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MANAGING UNCERTAINTY IN MENTAL HEALTH CARE

Jose Silveira, MD, and Patricia Rockman, MD • Oxford University Press

This is an extraordinarily honest book about one of the hardest challenges we face: assessing and treating mental health problems and addictions. We’d like them reduced to a checklist of symptoms, diseases, and treatments. Hard enough with bones, organs, and blood vessels, but the mind is so intangible and perplexingly varied, determining what needs to be treated and how is a challenge of the highest order of complexity. Silveira and Rockman evince compassion from the first page, writing of patients “drowning in their distress…who sometimes draw others down with them.” They stress that clinicians treat not diagnoses but individuals, each of whom “experiences a unique journey that shapes their brain and mind into one of a kind” that “deviates from the script written from population studies.”

In other words, a clinician facing an individual may have to admit what they do not know—not what the world expects of “experts.” The authors liken the work to meteorology, where professionals’ conclusions emerge from wrestling with nature’s chaos. Like meteorologists, mental health clinicians try to impose order on disorder, and often