Featured Research

from universities, journals, and other organizations

Psychiatric diagnoses: Why no one is satisfied

Date:
February 15, 2012
Source:
University of Michigan
Summary:
As the Diagnostic and Statistical Manual of Mental Disorders is revised for the first time since 1994, controversy about psychiatric diagnosis is reaching a fever pitch.

As the Diagnostic and Statistical Manual of Mental Disorders is revised for the first time since 1994, controversy about psychiatric diagnosis is reaching a fever pitch.

Related Articles


Suggested changes to the definitions of autism spectrum disorders and depression, among others, are eliciting great concerns. However, there are larger concerns about the DSM as a whole.

"Almost no one likes the DSM, but no one knows what to do about it," said University of Michigan psychiatrist Randolph Nesse.

The current round of revisions is the fifth since the DSM was originally published by the American Psychiatric Association in 1952.

"A huge debate over when depression is abnormal seems likely to be resolved by removing the so-called 'grief exclusion,'" Nesse said. "At the moment, depression is not diagnosed in the two months after loss of a loved one.

"The result of this proposed change would be that people experiencing normal grief will receive a diagnosis of major depression. Doing this would increase consistency in diagnosing depression, but at the cost of common sense. It's clear that bereavement is not a mental disorder."

Nesse is the co-author with University of Cape Town psychiatrist Dan Stein of an article in the current issue of BMC Medicine titled "Towards a genuinely medical model for psychiatric nosology."

The article provides a diagnosis of the difficulty of categorizing mental disorders that the authors expect will displease many of their colleagues.

"The problem is not the DSM criteria," Nesse said. "The problem is that the untidy nature of mental disorders is at odds with our wish for a neat, clean classification system."

The proposed abolition of the grief exclusion in diagnosing major depression is just one example of a push to define psychiatric disorders according to their causes and brain pathology.

But Nesse and Stein point out that the rest of medicine recognizes many disorders that do not have specific causes.

"Conditions such as congestive heart failure can have many causes," Nesse said. "This doesn't bother physicians because they understand what the heart is for, and how it works to circulate blood."

Furthermore, he said, physicians recognize symptoms such as fever and pain as useful responses, not diseases.

"These symptoms can be pathological when they're expressed for no good reason, but before considering that possibility, physicians look carefully for some abnormality arousing such symptoms," Nesse said. "Likewise, the utility of anxiety is recognized, but its disorders are defined by the number and intensity of symptoms, irrespective of the cause.

"It's vital to recognize that emotions serve functions in the same way that pain, cough and fever do, and that strong negative emotions can be normal responses to challenging or anxiety-provoking situations."

So, as the DSM is revised once again, Nesse urges his colleagues and concerned members of the public to adopt realistic expectations.

"Instead of specific diseases with specific causes, many mental problems are somewhat heterogeneous overlapping syndromes that can have multiple causes," he said. "Most are not distinct species like birds or flowers. They are more like different plant communities, each with a typical collection of species. Distinguishing tundra from alpine meadow, arboreal forest and Sonoran desert is useful, even though the categories are not entirely homogenous and distinct."

Nesse is the co-author with George Williams of the book "Why We Get Sick: The New Science of Darwinian Medicine." He is a professor of psychiatry at the U-M Medical School and a professor of psychology at the U-M College of Literature, Science, and the Arts. He also directs the Evolution and Human Adaptation Program, sponsored by the U-M departments of Psychology and Psychiatry, LSA and the Research Center for Group Dynamics at the U-M Institute for Social Research.


Story Source:

The above story is based on materials provided by University of Michigan. The original article was written by Diane Swanbrow. Note: Materials may be edited for content and length.


Journal Reference:

  1. Randolph M Nesse, Dan J Stein. Towards a genuinely medical model for psychiatric nosology. BMC Medicine, 2012; 10 (1): 5 DOI: 10.1186/1741-7015-10-5

Cite This Page:

University of Michigan. "Psychiatric diagnoses: Why no one is satisfied." ScienceDaily. ScienceDaily, 15 February 2012. <www.sciencedaily.com/releases/2012/02/120215142959.htm>.
University of Michigan. (2012, February 15). Psychiatric diagnoses: Why no one is satisfied. ScienceDaily. Retrieved December 18, 2014 from www.sciencedaily.com/releases/2012/02/120215142959.htm
University of Michigan. "Psychiatric diagnoses: Why no one is satisfied." ScienceDaily. www.sciencedaily.com/releases/2012/02/120215142959.htm (accessed December 18, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, December 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Kids Die While Under Protective Services

Kids Die While Under Protective Services

AP (Dec. 18, 2014) As part of a six-month investigation of child maltreatment deaths, the AP found that hundreds of deaths from horrific abuse and neglect could have been prevented. AP's Haven Daley reports. (Dec. 18) Video provided by AP
Powered by NewsLook.com
UN: Up to One Million Facing Hunger in Ebola-Hit Countries

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

AFP (Dec. 17, 2014) Border closures, quarantines and crop losses in West African nations battling the Ebola virus could lead to as many as one million people going hungry, UN food agencies said on Wednesday. Duration: 00:52 Video provided by AFP
Powered by NewsLook.com
When You Lose Weight, This Is Where The Fat Goes

When You Lose Weight, This Is Where The Fat Goes

Newsy (Dec. 17, 2014) Can fat disappear into thin air? New research finds that during weight loss, over 80 percent of a person's fat molecules escape through the lungs. Video provided by Newsy
Powered by NewsLook.com
Why Your Boss Should Let You Sleep In

Why Your Boss Should Let You Sleep In

Newsy (Dec. 17, 2014) According to research out of the University of Pennsylvania, waking up for work is the biggest factor that causes Americans to lose sleep. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins