Are Mental Disorders real illnesses? What of the DSMV controversy?

As I have been writing on most of the main types of mental illness a media controversy has raged. The release of the DSMV was seen by many as an opportunity to throw the spotlight on the validity of psychiatric diagnostic systems. In particular, the announcement of a new highly experimental approach the RDC was spun as a rejection of DSMV, which has since been denied.

There are a few things that are worth saying in response to that.

  • I don’t believe that any psychiatrists today think our classification system is perfect and that it maps precisely on to known underlying causes.
  • Mental illnesses are symptom clusters, that seem to go together, and form part of a pattern of similar distress that can often be associated with response to treatment, and the likely future outcome for a patient. Thus for example, Bipolar Disorder does seem to respond to certain treatments very well in many cases, and can often be better controlled than schizhophrenia.
  • Our current symptom clusters may eventually be superseded by so called “Research Domains” However these are experimental, and right now the current system is the best we have.
  • It seems likely that diseases like schizophrenia and bipolar are probably in a sense forms of “brain failure.” Eventually we may discover that different underlying problems can cause both of these syndromes in different people. This is a bit like liver failure which has many different causes, each of which can present in different ways.
  • Recent research has suggested that genetic factors are associated with mental illnesses, but that these factors probably are related to a group of mental illnesses rather than a single one.
  • There remains no doubt that, especially in the case of the more severe mental illnesses we are looking at biological problems, but as I have said before there are psychological, social and spiritual components to both the cause and treatment of most mental illness.


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