To the Editor: In his questionnaire study of psychiatric residents’ understanding of mood and affect (1), Michael Serby, M.D., identified an important problem in modern-day American psychiatric education. However, his conclusions were unnecessarily conservative. Dr. Serby highlighted a problem that goes beyond mere semantics and conceptual confusion about a particular terminus technicus. His study points to a three-pronged structural flaw in psychiatric residency training (and thus in psychiatry in general): 1) undue and preeminent focus on patient self-reports of cross-sectional symptoms; 2) little, if any, reliance on the mental status examination; and 3) the consequent inability to make well-substantiated syndromal diagnoses. Too often, patients are permitted (perhaps encouraged) to simply enumerate symptoms rather than describe their experiences phenomenologically. In this enterprise, the psychiatrist is frequently an indictable coconspirator in equating the layman’s vernacular (e.g., "depressed," "mood swings," and "racing thoughts") with an expert’s diagnostic jargon (2). Examples are not only limited to symptoms and experiences in the affective domain but include many more (e.g., paranoia, obsession, anxiety, and trauma). In essence, the patient tells the physician what his or her diagnosis is.