Ambiguity at the crossroads of psychiatry and demoralization: Reflections and possibilities

Abstract

Background and Objectives: The concept and the impact of Ambiguity in the complex field of all human transactions have been captured by the texture of Culture and its many faces across the world. It generates intense debates reaching even most if not all areas of Science, once considered an unchallengeable source of precision and clarity. This article deals with the role Ambiguity plays in contemporary Culture and in the current state of Medicine in general, and Psychiatry in particular, in spite of advances in basic, clinical and technology-based research and practice. Ambiguity affects psychiatric nosology, diagnosis, treatment, prognosis and outcome. Almost inevitably, Ambiguity leads to polarities, disagreements and conflict. Examples of each if these situations are presented. Not surprisingly, it also influences the emergence of Demoralization, a psychoexistential feature that, paradoxically can be both the acme of failure, and the pathway towards hope, an essential ingredient in the psychotherapeutic encounter. As the latter, Demoralization cannot be a "mental disorder", although its ambiguous nature contributes to a pervasive uncertainty. At the crossroads of Ambiguity, Psychiatry and Demoralization must look for a better level of communication as a way to lessen the impact of Ambiguity and make it not only a core, positive component of Psychiatry's role but also a favorable ingredient in Demoralization's effect on the trajectory of patienthood.