Early in January Psychiatric Times defined psychiatry generally as “a Medical specialty that wrestles with the included middle, requiring judgement, patience and humility”.  They reminded us all that, “what we call disease is solely an abstract concept with the help of which we separate particular phenomenon for daily life from all others…”

They reminded us also that we can too often use the “Law of Bivalence”, under DSM tyranny through the years, asking all questions with a result expected as “p or not p”, where in the reality of the mind and the body most phenomenon and symptoms are mixed.

I love being challenged to think and think again about what is too easy and dangerous to simplify. The way the brain works there are more than just “blurry edges”. Where a bone is either broken or not, the brain in contrast is both fluid and flexible in its inter-reactive actions. As human beings we can be feeling depressed one day and not another, and this may indicate a “slide” down towards a major depressive episode but may also be weather or relationship related. We are always to be careful and humble in our diagnostic assertions.

I love the turn of phrase of some of the writers. “Validity in the diagnostic context has to do with the ontological reality – the ‘is-ness’ of a condition or disorder”. It reminds us to always be thinking, is this person being “disordered” by their condition?  Are they less able to survive and thrive? Then, keep the eye on the goal, which is always to be life-change for the better, to improve all aspects of health and all aspects of survival.

We are not passive sponges absorbing feelings and thoughts of others, but active participants in positive health, seeking the best outcomes for all we work with, for their survival first, but then also for their health and wellness and joy.