One of the elements of psychological and psychiatric assessment which has always puzzled me is clothing. Time and again, I read references to patients (more often than not women) being ‘well-dressed’ and aspects of the clothing. Apparently, it tells us something about the person’s mental state. And this is what I want to write about in this post, inspired to write it by a new blog in which its author tells us about about assessments and notes made about her.Indeed, the little snippet from the notes at which we are allowed to glance on the blog, shows the almost inevitable ‘well-dressed’ in the section on ‘current mental state presentation’. What does the phrase mean? Well, for me ‘well-dressed’ means someone whose clothes are well-matched, well-fitting, of good quality. But if you look the phrase up, you will see that my understanding is right on the money in some cases and somewhat off in some others. And so, the definitions of ‘well dressed’ you can find find in online dictionaries are for example:

• wearing smart or fashionable clothes.
• attired in clothing that is of good quality, is properly fitted, and is appropriate and becoming.
• neatly, expensively, or fashionably attired
• a well-dressed person is wearing good and fashionable clothes
• Someone who is well-dressed is wearing smart or elegant clothes.

Quite interestingly, while there are overlaps in the definitions above, there are also differences.  And so, depending on what you read, a well-dressed person might be wearing expensive, fashionable, well-fitted, elegant, smart clothes which might also be of good quality.

And now I have a question – which of those characteristics did the person making the assessment have in mind? Did s/he focus more on cash or on fashion? Even more importantly, what exactly makes a clinician qualified to make a judgement as to whether the person is or is not well-dressed? Are they trained to quickly ascertain the value of clothing and its fashion-currency? Ideally, also to recognise whether the clothes were bought in a boutique or perhaps only in a discount outlet at a fraction of the price. After all, your designer label can cost you an arm and a leg, but if you’re lucky only a finger or two.  I don’t even want to start thinking about how it all relates to the ‘mental state’.

Now, I imagine all these questions are without answers, not only because the haute couture industry is not exactly threatened by clinical psychology or psychiatry, but also because such judgements about a patient’s clothes are fairly inappropriate and, to be completely honest, idiotic. But yet, I read the ‘well-dressed’ is not infrequent in my experience, so the question I want to ask is: why?!

I think there are two answers. The first answer is the ‘theory’. For example, the famous Clinician’s Thesaurus by Edward Zuckerman, a guide to conducting interviews and writing psychological reports, suggests considering a client’s clothing. The problem is that the ‘theory’ is not really about fashion judgements. In fact, the guide specifically says that:

the relevant perspectives are not fashion, cost, or newness, but what clothing means about the client’s ability to care for her-/himself and her/his judgment of appropriateness.

This would mean that the judgement about whether the client is ‘well-dressed’ is quite off limits and you, clinician, have no business assessing it. (A digression here. Before you think about the wonders of the Thesaurus, please don’t. I seriously dislike for example the idea that the clinician should make a judgement whether I dress ‘modestly’, as the guide suggests. There are other problems, too. But they so deserve a separate blog!).

Ignorance then? Possibly, but I am not entirely certain it explains it all. I think such comments are a way in which the clinician can simply say – I like this person or I don’t like this person. It’s a way to pass judgement pretending that you focus on something fairly objective like clothing. The well-dressed person is simply one of us, the person who is ‘badly dressed’ is not.

This is because if we exclude extremes, judgements as to clothing are arbitrary, as it is just about impossible to consider tastes, quirks, individualities, histories, cultural and professional backgrounds, let alone the wish to spite, say, the dean who always wears a tie.  All that not even beginning to speak of the custom of wearing a T-shirt in the frosty morning just because the sun is shining (I saw it this morning!)

So, let me tell you a true story of one my conference attire a few years back. As the conference venue was close to the institute I used to word, I went to visit friends and colleagues who still worked there. It was so nice to touch base, but after a while the visit went south. With a reference to my clothes, I was asked when I was going to change.

How was I dressed? Well, I had a shirt, a pair of (blue) jeans, suede shoes and, it was greeted with horror, no socks (it was summer). When I said I was not going to change, my former colleagues’ faces dropped. Clearly, living in ‘the West’ must have made quite a few screws loose in my brains and I didn’t know what I was doing. A professor with no socks was bad enough, a professor with no socks on (let alone with no suit!) just didn’t compute.  They really did look at me as if I had gone mad. But here is the punch line. I went to the conference, my clothes were mostly unnoticed, as I easily blended in a throng of Western academics. Most of us did notice, some commented, however, the Eastern European contingent – all formally dressed.

There is no telling what psy people would have made of it all.