What does “normal” mean in mental health, and how do clinicians decide when a personality trait becomes a psychiatric disorder? In this episode, licensed professional counselor Josh Korac speaks with child and adolescent psychiatrist Dr. David Rettew about psychiatric diagnosis, medication stigma, overdiagnosis, underdiagnosis, and the difference between ordinary human variation and clinically significant impairment. Dr. Rettew explains that mental health exists on a spectrum. Traits such as anxiety, distractibility, moodiness, impulsivity, or emotional sensitivity can be part of a person’s temperament without automatically indicating a disorder. Diagnosis becomes more relevant when symptoms are persistent, cause significant distress, or interfere with relationships, school, work, or daily life. Josh and Dr. Rettew discuss why diagnostic categories can be both helpful and limiting. A diagnosis may give someone language for their experience, reduce confusion, guide treatment, and provide access to services. At the same time, psychiatric labels can feel stigmatizing, oversimplify a person, or create the impression that there is a clear line between being “normal” and mentally ill. They also examine the risks of both overdiagnosing and underdiagnosing mental health conditions. Social media, insurance requirements, cultural expectations, limited appointment time, and differences between clinicians can all affect how symptoms are interpreted. Dr. Rettew describes why a thorough assessment should consider temperament, development, environment, family history, functioning, and the full context of a person’s life. The conversation also explores psychiatric medication. Dr. Rettew discusses medication stigma, the limits of a medication-only approach, and why treatment decisions should be individualized. Medication may be helpful for some people, but it is only one possible part of care and does not replace therapy, relationships, healthy routines, or attention to environmental stressors. In this episode, you will learn about: • How clinicians define psychiatric disorders • The difference between personality traits and mental health symptoms • Why mental health exists on a continuum • When distress or impairment may support a diagnosis • The benefits and limitations of diagnostic labels • Why psychiatric conditions may be overdiagnosed or underdiagnosed • How social media can influence self-diagnosis • The role of insurance in mental health diagnosis • Temperament, personality, and individual differences • Medication stigma and the limits of medication-only treatment • Why mental health assessment requires context • Moving beyond the idea of a single definition of “normal” Dr. David Rettew is a child and adolescent psychiatrist and medical director of Lane County Behavioral Health in Eugene, Oregon. He previously served as an associate professor at the University of Vermont Larner College of Medicine. Dr. Rettew has published more than 100 journal articles, chapters, and scientific abstracts on child mental health. He is the author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and Parenting Made Complicated: What Science Really Knows About the Greatest Debates of Early Childhood. He also writes “The ABCs of Child Psychiatry” for Psychology Today. Josh Korac is a licensed professional counselor in Colorado who specializes in trauma, family estrangement, loneliness, and complex relationship concerns. He is also the Lead Moderator of Estrangement.com. Learn more about Josh at joshuakorac.com. This podcast is for educational purposes and does not constitute medical advice, mental health treatment, diagnosis, or an established therapeutic relationship. Do not start, stop, or change psychiatric medication without consulting a qualified healthcare professional.