How is mental illness defined? Why is the philosophy of psychiatry the way it is today? Is there hope for improvement in the societal context of ill persons?

1. How Should Mental Illness be
Determined?
Lyndon Woytuck
Theory of Knowledge

2. “Correct” Diagnosis

3. The American Psychiatric Association
The process of differential diagnosis can be
broken down into six basic steps:
1) ruling out Malingering/Factitious Disorder
2) ruling out a substance etiology
3) ruling out an etiological general medical
condition
4) determining the specific primary disorder(s)
5) differentiating Adjustment Disorder from Not
Otherwise Specified (NOS)
6) establishing the boundary with no mental
disorder

5. Statistical Diagnosis
• Based on census and military data
• More to do with “bottom line”
rather than “spectrum”
• Common usage of such texts
• Too broad?

6. Brain Scanning
• Which is first, the disease or the
apparent difference in brain
structure or function?
• "The differences observed are not
in and of themselves outside the
range of variation seen in the
normal population"
- Dr. Jeffrey Lieberman (chairman of
psychiatry department, Columbia
University Medical Center; director of
New York State Psychiatric Institute)

7. Criminality
• Mental illness common in
criminals
• Mentally ill or legitimate
offenders?

8. Multiple Disorders
• Severe/major mental illness &
substance disorder(s)
• Substance disorder(s) & personality
disorder(s)
• Substance disorder(s), personality
disorder(s) & substance induced acute
symptoms which may need psychiatric
care (i.e. hallucinations, depression, &
other symptoms from substance
abuse/withdrawal)
• Substance abuse, mental illness, &
organic syndromes in various
combinations. (Organic syndromes
may be independent or a result of
substance abuse)

9. Social Diagnosis
• “After multiple racist killings during the civil
rights movement, a group of black psychiatrists
sought to have murderous bigotry based on
race classified as a mental disorder. The APA’s
officials rejected that recommendation,
arguing that since so many Americans are
racist, racism in this country is normative.” -Dr.
Alvin Poussaint (recalling 1969)
• “If there is general agreement among
clinicians, who would be expected to
encounter the condition, that there are
significant number of patients who have it and
that its identification is important in the clinical
work it is included in the classification.” –DSM
task force (1980)
• “[Racism] is not something that is designated
as an illness that can be treated by mental
health professionals.” -Chairperson of APA’s
Council on Psychiatry and the Law (1999)

10. Social Diagnosis
• “In a culture that scorns and demeans lesbians
and gay men, it is hard to be completely
comfortable with one’s homosexuality, and so
the DSM-III authors were treating as a mental
disorder what was often simply a perfectly
comprehensible reaction to being mocked
and oppressed.” -Paula Caplan
• “The problem with PMDD is not the women
who report premenstrual mood problems but
the diagnosis of PMDD itself. Excellent research
shows that these women are significantly more
likely than other women to be in upsetting life
situations, such as being battered or being
mistreated at work. To label them mentally
disordered — to send the message that their
problems are individual, psychological ones —
hides the real, external sources of their
trouble.” -Paula Caplan

11. Over-diagnosis
• In 2005, a major study announced that “About half
of Americans will meet the criteria for a DSM-IV
disorder sometime in their life…”
• “…a large proportion of behaviors that are currently
regarded as mental illnesses are normal
consequences of stressful social arrangements or
forms of social deviance. Contrary to its general
definition of mental disorder, the DSM and much
research that follows from it considers all symptoms,
whether internal or not, expected or not, deviant or
not, as signs of disorder.” -Alan Horowitz
• A 2007 survey of 8- to 15-year-olds discovered that
nine percent met the DSM criteria for attention
deficit/hyperactivity disorder (ADHD). The survey
found that fewer than half of these children had
been diagnosed or treated, “suggesting that some
children with clinically significant inattention and
hyperactivity may not be receiving optimal
attention.” Noting that poor children were least
likely to receive medication, the authors of the
study recommend “further investigation and
possible intervention.”

12. Cultural Diagnosis
• Spiritual
• Stigma
• Different susceptibility
• "Genuine human engagement and
spirituality can be powerful tools in
promoting well-being. The healers are
intimately involved with their patients
and their community, and they share in
the results of their work.“ -Mariana G.
Hewson, PhD

13. How Should Mental Illness be
Determined?
What is the definition?
SocialCircumstance?Medication
Money
Biology?
Psychology?
Criteria/Statistics?

14. Bibliography
• DSM-IV-TR® Handbook of Differential Diagnosis. American Psychiatric Publishing,
Inc. http://www.psychiatryonline.com.
• http://books.google.ca/books?
hl=en&lr=&id=RgnFHUmpVckC&oi=fnd&pg=PP15&dq=diagnosis+mental+illness+p
hysiological&ots=WnA5Fwt_dB&sig=CjCYZP3rn9MHUSmtZLYulXukZjY#PPA2,M1
• http://www.nytimes.com/2005/10/18/health/psychology/18imag.html?
ex=1287288000&en=623b95b778748ffa&ei=5088&partner=rssnyt&emc=rss
• Sciacca, Kathleen. Glossary of Terms - Dual Diagnosis, Co-occurring Disorders.
http://users.erols.com/ksciacca. 1996.
• http://www.washingtonpost.com/ac2/wp-dyn/A57411-2001Dec17?
language=printer
• http://www.medhunters.com/articles/theyrePossessed.html