What clinician has not experienced with perplexity the chance meeting of a patient in a social or non-clinical setting when he or she appears remarkably different, more or less distressed or capable than the therapist expected from the previous clinical encounter? This experience may relieve or shock the therapist. We are likely to be philosophical about the encounter or muse over the problems of diagnosis and the perplexing nature of man. We may also mention it to the patient depending on our therapeutic proclivity, but more systematic inquiries into the questions raised by the discontinuity of clinical perception are generally not considered. This situation is an understandable outcome of the assessment methods that we employ in psychiatry. Most often we rely on the clinical interview or at best a few observations to provide us with data about patients' lives. These standard psychiatric diagnostic instruments, however, provide neither sufficient access to the subjective experience of the patient nor to the context of his or her life. Yet, we do err, often fooled by the intimacy of our interaction with patients that we have accumulated such knowledge and undisturbed tend to carry on with our psychosocial formulations about the dynamics of patients' lives.

Recent diagnostic advances such as the ICD-io and DSM-III-R (or IV) have attempted with multiaxial strategies to describe the patient more fully. But as clinicians know, diagnosis sets the frame for professional communication, but is not adequate for treatment.