Diagnosis & Mental Health

I just started reading ‘The Book of Woe’ by Gary Greenberg, about the generation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5, the document that physicians will use to diagnose the mental illnesses of their patients and to receive reimbursement from insurance companies. The first several chapters outline the history of classification of mental illness. He notes the problems of identifying illnesses from behaviors, beginning with what we would consider today to be a bizarre example of an illness. He chronicles the ‘discovery’ of drapetomania, a term bestowed by a New Orleans doctor, in 1851, for ‘a disease that causes slaves to run away’. Furthermore, Greenberg posits that it is not beyond the realm of possibility that, had DSM existed at that time, it would have been adopted as an illness. After all, homosexuality was deemed a mental illness in DSM until 1973.

Catch 22

Although the American Psychiatric Association (APA) did not publish the first DSM until 1952, it would have fit nicely into Joseph Heller’s novel, ‘Catch 22’, as the reasoning behind WWII pilot, Captain Yossarian’s failure to attain a Section 8 military discharge for mentally unfitness. Yossarian cannot get a discharge for being mentally unfit, since the very fact that he seeks one to avoid dangerous missions is judged to be a perfectly sane act.

What’s missing?

I must read more about DSM, but from all reports I’ve read, the latest version is not scientifically based[1][2]. Statistical analysis of behaviors and correlation with mental illnesses do not necessarily contribute to knowledge of causes. It may be helpful for the Bureau of Labor and Statistics to know the distribution of certain behaviors among the population, but for a physician to rely on criteria based on statistics does not seem to be quite right. Rather, this seems a lot like a shotgun approach: actions that might help many people, but not the statistical outliers. It certainly is not an approach that will get to the root cause of an illness.

The need to find physical causes for mental conditions could not be more important.


5 thoughts on “Diagnosis & Mental Health

  1. The term ‘mental Illness’ is fraught with difficulties in itself, and is too broad a term I think that is used with frequency by physicians to put a label on the unquantifiable. When you think about it, any emotional state that compromises your sense of well-being can be termed a mental illness, albeit for a brief period of time. However, it’s the permanence that it seems to adopt when used as a medical label to explain a state of being, that can cause unnecessary damage. It’s too much of a grey area. The term ‘mental illness’ carries with it a heavy burden and very negative cultural connotations, and personally I think it’s time the term itself was redressed and changed. Thanks for sharing your article today.
    Regards, Maria

    • Thank you, Maria, for commenting. I agree with you. Syndromes, conditions, mental states, are all terms that have been used. The problem as you said, is not only the stigma and how people are treated, but how a person so labeled is prone to think of him or her self.

      This is a complicated subject. I am trying to tackle it little by little. If you get a chance, I’m interested in your thoughts about my other posts on the subject.

      Thanks again.


      • I shall indeed have a look at your other posts. It’s a subject that interests me inasmuch as I have been caught up in that very sticky web myself because of my own various health conditions and syndromes, which I’ve mentioned from time to time in my own posts. It is indeed a complicated subject.

  2. Good post, and a good comment from Ishaiya too. One of the difficult aspects of labelling developmental disorders, particularly, is deciding what is personality and what is a syndrome. My son, for example, who has been labelled Asperger’s Syndrome refuses to use the label now he is a teenager. I think he’s right – how can you grow up, uncertain what is you and what belongs to the label? And does it help to be told that your perfectionist tendencies, for example, belong to the label? That drive for perfection is just who you are, just as sloppiness is somebody else.

    The history of autism in the DSM must be an interesting one. It seems to be permanently changing.

    • Yes, labels are powerful things. They are like prejudices in a way, in the sense that judgement is made on the basis of a list of criteria that may or may not hold true. Some labels are hard to live up to and some are hard to overcome.

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