The History of Psychiatric Diagnoses
The DSM (Diagnostic and Statistical Manual of Mental Disorders) has played a significant role throughout the history of psychiatry. As the bedrock of Western psychiatry and the guide for millions of physicians and healthcare providers, it represents the most critical advancement in diagnosing and treating mental diseases (Armour et al., 2016). However, despite its success, significant complaints about its function have surfaced. However, few individuals are aware how this evocative and meaningful novel came to be. This short overview examines the DSM’s history, the process of establishing it, the task force that determines what constitutes a disease, the techniques they utilized, and the DSM’s criticisms and merits. Additionally, it casts doubt on the reality of mental disorders, their diagnosis based on a scientific paradigm, and their causation.
The DSM originated in 1840 when the government desired to gather statistics on mental disorders. In that year’s census, the phrase “idiocy/insanity” emerged (Chanques et al., 2018). The census was enlarged forty years later to include the following seven diagnoses: mania, paresis, melancholia, dipsomania, monomania, dementia, and epilepsy. However, standardized data collection across mental facilities remained necessary. The Census Bureau adopted the Statistical Manual for the Use of Institutions for the Mentally Ill in 1917. The American Medico-Psychological Association’s Committee founded it on Statistics; it is currently administered by the American Psychiatric Association and the National Commission on Mental Hygiene. The committees classified mental diseases into 22 distinct categories (Kirk et al., 2017). Until 1942, the handbook was revised ten times.
While the requirement for the classification of mental diseases has been accepted throughout medicine’s history, there has been little accord on which disorders should be included and how they should be organized until recently. The several categorization systems produced over the last 2,000 years varied in their focus on phenomenology, etiology, and course as distinguishing characteristics (Wright et al., 2017). Some systems had just a few diagnostic categories, while others contained hundreds. Additionally, the different methods for classifying mental diseases have varied in their primary usage in clinical, research, or administrative contexts.
The American Medico-Psychological Association’s Committee on Statistics (which eventually became the American Psychiatric Association and another body, the National Commission on Mental Hygiene, published the Statistical Manual for the Use of Institutions for the Insane in 1917. According to Chanques et al. (2018), these two panels classified mental illnesses into 22 distinct categories, then employed by the Bureau of Census. The publication was edited regularly and went through ten editions till 1942. The handbook is regarded as the forerunner of the DSM’s first edition. It provided extensive classifications of mental diseases and was only marginally helpful in diagnosing them (Kirk et al., 2017). Additionally, the Freudian paradigm dominated psychiatry during this period, and diagnoses reflected this impact.
Confusion about what to analyse was exacerbated by a variety of other diagnostic systems in the United States. There was a genuine call for designing a categorization system that mitigated this scenario and resulted in consensus in the field of psychiatry, and the supply of a nationally applicable diagnostic system. The APA agreed to design a new categorization system, and the DSM’s first edition was published in 1952. (Bovin et al. 2016). Surs et al. (2016) noted that the DSM-I contains 102 extensive diagnostic categories depending on psychodynamic concepts. Diagnostic categories were separated into two broad categories of mental illnesses, which comprised the following: circumstances that were considered to be caused by some form of brain malfunction and circumstances that were supposed to be the consequence of an individual’s incapacity to adapt due to the impacts of environmental stress.
The second category was classified as (1) psychoses, which comprised severe problems such as manic depressive disorder and schizophrenia, and (2) psychoneuroses, which included depression, personality disorders, and anxiety-related diseases (Hutsebaut et al., 2017). Despite the manual’s construction of a structured categorization system with diagnostic categories, it lacked diagnostic value and had little impact on the diagnostic procedure. This paved the way for the creation of the DSM’s second edition. The DSM offers symptoms, descriptions, and other diagnostic criteria for mental diseases (Wright et al., 2017). It develops a shared vocabulary for experts to speak with their patients and produces trustworthy consistent diagnoses for use in mental illness research.
The most fundamental scientific critique of the DSM is directed at its diagnostic validity and reliability. This broad term relates to the extent to which the diseases it identifies are genuine ailments affecting real individuals in the real world and can be time after time recognized using its criteria. They are long-standing critiques of the DSM, first raised in the 1970s by the Rosenhan experimentation and maintained despite modest improvement in dependability with the adoption of more explicit rule-based criterion for each category (Hutsebaut et al., 2017).
Proponents claim that the inter-rater consistency of DSM diagnoses obtained through a specialized Structured Clinical Interview for DSM-IV (SCID) rather than through standard psychiatric assessment is logical and that there is compelling evidence of discrete patterns of mental, behavioural, or neurological dysfunction to which DSM disorders correspond well (Armour et al., 2016). However, it is acknowledged that there is an “enormous” range of consistency findings in studies and that soundness is unknown since of the absence of analytic laboratory or neuroimaging tests. Standardized interviews are “minimal,” and only a (“imperfect”) “best estimate diagnosis” is probable even with a complete evaluation of all data over time (Bovin et al., 2016). According to critics such as psychiatric specialist Niall McLaren, the DSM lacks validity since it is not based on an accepted scientific model of mental disease. So the judgments made concerning its categories or even the issue of types versus subtypes are invalid. It lacks dependability because various diagnoses share many criterion, and what seem to be distinct criterion are often merely rephrased versions of the same notion. It thus implies that the choice to assign a patient to one diagnosis or another is to some degree a question of personal opinion.
What Exactly is a Mental Disorder?
