Descriptive Psychopathology: The Signs and Symptoms of ...

6Psychopathology of everyday behaviorand general appearanceWith the growth of psychopharmacology and the development of biochemical and neurophysiologicalresearch, the need for careful description of the clinical phenomena in psychiatryis greater than ever before. Without good clinical knowledge research in psychiatry will befruitless. 1A person’s general appearance is revealing. A graphically tattooed woman withspiked purple hair and metal nose, ear, and lip studs is likely to be deviant inother ways. 2 A clean-shaven, middle-aged man in a three-piece Brooks Brotherssuit is more likely be a professional or in business than the drummer in a rockband. Self-decoration, choice of clothing, demeanor, and similar factors provideclues to temperament and social class, and sometimes to illness. Non-verbal cuesduring employment interviews (e.g. dress, posture) predict the outcome of theinterview. 3 The voting public in the USA apparently places great store in suchinformation, although subliminally, as inferences of competence based solely onthe facial appearance of federal senate candidates predicted the election outcomein 68.8% of the races of 2004. 4The initial “big picture”133The general appearance “big picture” is always defined first, and may be characterizedby a single striking feature (e.g. the patient is pregnant, devoid of all bodyhair, or is mute and immobile). Most often, however, it is an image blendingmany details. Observing the patient outside the examination room setting beforeformally starting the evaluation provides this information. Emergency room caregivers,for example, often rely on the big picture in assessing acuity. A supinepatient with ankles crossed, hands crossed behind the neck, or folded over theabdomen is unlikely to have any acute, life-threatening condition. 5In the waiting area, is the patient sitting calmly reading a magazine, watchingother patients, or pacing, fidgeting, or talking to himself? In the emergency room,