How Does the DSM Define Mental Health?

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Reader’s Question

I’m curious as to what the definition of mental health is or what the criteria might be. I have read the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association) and notice how its criteria for mental illnesses are merely lists of symptoms. So, I’m wondering what the standard, or model of health, is that the DSM compares its “disorders” against.

Psychologist’s Reply

The model for diagnosing mental illness has changed considerably over the years. In an effort to gain greater objectivity and reliability with respect to diagnoses, the official diagnostic schemes are now comprised of objectively verifiable, observable behaviors either exhibited by a person (signs) or reported by the person (symptoms). That’s not to say that the present diagnostic methodology isn’t without legitimate criticism. One of the biggest criticisms, of course, is that just about every behavior that deviates from the norm or in some way causes distress can sometimes be labeled a “disorder,” and that connotation sometimes implies a condition for which the person bears no responsibility or over which they have no control.

Generally speaking, for a syndrome to be considered a “disorder,” it must represent a significant departure from generally accepted developmental, social, health, cultural, etc. norms and cause significant impairment in one or more areas of functioning. So, from a practical standpoint, what’s “normal” is technically more of a statistical term (literally meaning that which is most common in a given population — i.e., closest to the “norm” for a particular culture). Also, what’s considered healthy has mostly to do with how adaptive a set of behaviors is with respect to allowing a person to function physically, emotionally, socially, etc. without causing significant distress to themselves or others.

The question you raise is interesting from many perspectives. There have been several times during my years of clinical practice when I was certain there was a disorder present that wasn’t neatly outlined in the official manual. Further, there were also times when individuals presented themselves for counseling about problems when the only valid diagnosis was “No Diagnosis” — meaning that the problems they were having were not really the result in any way of any true mental disorder.

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Hopefully, this information has helped answer a really difficult but nonetheless important question. You might find some additional helpful information on the websites for the American Psychiatric Association, World Psychiatric Association, World Health Organization, and American Psychological Association.

[Editor’s Note: For more on the ways in which psychiatric diagnoses are very unlike medical diagnoses, see our separate page on diagnostic criteria and basic science.]

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