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Fuzzy boundaries and tough decisions in psychiatry 

Fuzzy boundaries and tough decisions in psychiatry
Fuzzy boundaries and tough decisions in psychiatry
Vagueness in Psychiatry

Hanfried Helmchen


In the field of mental disorders the boundaries between mental normality and disease are often blurred. Psychiatrists, being aware of the instrumental nature of psychiatric diagnoses, try to deal with these blurred boundaries by stipulating strict definitions of clinical categories, by operationalizing diagnoses, and by using evidence-based methods of production and algorithmic application of medical knowledge. However, the clinical uncertainties can only partially be reduced by these means, because the physician always has to consider the individuality of the patient as well as to find a helpful solution to the dilemma of not treating a treatable but only probable or even only possible disease condition versus treating a variation of normal behavior against the risk of obtaining unwanted side effects of drug therapy or stigmatization. As is shown in the chapter, subthreshold mental disorders provide illuminating illustrations of these limits of medical standardization.

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