I mean impossible in the good sense, of course. Time is limited tonight, so I enthusiastically recommend a fine brief commentary I came across today on the strange, agnostic difficulty of psychiatry. Written by Rachel Dew, M.D. in the American Journal of Psychiatry, it is by a psychiatrist and intended primarily for other psychiatrists, and it conveys nicely the mind-boggling nature of the undertaking.
The piece speaks for itself, but no blogger can resist a few comments. When Dr. Dew claims psychiatry as "the hardest specialty," I assume she means "hard" in a moral and not a simplistically cognitive way. For the very reason that so much ambiguity does still prevail in psychiatry, there is not nearly as much of the kind of mental calisthenics--the grand connect-the-dots-game involving obscure diseases, symptoms, and physical and lab findings--pertaining to much of the rest of medicine.
If much of medicine is, cognitively and sometimes physically, a kind of triathlon, perhaps with elaborate obstacle courses thrown in, then psychiatry might be more akin to...meditation. Obviously aspiring to mindfulness, psychiatry at its best tries to slow things down, to notice things otherwise unnoticed, to accept an emptiness at the heart of things without giving in to despair. It attends to suffering, knowing that pain often cannot be eliminated but that pain need not be shrouded in affliction.
Psychiatry is not just that, obviously. There are a number of things we do know, even if only in a pragmatic and not a metaphysical or in a purely scientific way. No triathlon perhaps, but one can meditate while walking.
In addition to the inherent difficulty here, there is the added complication that, these days especially, many patients show up to psychiatry looking for a triathlon (to watch, that is). Increasingly, practicing psychiatry is like offering a meditation class in which people keep showing up, asking "Where does the race start?" Well, I don't know, but tell me what you're looking for.