The definition of the concept of a mental disorder, fundamental to the mental health field, has been an important and controversial issue in psychology. Labeling a person s behavior abnormal, effects the way they are viewed and view themselves, and determines the recommendations for treatment. Since the term describes such a broad range of illnesses, it is difficult to come up with a definition that is adequately inclusive and consistent. J.C. Wakefield (1992) made a compelling argument that defined a mental disorder as a harmful dysfunction. However, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (as cited in Emery & Oltmanns, 1998) provides a more complete definition that includes the different characteristics of mental disorders, while excluding certain conditions that could lead to behavior that may be misconstrued as evidence of a mental disorder.
Specifically, the DSM IV (as cited in Emery & Oltmanns, 1998) requires that present distress, disability, or a significantly increased risk of suffering death, pain, disability, or an important loss of freedom must characterize a behavioral or psychological syndrome for it to be a mental disorder. Present distress refers to physically or psychologically painful symptoms experienced by a person. Together, the increased risk and present distress characteristics roughly correspond to Wakefield s belief that mental disorders must be conditions that cause harm to an afflicted person (Wakefield, 1992). This harm might be in adjustment (such as ruining interpersonal relationships), mental distress (such as anxiety or depression), or physical effects (such as suicide, or other bodily harm). Likewise, disability, referring to the impairment in one or more important areas or functioning, corresponds to Wakefield s belief that conditions must also result from the inability of some mental mechanism to perform its natural function (Wakefield, 1992).
However, the DSM-IV (as cited in Emery & Oltmanns, 1998) requires that a syndrome must not be merely an expectable and culturally sanctioned response to a particular event, deviant behavior, or a conflict between the individual and society. Likewise, Wakefield believed that harmfulness should be judged by the standards of a person s culture, but lacks specifications for that critical judgement. Along with A. Kleinman (1988), he criticized the inadequate consideration of cultural differences in the DSM s previous editions. These conditions for exclusion are essential in accounting for differences in what is considered normal behavior cross-culturally, and indicate the difficulty in deciding whether the behavior of a person in another culture is indicative of a mental disorder.
The importance of the DSM-IV s exclusion criteria can be illustrated by comparing anorexia nervosa, a condition that is a mental disorder by the DSM-IV s definition, to religious fasting, a condition that is not considered to be a mental disorder. Anorexia nervosa is a mental disorder characterized by extreme emaciation, a disturbed perception of (one s own) body, an intense fear of gaining weight, and the cessation of menstruation (in women) (Emery & Oltmanns, 1998). This condition is included as a mental disorder by the DSM-IV s definition by all three defining characteristics. The fear of weight gain and obsessive thoughts related to body image indicate present distress. The stopping of menstruation attests to impairment in reproductive functioning, and the extremely low body weight increases the risk of suffering death or disability (such as osteoporosis). Since anorexia is not merely an expected response to any event, deviant behavior of a minority group, or a conflict between the individual and society, it is a mental disorder.
In contrast, certain religions are known to fast, choosing not to eat for specified periods of time, in connection with their religious beliefs. Observation of a person displaying this behavior, without an understanding of its religious motivations, would cause inaccurate classification. This behavior would increase the risk of death or disability if it were continued for a long period of time. However, an understanding of fasting s religious ties, would disqualify the behavior as merely deviant behavior of a religious minority.
Accurately picking out mental disorders, as the difference between anorexia nervosa and religious fasting shows, relies on judgement. The specific definitional guidelines described in the DSM-IV provide a procedure for analysis, and therefore are only as good as their application within a culture.
Emery, R.E., & Oltmanns, T.F. (1998). Abnormal Psychology (2nd ed.). Upper Sadle River, NJ: Prentice-Hall, Inc.
Kleinman, A. (1988). What is a psychiatric diagnosis? In A. Kleinman (Ed.), Rethinking psychiatry (pp. 5-17). New York: The Free Press.
Wakefield, J.C. (1992). On the boundary between biological facts and social values. American Psychologist, 47, 373-388.