First recorded depiction of mental illness - 3000 B.C. in Egypt - Senile Dementia First references to melancholia and hysteria found as early as 2600 B.C. Hippocrates (460-377 B.C.) first to place psychiatric conditions within secular and naturalistic domain of medicine.
Introduction What is a “mental disorder” How do we define and recognize these disorders? What different types of disorders exist? What causes mental disorders?
Epistemology: study of the nature of knowledge There are balls and there are strikes and I call them as they are (realism - Middle Ages), There are balls and there are strikes and I call them as I see them (middle ground - DSM IV), There are no balls and there are no strikes until I call them (nominalism - no reality outside the mind of the observer)
Medical illnesses are defined on a widely varied conceptual basis, reflecting our historically evolving concept of disease. Mental disorders have also been defined by a variety of concepts (distress, dyscontrol, disadvantage, disability, inflexibility, etiology, statistical deviation)
Before post world war II, the majority of patients classified were severely ill ind. living in asylums, there were fewer and more easily defined categories of mental disorders.
The ever increasing number of new categories meant to describe the less impaired outpatient population raises the question of where psychopathology ends and the wear and tear of every day life begins.
The DSM I had 106 different diagnostic categories The DSM II had 182 The DSM III listed 265 The DSM III R included 292 What is the effect of this increase?
Multiple Diagnosis 1.The removal of diagnostic exclusion criteria 2.The profusion of new categories 3.The division of old categories 4.The use of structured interviews in clinical practice
Question 1.Has psychiatry taken upon itself the task of pathologizing statistically or morally deviant individuals? 2.Could the use of an over-inclusive definition of mental disorder give the profession a wider purview of influence and social control than it can reasonably handle?
What is a mental disorder? DSM-IV Definition A significant behavior that occurs in an individual that is associated with distress or disability, or an increased risk for suffering death, pain, disability, or an important loss of freedom. This syndrome must not be due to a culturally sanctioned response.
How do we define and identify mental disorders? Mental disorders are generally characterized as abnormal behaviors Abnormal behaviors can be defined – Statistically – Culturally – Personal Distress – Maladaptive Behavior
The DSM “mental disorders” are best understood as descriptive syndromes likely to assist in our increased understanding of the underlying disease, but only in selected cases do they, actually represent such diseases.
Historical Views of Abnormal Behavior Evil Spirits – Exorcism Birth of Reason – Hippocrates- Science Hippocrates Reason Lost – Witch Hunts Witch Hunts Reason Returns – Psychology-Wundt – Psychopathology and DSM (1952, 65, 74, 80, 87-R, 94)
History of the DSM DSM I – 1952 – Myers psychobiological view – Disorders cause by personality “REACTION” DSM II – 1968 – Basically the same but references to “reaction” were removed
History of DSM cont. DSM III – Published in 1980 – Free from theories of etiology – Initiates use of Multi-axis system DSM III-R – 1987 Revisions made to clarify diagnoses DSM IV – Published 1994 – Categorical – Cultural and ethnic considerations – Not based on deviant behaviors
DSM IV-TR Most current version to date Published in 2000 No changes to diagnoses or criteria Changes made to text that was considered ambiguous Update of statistical data from new studies.
DSM IV-TR Categories Diagnoses usually made in infancy, childhood, and adolescence. Delirium, Dementia, and Amnesic and other cognitive disorders. Mental disorders due to a Medical Condition Substance Related Disorders Schizophrenia and other psychotic disorders