Psychiatric diagnosis guides treatment....except when it doesn't

In most specialties of medicine, the dictum "Diagnosis guides treatment" is the law of the land. In psychiatry, however, most of what we treat are often overlapping syndromes, not actual diseases, and these syndromes involve hugely varying dimensions of symptoms with a vast array of potential causes and exacerbating factors.
Maggie came to Dr. H with a challenging clinical presentation: likely genetic loading for a mood and/or anxiety disorder, childhood emotional neglect, years of school problems, hormone irregularities and progesterone hypersensitivity, all leading to steadily worsening mood instability, depression, and hopelessness. Over the course of the last 12 years, Maggie and Dr. H were eventually able to co-create both a successful treatment course and a shame-free narrative, without a clear diagnosis to guide them.
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