Using a case example, the authors contrast two different approaches to psychiatric assessment: the medical approach, in which the physician examines signs and symptoms and compares them with diagnostic criteria for various disorders, and the narrative approach, in which the clinician tries to understand symptoms as a part of a meaningful story and as understandable responses to external conditions. Both approaches make essential contributions to psychiatry. The current conflict between biological psychiatry and psychotherapeutic psychiatry can be seen as a result of reductionist polarization involving these opposite approaches. The reconciliation of these opposites may be vital for the survival of general psychiatry as a medical specialty.