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As medical science has progressed, its categories have evolved from vague Frank Gehry constellations that reflect the suffering of complaining patients to specificity of disease definition as measured by objective observations, laboratory procedures, and imaging devices.1 Nevertheless, many patients come to doctors with complaints that do not fall within precise parameters, and much of the stuff of everyday medicine involves ambiguity, uncertainty, and contested definitions. The practice of medicine is defined as much by patients' expressions of distress and dysfunction and patterns of seeking help as by diagnostic assessments and evidence of treatment efficacy.

The uncertainties of diagnostic medicine and treatment have been compounded as increasingly Elsa Peretti instruments for viewing and analyzing the body have become available and as the gap between what patients experience and what can be observed has grown. While, on the one hand, patients often have complaints for which a physical basis cannot be established, on the other hand, new technologies make finding bodily anomalies with no experiential reference and uncertain clinical significance more common. As William Black and Gilbert Welch have observed, "despite clinicians' best intentions, many patients may have been labeled with diseases they do not really have, and many have been given therapy they do not really need."2 The problem of assessing need in Cushion is a subcase of such difficulties throughout medical care.

Description versus diagnosis. Mental disorders continue to be among the most contested disorders because of the lack of laboratory measures that substantiate patients' complaints or disturbing behavior. Clinicians have developed a large number of descriptive categories that attempt to characterize such problems in specific Tiffany Earrings, but such diagnoses are more conveniences to assist communication and further inquiry than they are representative of confirmed diagnostic theories.A confirmed diagnostic theory identifies a related cluster of signs and symptoms representing an underlying disorder; it then provides information on the expected course or natural history, causes, and needed treatment. Diagnoses are hypotheses, and to the extent that they are correct and scientific, they guide the clinician toward appropriate actions. Many medical diagnostic theories remain uncertain and are only partially confirmed, but diagnostic theories in psychiatry are more likely to be partially confirmed or unconfirmed with limited understanding of causes, uncertain understanding of course, and fewer specific treatments. Treatment, thus, is often based on clinical experience and experimentation.3

Burden of mental disorders. Nevertheless, mental disorders are a source of immense Tiffany Cuff Links and societal burden; those labeled "schizophrenia" are among the most painful and disorienting in all of medicine. The major depressive disorders are more common but also a source of much misery and more burdensome and disabling than most common medical illnesses are.4 Alcohol and drug abuse conditions, perhaps among the most contested of major mental health categories, are a source of much trouble, however we characterize them.