Learning about mental health at medical school was all about lists. I scribbled lists down the margins of my lecture pads: the DSM-IV criteria for depression and schizophrenia, the side effects of the atypical antipsychotics, the assessment of suicide risk. Lists can be vital in recognising the conditions that need treatment to prevent significant morbidity. In some cases, the right treatment can be lifesaving. However, in the messy mix that is general practice, lists are only part of the equation. In my practice I see many patients who are distressed by psychological symptoms that don’t meet the DSM-IV criteria for a specific diagnosis. In these cases, the real challenge is to find ways to help the patient find meaning and a way through the mess.
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