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The perfect is the enemy of the good. We have, we hope, covered a large but not unwieldy swath of territory of practical relevance for the everyday clinician trying to make pharmacological decisions informed by evidence. As illustrated throughout the preceding pages, the availability of empirical data to guide treatment decisions varies greatly within and across disorders. It probably matters more that clinicians know how tothinkempirically – that is, knowing when, where, and how to look up information pertinent to a given case – rather than try to tackle the impossible task of comprehensively knowing the ever-changing clinical trials database for all disorders. Wisdom equally involves recognizing when evidence is lacking, prompting reliance on opinion, extrapolation, and plausible rationales – but not conflating those guideposts with an empirical database.
I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom.
We are much too much inclined in these days to divide people into permanent categories, forgetting that a category only exists for its special purpose and must be forgotten as soon as that purpose is served.