Few would argue with Professor Kingdon when he states that ‘Everybody gets stressed… it's just the way we react that differs’. ^{Reference Kingdon1} Indeed, as Kingdon asserts, there can be no doubt that continua exist between normality and certain states currently classified as mental disorders. However, the artificial dividing lines towards the ends of each spectrum, set purely by societal expectations, surely call into question the validity of those very diagnoses that have perpetuated the myth of massive unmet need in psychiatric services. ^{Reference Richman and Barry2} Rather than adopting a stress model of diagnosis based on dimensions, perhaps diagnoses such as mild depression, social phobia and personality disorder should instead be dispensed with altogether.

On the other hand, major mental illness is not primarily stress-induced. Although environmental risk factors exist for schizophrenia, bipolar and unipolar (endogenous) mood disorders and dementia, there is no convincing evidence to suggest that these illnesses are any more likely than peptic ulcer, cancer or myocardial infarction to be triggered by psychosocial stress.

Furthermore, in psychiatric practice, a diagnosis is not a checklist of symptoms; it is a process we have each spent many years learning to craft. Symptoms and signs such as hallucinations and delusions undoubtedly sit on continua, but it does not follow that schizophrenia sits on a similar continuum. Using Kingdon's analogy, chest pain may vary in aetiology and sit on a continuum of frequency and severity, but myocardial infarction remains a categorical diagnosis.

Lastly, one should not reconceptualise and reclassify mental disorder as a response to the stigma attached to it. If cardiac illness were to suddenly become stigmatised, I doubt physicians would rewrite the diagnostic criteria for myocardial infarction. On the contrary, diagnosis would remain necessary for both immediate and long-term management, and it would still be vitally important to separate those with cardiopathy from those without.