Diagnostic classification systems

Abstract

On the surface, the purpose of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) is straightforward. Contemporary practice requires a standard catalogue of mental disorders, with each disorder defined conceptually, and criteria for formal diagnosis set forth. This chapter explores the development of the DSM-IV-TR, the history of the DSM including previous versions, advantages and disadvantages of the current model of classification, and possible revisions for future editions of the DSM. To begin, however, one must understand that the concept of mental disorder is complicated by many issues, including the idea that mental disorders are rooted in societal norms as well as the context of history. The origin of the concept of mental illness may date back to prehistoric man. That is, it is likely that prehistoric man had some understanding of the mind, and that surgery to the skull might relieve symptoms of illness due to head injury (Liu & Apuzzo, 2003). As human society has progressed, however, the concept of mental illness has both expanded as well as become more complex. Consider, for example, the mental disorder of depression. In the case where a person may suffer a personal loss and experience grief, at what point in time does that grief become psychopathological depression? In this case, culture and society must somehow draw the line between the normal grieving process and psychopathology. The distinction must be made in terms of the specific behaviors exhibited (frequent fatigue or suicidal ideation) as well as the duration of the pathological behavior (one week versus one year). Also consider schizophrenia. Typical symptoms of this disorder include the presence of delusions. However, if one were to admit that she believed in a spiritual world or the afterlife, she would probably not be labeled delusional despite the fact that there is no supporting scientific evidence for an afterlife. Therefore, even mental disorders with the greatest amount of research in some sense are founded on society's assumption of what is, and is not, normal. © 2009 Springer New York.