Mental Illness: Historical Context and DSM Overview

Ancient Greece and Hippocrates: early biomedical explanations for abnormal behavior; illness viewed as an issue of bodily humors and brain function.
Byzantium (Eastern Roman Empire): notes suggesting biomedical explanations for psychiatric symptoms; challenges linear progressions in understanding.
Renaissance and Reformation (c. 1500s): shift away from biomedical explanations to demon possession, witchcraft, and sorcery; greater marginalization and confinement in asylums; concept of orthodoxy vs orthopraxy altered how belief and practice were valued.
Late 1700s reforms: movement toward humane treatment and rehabilitation rather than mere separation from society.
- Key factors: reduced reliance on punishment, increased interest in welfare of the mentally ill.

Vincenzo Chirubi (Italian physician): recognized suffering and pushed toward better conditions for treatment.
Philippe Penel (French physician): championed moral therapy, advocating working with patients to reintegrate them into society.
William Tuke (English Quaker): funded and organized institutions focused on moral therapy.
Dorothea Dix: campaigned for federal funding and the creation of humane, morally oriented facilities; lobbied Congress for federal hospitals dedicated to moral therapy.
Benjamin Rush: often called the first American psychiatrist; signer of the Declaration of Independence; known for the tranquilizing chair, reflecting historical context rather than modern practice.
1854 legislation and veto: Dorothea Dix influenced a bill to fund federal and state mental health facilities; President Franklin Pierce vetoed it, arguing the federal government shouldn’t handle social welfare at that scale.

DSM: Diagnostic and Statistical Manual of Mental Disorders; current working focus in class is the DSM-5-TR (2022).
Origin and basis: DSM builds on the ICD (International Classification of Diseases) system from the World Health Organization, created in the 1950s for global disease classification and coding.
Evolution: DSM-I (1952) → DSM-IV (1994) → DSM-5 (2013) → DSM-5-TR (2022).
Number of diagnosable disorders: around $300$ diagnoses in the DSM-5-TR (not thousands; the exact number reflects diagnostic categories and specifiers).
Editions differ: some disorders stay unchanged, some are modified, some are removed or added; major reconceptualizations occurred with DSM-5‑TR.
Role of specifiers: provide nuance for how disorders present (e.g., postpartum depression, seasonal affective disorder, etc.).
Practical use: DSM is a key reference for diagnosing and coding mental disorders and facilitates communication across clinicians and settings.

Abnormality is both art and science: context matters in judging when behavior, mood, or perception constitutes a disorder.
Example framing: slipping from a non-conforming fashion choice (e.g., wearing a kilt) to a clinically significant issue depends on functional impact and social context.
DSM as a tool: used to guide diagnosis, organize symptoms, and categorize disorders; not a sole determinant of pathology.

Orthodoxy: beliefs about a faith or system; what you hold to be true.
Orthopraxy: practices and rituals; what you actually do in worship.
Examples: Catholic vs Lutheran differences in saints, intercession, and liturgical practices; how beliefs and practices shape religious experience and identity.
Relevance to psychopathology: cultural and religious contexts influence perceptions of abnormality and help-seeking behaviors; historical shifts show how beliefs about illness and treatment evolve.

Mental illness has historical roots in both biomedical and social-religious frameworks; reform movements in the late 18th–19th centuries shifted focus toward humane care and rehabilitation (moral therapy).
Key reformers/tools shaped modern care: Chirubi, Penel, Tuke, Dix, Rush; moral therapy helped lay groundwork for humane treatment.
The DSM-5-TR, rooted in ICD classification, provides a structured, codified approach to diagnosing mental disorders (≈ $300$ diagnosable disorders with specifiers).
Diagnosis blends science and clinical judgment; context, culture, and individual presentation matter in determining abnormality.