological dynamic or a political dynamic, but it's a lived dynamic, most importantly. And so when we encounter the world, as obviously,  around us at the moment is the horrors of Gaza and Congo and Sudan going on, as well as various other problematics. When we look at the world, we often seem to want to also diagnose that world. Is it just a metaphorical relationship to diagnosis or does in some ways that kind of relationship to the world, when we kind of try and understand what's going on, is that maybe even a better, kind of cleaner relationship to what actually diagnosis is?  Is it a way of trying to grasp something around us that doesn't seem right or doesn't feel like it's working? And that, you know, once it's less individualized, we can kind of begin to think of it in a sense of understanding. So diagnosis in that sense is a kind of process of us trying to understand something. Does that seem like just a simple metaphor or is that perhaps, as I say, maybe a core of what diagnosis actually is? Eric.",[10,187,107],{},[10,189,190],{},"I'm wondering if we're losing the capacity for complexity. Once upon a time in certain parts of Africa, when someone was seeing things or hearing voices, they would undergo a whole rite of passage in relation to the community.  they would go through this rite of passage and at the end of the process they would become a healer for the community and they'd be reintegrated in the community. Whereas nowadays the short -term, the quick solution is are you taking your meds? Are you hearing any new voices?  and if there's any concern, any risk, let's increase the meds. And then of course it creates a vicious circle because a lot of these individuals are so gone down that they have a shortened life expectancy and they don't do the necessary tests to see all the effects, etc. etc. etc. But the point I'm trying to make is I think it becomes a lazy shorthand.  It becomes, it's not a hundred miles away from TikTok, where in a sense we're losing the capacity to just be present to things, to think about the complexity, and we want to move on to the next task, the next email, the next demand.",[10,192,12],{},[10,194,195],{},"Kirsten, do you want to come in?",[10,197,51],{},[10,199,200],{},"That was making me think.  about kindness and that I'm thinking of patients I've worked with over many years who've had a number of different diagnostic labels and they clearly have a complex complexity that sort of defies simple categorization but actually that's not really what they've suffered from. They've suffered from a sense of being disconnected from the world because other people  don't show them kindness and acceptance because they're different. And Blake, I was thinking of your, the Maori word for autism. And I think if we could work towards a society where difference was tolerated and we were kind to people in a way that I think society is not very kind to people who are different in any way, whether that's because of a...  a pattern of behaviours or something that makes them different to other people around them. And I'm thinking of many, many people I've worked with that have lived years and years in a sort of disconnected world from society. And it's not diagnosis that will help them. It's just a gentleness and a kindness from all the people around them, whether it's family, friends.  People they meet on the street, doctors, carers. It's just kindness really that people need.",[10,202,12],{},[10,204,205],{},"Yes, that's an interesting word isn't it? I mean I've noticed recently and it's been there for a while but it struck me recently when Corbyn like announced his independent candidature and this word kindness that he keeps using and in some ways when he was leader of the Labour Party it seemed to me that it almost disempowered him. It's just kind of relationship to kindness but it's also...  It strikes one in our current sort of situation as naive. For him to use that word often makes him appear, I think, to a lot of people as somehow naive as though it's not possible. You're a politician. Why are you even thinking of using this word kindness? And yet it often seems to be, as I say, I noticed it and then went and looked back and it's a very, very prevalent word he uses. It's very, very common and it is a very strange kind of word in that context of a politician. Ed.  you would like to come in.",[10,207,18],{},[10,209,210],{},"Yeah, I just wanted to, in a way, ask a question. So, Matt, you were talking about diagnosis at this large scale of how to understand maybe a problematic that we're living in. And I wanted to ask Kirsten and maybe Eric whether they felt that that's what they were doing. As in, do you think, was that a diagnosis to say, ⁓ we are living in some kind of...  situation of kindness deficiency. Like I'm trying to name where the problem lies or when Eric was talking, he said about lack of complexity. And I wonder whether sometimes when we're having these kinds of political conversations, maybe ideological conversations, what we're doing is offering contested like different diagnoses. I know the problem is really here. And someone's saying, no, no, actually, the problem is really elsewhere. The problem is really here. And like, maybe our  political differences sometimes are because of our different diagnoses of the kind of causes of social problems. Anyway, my question was really, could you understand that as a diagnosis, Kirsten, or Eric, when you said, you know, the problem is a lack of this.",[10,212,12],{},[10,214,215],{},"Before you respond, I'm just going to get Laura to come in. You want to just come in, Laura?",[10,217,29],{},[10,219,220],{},"I'm in two minds because I like what Kirsten