The underlying issues raised by Kingdon ^{Reference Kingdon1} and King ^{Reference King2} are those in the foundations of the theory and practice of psychiatry. Interestingly, the views expressed echoed, at least in part, some of my own views expressed in another publication:

‘Mental illness is never far away as it is simply one end of normality. In other words, we all have thought processing difficulties (TPD) from time to time. Depression is the best example of a thought processing difficulty. However, difficulty may become a disorder when the normal thought processing mechanisms and adaptations fail. A basic mental breakdown, without complicated diagnostic categories, takes place. The manner of the breakdown is unique to the individual sufferer whose internal life is surely more than the standardised criteria set in the scriptures (ICD-10 and DSM-IV)!’ ^{Reference Metseagharun3}

The definition of stress adopted by the UK Health and Safety Executive recognised it as relating to pressure and demands: ‘the adverse reaction people have to excessive pressures or other types of demand placed on them at work.’ ⁴ The intuitive thinker will immediately see the metaphorical relationship to a hydraulic or fluid-based system. If we accept that the mind is metaphorically fluid, then there will be no real boundaries and categories, making vague but universal concepts valid according to the demands of the specific situation. Thought processing difficulty/disorder is as defensible as ‘stress’ from a psychopathological perspective as well as in terms of social acceptability and (best of all) accuracy. I have creatively used the acronym TPD (with ‘D’ meaning either difficulty or disorder according to the patient's preference) to successfully resolve diagnostic disputes with virtually all my patients who felt stigmatised and erroneously labelled as schizophrenic or as having borderline personality disorder. Most chose ‘D’ as representing a difficulty for which they seek help in a collaborative fashion. It is of course less bruising to anyone's ego to accept having a difficulty (or stress) than to accept having a disorder (an implicit indication of socially undesirable or deviant behaviour). Thought processing difficulties/disorder has indeed been my Occam's razor for all psychiatric diagnoses and I recommend it to fellow colleagues. I understand that it will not be specific enough for the ‘square thinker’ - to use Robert Pirsig's reflection of the views of some African Americans who believed that too much intellectuality and too little soul made a person square. Such a person could not recognise quality, and nothing was real for them unless it was put into boring categories and defined. ^{Reference Pirsig5}