Academic journal article Ethical Human Psychology and Psychiatry

The Need to Operationally Define "Disease" in Psychiatry and Psychology

Academic journal article Ethical Human Psychology and Psychiatry

The Need to Operationally Define "Disease" in Psychiatry and Psychology

Article excerpt

A universally accepted operational definition for the term "disease" is not yet established in contemporary psychiatry. In clinical psychology and psychiatry, disease has been used indiscriminately. The term disease has been invoked (even when no systemic etiology or pathology has existed) to describe addictions, a cluster of bizarre symptoms, and to justify crude medically based treatments (e.g., electroshock, lobotomy, involuntary commitment, medication prescription). More recently, sophisticated machines such as CAT scans, PET scans, and MRIs have been used for questionable research conducted to try to identify supposed diseases, to justify the overuse of psychotropic drugs. Economic and industry interests have superseded scientific concerns. To establish scientific rigor in psychiatry and clinical psychology research, an operational definition of disease is proposed.

Keywords: mental disease; mental illness; psychiatric diagnosis; mental disorders; mental syndromes; mental symptoms

Everything should be made as simple as possible, but not more so.

Albert Einstein

Historically, the disease concept has been used in psychiatry to describe a wide range of phenomena. The inception of the idea that abnormal behavior was caused by malfunctions of the body can be traced to the somatogenis hypothesis proposed by Hippocrates (460-357 b.c.e .). The first modern disease concept was promoted in the nineteenth century by the German physician, Griesinger (cited in Davison & Neale, 1994). Griesinger proposed that every mental condition had a specific physiological etiology. This was outright conjecture however, with no empirical support. Kraepelin (1899) advanced this early biomedical model with the publication of an extensive diagnostic classification system. Kraepelin used the term syndrome to describe a cluster of symptoms that regularly occurred together. This implicated supposed underlying bodily and physical causes (even though no specific physical abnormalities had been clearly identified). Kraepelin (1898) had previously integrated two different ideas. The first idea was from existing knowledge about syphilis. In 1815, the medical establishment had already designated syphilis as a disease and labeled it general paresis. The second idea was borrowed from Pasteur, who in the 1860s and 1870s had promoted the germ theory of disease. Kraepelin (1898) also described a syndrome with symptoms similar to the late stages of general paresis, which consisted of delusions, bizarre behaviors, and hallucinations. He suggested these symptoms should be labeled dementia praecox, thus attempting to integrate general paresis and the new germ theory. Kraft-Ebing (as cited in Davison & Neale, 1994) later showed that paretic patients injected with syphilitic matter did not subsequently develop syphilis. He concluded (incorrectly) that these patients previously had syphilis. Despite the lack of support for Kraepelin's disease theory, it was subsequently widely accepted into the twentieth century era of psychiatry.

Kraepelin's diagnostic system dominated psychiatry until 1980. The Diagnostic and Statistical Manual of Mental Disorders (American Psychological Association [APA], 1957), and the DSM-II (APA, 1968) were subsequently developed by physicians, psychiatrists, and other members of the American Psychiatric Association. The DSM and DSM-II were founded on disease-type formulations about psychosocial and mental health disorders. The origins of the DSM can readily be traced directly back to Kraepelin's diagnostic system and associated beliefs about disease states. The biopsychiatric aspects of the DSM however created many critics, including Szasz (1961), Laing (1969), Glasser (1965), and Bateson, Jackson, Haley, and Weakland (1959). All these critics noted the major absence of empirical support for the disease theories. Actually the absence of conclusive data for either side left the argument unresolved.

A second disease movement can be traced to alcohol and drug abuse-addiction literature. …

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