said about kindness and I like the way it connected with what several people have been saying and I do think it's important to think about kindness. But I'm very uneasy about either  generalizing from a psychiatric diagnosis to a social diagnosis. I think, you know, there's so much loose talk about schizophrenic societies, anxious societies, and so forth, and it, I don't think there is such a thing as just one society that has one diagnosis. I mean,  I think it's really important to talk about, you know, the usualist class, race, gender, disability, and to say there isn't just one society. Who do we mean by society? I mean, I notice this with my patients where I suddenly realize they're saying something or other assuming I know what they mean, and actually I haven't a clue. My, my, the example that really hits me is if they've been to a British  public school because I have absolutely no personal experience of that. So I ask some questions because it seems so different from my life. But everybody has the thing that they're baffled by in terms of the patient's cultural background. So I think we've all got such different cultural backgrounds that it's hard to generalize about society.",[10,222,12],{},[10,224,225],{},"Yeah, I think I'd probably agree with that. It's one of the reasons I think I prefer that often to talk about terms like community and thinking in terms of the specific because there's a kind of pluralism and there's a dynamic that Kerstin you'd like to come in.",[10,227,51],{},[10,229,230],{},"I also think it's very difficult to talk about diagnosis at a societal level and just thinking about the news today about the rise of the far right across Europe and if we see what's happening in Gaza and other parts of the world you can feel society is absolutely pathological but actually it's not just bad and pathological there are people doing wonderful creative  revolutionary things all around the world as well. There are people showing huge bravery in the face of quite difficult circumstances. So I think we can't use a diagnostic label on something as big and complex as society.",[10,232,12],{},[10,234,235],{},"Eric, do you want to respond briefly to Ed's questions? After which I'll give you a round in which you can have a kind of final comment or thought and then we'll probably wind up.",[10,237,107],{},[10,239,240],{},"I was just thinking of some of the homeless hostels I've worked in where there were all kinds of problems and people were trying to think about them so they started these things called reflective practices for the staff and  It was complicated because as the staff started to slow down and reflect on the experiences, some staff would then end up leaving, and other staff would feel patched up and go back to the work. But in the reflection, what seemed to emerge, you were continually moving between different layers. Individual issues, group issues, community issues.  and layers of complexity and in a sense there was a level of confusion in terms of what was the official role of the staff member, what was the unofficial role, what was the actual issue they were addressing. So for example a lot of staff would come in and they were genuinely came with good intention but after a while they found that their role was to police people.  there was an unofficial role where they were actually policing people and collecting a whole lot of data on them which would then follow that person around to another hostel or another setting and this data diagnosis sometimes would precede the person going somewhere else.  So in effect, what you were moving between was this movement from the macro to the micro. You never quite knew what you were actually dealing with. Ed, I don't think I really answered your question there.",[10,242,12],{},[10,244,245],{},"Right, so as I say I'm going to go round and give everyone in reverse order from where we began. So just any kind of final thoughts, final comments, anything you'd like to just chime in and chip in before we finish. So I'm going to start with Kirsten and then I'll go through Blake, Laura and Ed. So Kirsten, any final thoughts or comments?",[10,247,51],{},[10,249,250],{},"I think it's been a really interesting discussion. I feel I've learnt a lot, actually. I don't think there are any certainties about diagnosis. I don't think I ever thought there were. But I suppose we've kind of thought around the topic a bit, and I found that quite interesting.",[10,252,12],{},[10,254,255],{},"Plague.",[10,257,40],{},[10,259,260],{},"Yeah, it's been a great discussion. It's brought up a lot of different thoughts for me, especially regarding the ambivalence. I recognize the helpfulness and medical interventions that have been described and I've experienced them myself. In regards to the individual and the social, I think about the role of the shaman that Eric talked about, the kindness that Kirsten talked about, and just like...  Just to think about diagnoses in terms of inclusion and possibility like agentic capacity. Think about neurodiversity, neurodivergence being more dynamic than a strict ADHD or autism disorder.  