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Of the half million words available in that richest of tongues, the English language, I learned to use an average of 15,000 by the time I graduated high school (Dale, 1965) and another 10,000 in college (Nagy, 1984; Carrol, 1971). Most nouns referred either to objects (a desk) or a non-Platonic class (e.g., all books), although some had variable connotations (soul, evil, destiny.) In music, a tailed circle in the middle of the clef called for a two-beat A, and sforzando a transient accent, whereas ad lib more freely meant “interpret as you will.” During general medical training a more difficult lexicon of some 15,000 new terms had to be acquired, usually with specific referents (renal tubules, inverted T-waves, McArdle's disease), although sometimes again with broader implications (asepsis, non nocere, ethics) (Bridge, 1962).
Psychiatry, however, required an explicative leap of disconcerting proportions (Masserman, 1946) in that many terms were merely tropes (L. tropus, vaguely allusive), whereas others were either misleading or absurd (White, 1955). Good Dr. Paul Briquet in 1859 did not attribute hysteria to his wandering uterus; an hypochondriac's difficulties lie not under his ribs but 2 feet higher within his cranium; paranoiacs do not possess parallel knowledge; and schizophrenics do not have split brains, although Sperry's (1982) findings may yet modify that cavil.
Fortunately, as my training progressed, diagnosis, instead of referring to archaic systems of nosolgy and taxonomy epitomized in successive DSM manuals,* began to include a comprehensive understanding (Greek dia, discerning, gnosis, knowledge) of the patient's characteristic modes of coping with past and current biologic, sociologic, and