Recognizing a problem
RECOGNIZING AN emotional problem and giving it a psychiatric diagnosis are very different processes. At what point does the depressed mood that everyone experiences from time to time become an illness that requires intervention?
Diagnosis in psychiatry is currently based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, commonly known as DSM-IV.1 The process of arriving at a standard nomenclature for emotional conditions and mental disorders has been complex, partly because so many of the conditions are themselves controversial topics in contemporary culture: Is alcoholism a disease, a habit, or a weakness? Is bulimia a disease, or a symptom of oppression? Is homosexuality a disease, or a lifestyle? Why do Vietnam vets apparently suffer from Post-Traumatic Stress Disorder at such higher rates than soldiers in previous wars? Should rebellious adolescents be hospitalized against their will because they can’t get along with their parents? Should people with chronic substance abuse problems be considered disabled, and thus entitled to Social Security benefits? These questions require answers that make us question our deepest values - do we have the ability to make our own decisions in life, or are our decisions programmed by our hered-
ity, nervous system, or early childhood experience? If our decisions are determined, what happens to the social contract, guilt, crime, and punishment?