According to the biomedical paradigm, mental disorders are brain illnesses that need expensive pharmacological intervention to correct perceived biological defects. For more than three decades, the American healthcare system has been dominated by biologically based research, policy, and practice. During this time period, the use of psychiatric medications has increased considerably, and mental disorders are increasingly seen as brain illnesses caused by chemical aberrations that may be treated with disease-specific therapies (Scull, 2018). Despite broad trust in neuroscience’s potential to revolutionize mental health care, the biomedical model era has been characterized by a general absence of clinical innovation and mediocre mental health outcomes. Additionally, by incorporating drug trial methodologies into psychotherapy research, the biomedical perspective has had a profound influence on clinical psychology. While this technique aided in the development of scientifically approved psychological treatments for a variety of mental illnesses, it ignored treatment processes, impeded treatment innovation and dissemination, and divided the field between practitioners and researchers. The neglected biopsychosocial model presents an intriguing alternative to the biomedical model, and an open and public debate on the biomedical paradigm’s authenticity and use is urgently needed.
Mental illnesses are disorders of the brain caused by faulty neurotransmitter regulation, hereditary abnormalities, and functional and structural abnormalities. Despite this, no scientific explanation for, or even a valid biomarker for, any mental disorder has been identified. Psychotropic medications work by correcting neurotransmitter imbalances associated with mental disease. However, there is no convincing evidence that mental illnesses are caused by chemical imbalances or that pharmaceuticals work by correcting these imbalances. Scull (2018) contends that advances in neuroscience have brought in an era of more safe and effective pharmacological therapy. On the other hand, most modern psychiatric drugs are neither safer or more effective than those discovered by accident half a century ago.
Biological psychiatry has made great achievements in reducing the societal cost associated with mental disease. However, mental illnesses have become more chronic and serious in recent decades, and the number of people who are unable to function due to their symptoms has risen significantly. Reduces stigma by informing the public that mental illnesses are medically recognized disorders. 2018 (Cooper). Despite increased public acceptance for biological causes and treatments, stigma has not diminished and seems to be worsening. Increased financing for neurological research will result in the development of physical diagnostic tests and curative medications. Due to a lack of plausible molecular targets for mental illnesses and the frequent failure of novel compounds to demonstrate superiority over placebo, the medical establishment has considerably decreased its attempts to develop new psychiatric drugs.
Although the DSM-IV categorizes mental illnesses, it must be noted that no definition truly defines the idea of mental disease. As is the case with many other notions in medicine and research, the idea of mental disorder lacks a universally applicable operational definition. Each medical illness is characterized at a different level of abstraction—for example, structural pathologies, such as ulcerative colitis, symptom presentation, deviation from a physiological norm, such as hypertension, and causation, such as pneumococcal pneumonia. Additionally, mental illnesses have been classified using a range of characteristics. They include; syndromal pattern, distress, disability, dyscontrol, disadvantage, irrationality, etiology, inflexibility, and statistical deviation (Scull, 2018). Each is a valuable sign of mental illness, but none is synonymous with the idea, and various circumstances need different definitions.
Psychological disorders such as schizophrenia, major depression, attention deficit disorder, and substance use disorders, according to the biological paradigm, are cardiopulmonary exercise brain diseases. The following are the fundamental concepts of this approach: (1) mental disorders are produced by biological abnormalities, particularly in the brain, (2) no significant distinction exists between mental and physical illnesses, and (3) biological treatment is emphasized. The major goal of biomedical research into the genesis of mental illnesses, according to the biomedical paradigm, is to identify their biological cause(s) (Surs et al., 2016). Therapeutic research, meanwhile, is focused on discovering somatic remedies that target underlying biological dysfunction. The ultimate goal is to discover magic bullets, or specific therapeutic agents that target disease processes directly without inflicting harm to the species, such as penicillin for pathogenic bacteria.
While contemporary proponents of the biological model acknowledge psychosocial theories and treatments, the decades-old picture of this paradigm remains an accurate description of the general approach to mental illness in the United States (Clark et al., 2017). The biomedical model minimizes the role of sociocultural elements in mental illness and adheres to the eliminative reductionist view that psychological events may be totally reduced to their biological origins. Paul Applebaum, former president of the American Psychiatric Association, stressed this point, stressing that human brains are, by definition, physical organs. Any kind of mental disorder is entirely normal (Clark et al., 2017). From this vantage point, the biological and psychological levels of analysis are inextricably intertwined. Psychology is relegated to the status of a “stand-in science,” to be overtaken by neuroscience and organismal biology.
To conclude, classifying mental illnesses into mutually exclusive categories defies our understanding of human behavior. As it turns out, the DSM sequence’s so-called generally exclusive diagnostic categories are not mutually exclusive, and committees have advocated but not yet approved alternate, more functional approaches to certain diagnostic categories, such as psychological disorders. The committees’ and APA’s conceptual frameworks of mental disease are often at odds with the majority of available research in the field. However, the committees that make diagnoses do research and use it to develop their diagnostic criteria and categories, demonstrating that trying to describe mental illnesses in the same way as physical disorders is not a feasible strategy.
The conclusive effect of DSM-5 cannot be ascertained until the manual has been in use for a length of time. The DSM-5’s immediate subsequent phases involve developing tools to assist with its usage in primary care settings, adapting evaluation tools to the DSM-5, and documenting the evidence base for revision options in the DSM-5 electronic archives. Dimensional assessments from the handbook will be evaluated and refined, including a pediatric version of the widely used WHO Disability Assessment Schedule 2.0.
By partnering with the WHO on future DSM editions, scientists can assure that global statistical classification of mental illnesses is more similar. Additionally, they may get closer to developing a completely unified nosology and diagnostic strategy. This collaborative effort will enable psychiatrists worldwide to provide superior care to individuals suffering from these life-altering and potentially dangerous conditions, while also advancing a more synergistic and iterative global research agenda for understanding the causes and ways to cure for these disorders.
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