Psychiatry: Puzzle or Mystery

I have been reading Malcolm Gladwell’s new book, What the Dog Saw, and have enjoyed it a great deal.  Most recently I read his essay on Enron in which he discusses the differences between a puzzle and a mystery.  The gist is this: puzzles are situations where a lack of information prevents a person from knowing an answer where as mysteries are situations where information is available but difficult to interpret thus preventing a person from understanding a situation.  Psychiatry has qualities of both.

There is a vast amount of information that is unknown about the human mind, making answers to why things happen difficult to come by.  In psychiatry this has often led to frustration from both doctors and patients.  This has in turn led to a tendency to oversimplify complex ideas and shoehorn patients into diagnoses that do not seem to fit.

Yet for any given person, there is a vast amount of information that is available but difficult to interpret and understand.  This is no less frustrating.  Misinterpretation of symptoms similarly leads to misdiagnosis and poorly directed treatment.

From my stand point, good psychiatry is psychiatry that has enough structure to be able to usefully interpret information a patient shares and enough flexibility to resist reducing life to a series of symptom checklists.  This is no easy task but one that I believe returns good outcomes for patients.

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