The Institutional Status of Medical and Psychiatric Diagnoses: The Consequences of the Speech Act of Diagnosis.

Diagnosis, as the statement of the disease from which the patient suffers, is a central element in modern medicine. However, a diagnosis is more than just a statement about an illness aimed at guiding treatment. It is also a powerful speech act with important social and other consequences for its recipient, as several sociologists have observed. In this article, I discuss the nature of the speech act of diagnosis. I then draw on social ontology, in particular Searle's theory about how the social world is constructed, to show how a statement of diagnosis generates an institutional fact about the person diagnosed, and thus how it can have power over its recipient. Next I describe some of the consequences of this in the contexts of somatic medicine and psychiatry, noting the consequences it can have for people's lives beyond those caused by the illness itself.