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Article #99: Mental Health Manuals: Controversy in the Field

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The complexity of human behaviour is and presentation of morbidity and
closely related to the multifaceted mortality statistics" (Wikipedia).
nature of mental health disciplines. Historical Development
There are several propositions and varied The development of the ICD traces back to
focus on how to perceive mental health the 1800's. In 1893, Jacques Bertillon (a
and to create standards which recognise French physician) created a system to
symptoms and diagnose patients. Two report causes of death - system which was
proposed standards have roots in the later adopted by several countries and
development of medicine, psychiatry, and organisations. In 1898 the APHA (American
health statistics: the DSM and the ICD. Public Health Association) recommended
What are these manuals, and why are they that the system should be revised every
so controversial? ten years in order to preserve its
The Diagnostic and Statistical Manual of validity and application. The system was
Mental Disorders first reviewed version in 1900, and the
The Diagnostic and Statistical Manual of next five versions followed in 1910,
Mental Disorders (DSM-IV) is a handbook 1921, 1930, 1939 and 1949. In the sixth
published in 1994 by the American revision (1949) the classification
Psychiatry Association used to diagnose expanded to two volumes, including
mental health disorders or illnesses. morbidity and mortality conditions, and
This book is primarily used in Western its title was officially renamed to The
society - particularly the US, Canada, International Statistical Classification
New Zealand, Australia, and some European of Diseases, Injuries and Causes of Death
countries - as a guide for diagnosing (ICD). In this edition the World Health
patients for health professionals. This Organisation also became the responsible
publication is a polemic and widely entity for the publications of the ICD.
discussed topic in mental health and The next three revisions were published
related areas, with many professionals in 1958, 1968 and 1979. The current
questioning its validity, purpose and edition, the ICD-10, was published in
applications. 1999. The ICD is the most widely used
Historical Development statistical classification system in the
The development of the DSM traces back world, and there are several modified
from 1952, when the DSM-I was first version which are adapted to specific
published, containing about 106 countries and type of data.
classifications of mental health Problems of the ICD
disorders. In 1968, the DSM-II was For the purpose of mental health, the ICD
published. The first two editions were does not offer the same level of
strongly influenced by a psychodynamic specificity as the DSM. Similar to the
approach, which provides no particular DSM, the ICD's focus on recording
contrast between the concepts of statistical data, classifying symptoms
normality and abnormality. The DSM-II and diseases, and creating comparable
provided one of the most polemic data across varied cultures can have a
diagnoses of the book's history, when it negative effect in its validity and
included homosexuality as a mental application.
disorder. Such decision evoked various Manuals, Mental Health and Controversy
protests and it resulted in a plebiscite How do we define normality? This question
which decided to remove the diagnosis in has raised many other questions about the
1973. In 1980, the first 'biomedically' validity of such manuals, particularly
modelled DSM was published: the DSM-III. the DSM-IV. The clinical approach towards
The DSM-III created a clear distinction all aspects of mental health, even
between normal and abnormal, resulting in cultural-related problems, is discussed
a more defined criteria as to whether by many mental health professionals as
diagnose and treat a patient suffering invalid because it attempts to label
from specific symptoms. In 1986 the individuals based on a set of symptoms
DSM-III was reviewed and it evolved into which could derive from various
the DSM-III-R. The DSM-IV, which is the conditions. There is also the argument
current version of the book, was first that the DSM-IV focuses only on the
launched in 1994. However, the most negative aspects of individual behaviour,
recent version is the revised DSM-IV-TR. failing to consider the positive aspects
The APA expects to launch the next and therefore being unable to create a
edition of the DSM around 2010: the balance which would recognise the
DSM-V. inexistence of a 'diagnosing' condition.
Problems with the DSM-IV Such issues regarding normality,
The DSM has been widely criticized in the diversity and cultural labeling have also
mental health community. The validity of been recently discussed in the 'Meeting
the classification criteria used by the of Minds' and it is a common topic
handbook has been discussed, particularly amongst behavioural professionals.
when defining normality, discussing Furthermore, there is a polemic
culture-related mental health problems, discussion around the underlying economic
and using a fixed set of characteristics benefits of maintaining the standards of
for diagnosis. Criticizers of the APA's both manuals. The DSM-IV is commonly used
publication affirm that the major issues by doctors in order to provide a
of the DSM-IV are: (a) the categories diagnosis, and some health insurance
lack independence and are too companies will only refund patients that
heterogeneous (co-morbidity high, can provide a numerical code based on the
overlapping criteria for diagnosis); (b) ICD and a written description derived
aetiology is not considered (principles from the DSM.
underlying categories are diverse); (c) In the other hand, the historical
there is low reliability (consistency) development of both manuals has proved
and low conceptual validity that they are responsive to the
(correctness); (d) the classified development of mental health disciplines
disorders are mainly based on prevailing and societal needs. Perhaps in the
cultural view; (e) classification and following decades or editions, they could
labeling has potentially harmful experience improvements that would cater
consequences; (f) and there is the for the current issues which are
prevalence of political agendas discussed by professionals, or conversely
represented by 'medicalising' life the way by which mental health is managed
problems (marginalization of sections of today could be modified. The reality is
society, drug companies, etc). that most of those questions are yet
The International Statistical without answers - and should remain that
Classification of Diseases and Related way in the foreseeable future.
Health Problems © Australian Institute of Professional
The International Statistical Counsellors. The Australian Institute of
Classification of Diseases and Related Professional Counsellors (AIPC)
Health Problems is a handbook published specializes in providing high quality
by the World Health Organisation (WHO) counsellor education, with a particular
and it embraces all types of diseases or focus on external and distance education.
illnesses, not only the mental For more information, visit the following
health-related ones. The ICD was links:
primarily "designed to promote Learn to be a Counsellor.
international comparability in the Subscribe to our FREE eZine.
collection, processing, classification, Visit our Article Library.






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