diagnosis, sorry, or even just like identity labels like queer is more dynamic than say bisexual for example, there's less limiting factor on what someone can do and so it just takes me back to that element of agency of yeah, people being able to define themselves a bit more and naturally that would hopefully that would make them feel more included within society. Thanks.",[10,262,12],{},[10,264,265],{},"Laura.",[10,267,29],{},[10,269,270],{},"I found it a really interesting discussion. I've learned a lot. I've got a lot to think about. I also had not a summing up, but two different anecdotes to end with, and I don't know which to end with or a little bit of both. One sort of follows on from Eric's anecdote and  So my story would be during the pandemic, one of my patients who said her team was really at each other's throats about all sorts of issues. And she was the second in command, not the most in command and not the least. And she felt really frustrated and stuck. I thought maybe she'd apply for a job in a different team.  but for the moment what could be done. And I said, well, I know lots of psychotherapists. It sounds like some of your people in your team need a bit of therapy. And we could say we're offering short -term therapy for people in the NHS or frontline social services short -term. And I'm sure I could refer everybody in your team and make it clear I'm not targeting at your team by just...  asking you to put it on the internal webmail and ask if anybody wants to get in touch. A lot of people got in touch and I referred them on for short -term therapy or a bit of reflective practice supervision. But the interesting thing was it wasn't a single refractive practice group like Eric was talking about. It was getting them to talk to different people so they weren't bitching.  behind each other's backs, but they were beginning to think about what was upsetting them as individuals. So that was sort of letting people fly away from the center and then maybe come back again at some point.",[10,272,12],{},[10,274,275],{},"and add.",[10,277,18],{},[10,279,280],{},"Thanks, I don't know. I think something which has really struck me as we've been talking is about how our different and what you might call practical life worlds affect our different ways of thinking about diagnosis. And being in a chat here with people who are working with diagnosis every day made me think a bit about  Something we haven't discussed a lot, which is diagnosis as a skill. You know, the ability to kind of read a situation or read a person and diagnose what's happening. There's a kind of positive notion there of diagnosis that it's something which comes with closeness and understanding and kind of familiarity as well. And I was just thinking, hearing Kirsten talk and hearing Laura talk especially,  about their experiences with patients. But I don't know, diagnosis has this positive, there's something to me that sounds positive about the ability to kind of understand and be close to something such that you can name it, there's a kind of wisdom there or something in diagnosis. So I don't know, I'm naming something at the end that we haven't talked about, but maybe I would have liked to.",[10,282,12],{},[10,284,285],{},"and Eric.",[10,287,107],{},[10,289,290],{},"Just a small little anecdote. One of the things about working in certain settings when there's high risk is that you can often have a prediction that something's going to go wrong. And you really get a sense and you can look at all the different variables and things and you think it's going to go one way and something does go wrong. But in a lot of the cases it's not quite what you expected.  And yet afterwards, it kind of makes so much sense. It seems so obvious. Of course, that was obvious it was going to go that way. But at the time, you kind of think you go down other roads and you just don't see it. And yet afterwards, it's, of course. But why didn't you see it?",[10,292,12],{},[10,294,295],{},"Well, I won't tell an anecdote, but I will kind of like wrap up by just mentioning a positive notion of diagnosis. I'm a motorcyclist and I don't know if you saw the news recently, but the motorcyclists have quite strong sense of community. And when one of the hairy bike, a motorcyclist died recently, some 20 ,000 of us rode from London up to the north as part of a funeral thing, which is a phenomenal event. But these events go on continuously. I every year go on numerous memorial rides and rides with other motorcyclists.  partly because it's enjoyable, but partly it's a kind of, we all live with death on the road and so we have a kind of bond and we have a thing called the nod as we go by each other on the road, that is part of that relationship and community. But within the motorcycle community, diagnosis has a very, very positive context in terms of diagnosing your engine problems and what's wrong with your bike. And you learn these skills and you learn it through the knocks and the logic of the system and through certain tests that you can carry out and...  Yeah, being able to know what's wrong with your bike and being able to diagnose why it's not starting or why it's wobbling is a kind of key and extremely positive skill there. So yeah, in some situations, there's no ambiguity there. It literally is just a positive relationship to being able to work and live with the machine. So there is definitely some spaces, and I imagine others, in which diagnosis plays that kind of almost straightforwardly positive role. Well, thank you very much, everybody. That was a lovely, interesting conversation. And...  I will look forward to hearing how it turns out and I will get back to you with all the details. I am now going to stop the recording and as I say, leave your pages open.",{"title":297,"searchDepth":298,"depth":298,"links":299},"",2,[],"Episode 5 of CONVERSATIONS ABOUT CONCEPTS explored the concept of diagnosis. Here","md",{"date":303,"episode":304,"image":305,"tags":306},"2025-06-18",5,"\u002Fimages\u002Fuploads\u002F3846c6ab-091e-480c-8d24-8818bfac79ee.webp",[307,308,309],"diagnosis","transcript","podcast",true,"\u002Fblog\u002Ftranscript-diagnosis",{"title":5,"description":300},"blog\u002Ftranscript-diagnosis","YRLnVG9FHpwSPCK3DDvkeBc2XaIlKuWBGXvTKJnWUjE",1777636239688]