Mental health articles

Since the publication of the D.S.M.-III in 1980, the D.S.M. has included a definition of mental disorder and what is mental disorder?

each of the mental disorders is conceptualized as a clinically significant behaviouralor psychological syndrome or pattern that occurs in an individual and that is typicallyassociated with either a painful symptom (distress) or impairment in one or more areasof functioning (disability). In addition there is an inference that there is a behavioural,psychological, or biological dysfunction, and that the disturbance is not only in therelationship between the individual and society.

With minor revisions this definition has also been included in later editions ofthe D.S.M. (for comparison, all these definitions are given at the end of the book inan Appendix). In this chapter I examine the notion of “disorder” used in constructingthe D.S.M. One major issue to be addressed is whether there are objective,biological matters of fact that determine whether a condition is a disorder, orwhether value judgements are necessarily involved.

At the outset, a note regarding terminology is necessary. In the philosophicalliterature on the pathological, as well as in much medical discourse, it has becomeusual to use “disease” or “disorder” interchangeably to refer to all pathologicalconditions – diseases in the narrow sense, injuries, wounds, and disabilities. This isthe sense of disease on which it makes sense to say, for example, that “Health is theabsence of disease”. Here I shall follow this philosophical and medical usage – andwill use “disorder” or “disease” interchangeably to refer to all pathologicalconditions.

As well as exploring conceptual issues, I will examine the political debates thathave surrounded the development of the D.S.M. definition of “disorder”. It mayseem odd to consider conceptual and political problems together, but there areadvantages. Many conceptual issues have come up in the political debates; thusconsidering the political debates can save the philosopher time. More importantly,many philosophers before me have written about disorder and have been almosttotally ignored by physicians.2 Inpart this is because medical debates over“disorder” often have political overtones to which philosophers have beeninadequately sensitive. For example, within psychiatry, debates concerning accountsof mental disorder have been linked to the question of whether psychologists should treat mental illness, and to debates concerning the status of homosexuality. Byconsidering these debates alongside conceptual issues I hope that my discussion ofaccounts of disorder will be of relevance to the debates within medicine as well as todebates within philosophy.

Tags: definition, disorder, mental, mental disorder