Words in Motion: Why a Philosopher’s ‘Diagnosis’ Raised a Psychiatrist’s Eyebrows

Can a philosopher “diagnose” an idea?

That question triggered a subtle but fascinating exchange in the Journal of Medical Ethics. It started when philosopher Henry Bair wrote an article dissecting how healthcare workers handle informed consent. Drawing on the ideas of Ludwig Wittgenstein, Bair argued that doctors often make a mistake: they treat "understanding" as a hidden event happening inside a patient’s head, rather than a practical capability a patient can demonstrate. To make his point actionable, Bair offered a simple fix: instead of asking a patient a passive question like "Do you understand?", clinicians should ask them to restate the information in their own words.

A graduate student explores the boundaries of language and ethics - AI Image

It was a sharp, practical observation. But it was Bair’s title—which referred to his paper as a "Wittgensteinian Diagnosis"—that caught the eye of Japanese psychiatrist Takeo Saio.

When Dr. Saio saw the word "diagnosis" in the title of a medical journal, he naturally expected to read about a new clinical tool, a diagnostic checklist, or a medical trial. Instead, he found a purely philosophical essay. While Saio agreed completely with the philosopher’s argument, the title left him feeling misled. He went on to publish a response gently arguing that because "diagnosis" carries immense legal, administrative, and clinical weight in healthcare, scholars should be careful about using it as a literary metaphor in medical publications.

At first glance, it sounds like a simple dispute over medical jargon. But it opens up a much bigger question about how we use language: Should we restrict words to their strict, technical definitions, or should writers have the freedom to use them creatively?

Language is rarely just about literal dictionary entries (denotation). Most of human communication relies on connotation—the associations, imagery, and emotional weight that words carry. When a philosopher uses "diagnosis," they aren't trying to pretend to be a medical doctor. They are tapping into a powerful metaphor: the careful, systematic effort to uncover a hidden, root problem behind visible symptoms.

In fact, many postmodern philosophers and linguists go a step further, arguing that strictly neutral "denotation" doesn't even exist—that all language is fundamentally connotation. From this perspective, even technical terms like "diagnosis" aren't objective facts etched in stone; they are institutionally sanctioned meanings that evolved over time. If all language is built on layers of social convention and association, attempts to strictly police how words are used become even harder to defend.

There is also a very real, practical factor at play: economics. Whether in medicine, academia, journalism, or independent writing, people need to make a living. There is nothing wrong with being mindful of the economic value of our work, and using engaging, attention-grabbing titles is simply part of standing out in a crowded marketplace.

In any field—whether philosophy, medicine, or blogging—trying to strictly police vocabulary can stifle fresh ways of thinking. Creative metaphors keep writing engaging and help connect abstract concepts to real-world experiences.

Some postmodern thinkers say everything is connotation and denotation doesn't really exist

Of course, clarity still matters. If an author uses a strong word in a metaphorical or punchy way, all it takes is a brief sentence to clarify their intent so the reader isn't left guessing.

Recognizing that words possess both everyday utility and implicit power explains why borrowing a term like "diagnosis" sparks such fierce debate. Ultimately, choosing our vocabulary is never just a matter of style, but an exercise of influence.

Ultimately, language shouldn't be locked behind rigid professional fences. As long as a writer provides clear context, they should be free to use evocative words to spark new ideas and reach an audience. After all, the best communication isn't about constraining words—it's about making sure the reader can follow where those words are trying to take them.