The Diagnostic and Statistical Manual of Mental Disorders is the reference source clinicians use for diagnosing, labeling, and treating psychological illnesses. Preparation of the latest, the fifth, edition has stirred years of strong controversies. A lot is at stake, from properly caring for the distressed to billing for their treatment.
Underlying the controversies over what constitutes a specific disorder and its symptoms is the fact that mental “illnesses” are not self-evident. Unlike, say, a broken leg, conditions like depression, schizophrenia, and ADHD get “socially constructed”: detected, defined, and diagnosed in negotiations among experts and the wider public. How Americans recognize and understand others’ and their own unusual experiences and behavior have changed greatly over the centuries. Obviously, many fewer Americans today than in the 18th century consider possession by an evil spirit or being bewitched as a reasonable account, say, for hearing voices or for suicide attempts (although these remain popular diagnoses elsewhere). Most intriguing is the possibility that changes in how we define mental disorders shape not just the labeling, but also people’s actual experiences and behavior.