Though I'd rather see a catalog of the symptoms of wellness, the mental health field continues to keep its focus on disease this month by releasing a new version of its mental health "bible," the Diagnostic and Statistical Manual-5. Used by all behavioral healthcare professionals in the United States, the manual is revised every 15 or so years after much debate, research, and field-testing. The purpose of the volume is to establish a common language for medical specialists as they work on behalf of clients, and for researchers comparing results study to study. But for the general pubic the practical reality involves the third party reimbursements many people count on to pay for their treatment.

As a "psychiatric social worker," and a university instructor of various types of family therapies over these past thirty years, I've seen each version of the manual be strongly influenced by the types of treatments available at the time, (lobotomy, electroshock, drugs, psychotherapy), the scientific breakthroughs in understanding the body and the brain, (brain imaging, behavioral outcome research) and the cultural biases of each decade.

  At the University Health Center where I worked in the 70s, the stigma associated with mental illness had students experiencing headaches praying for a brain tumor so there would be a physical reason for their symptoms. This same stigma keeps some people from seeking treatment, even today. But culture and attitudes do change and with them, the list of diseases. Thankfully homosexuality is no longer considered a disease, and the lack of control over one's drinking earns an addiction diagnosis today rather than a moral judgment on one's character.

When the first volume was published in 1952, followed by the second in 1968, Freudian psychotherapy was in vogue. The operating principle then, according to Rick Mayer and Allan V. Horwitz was that "overt symptoms did not reveal disease entities but disguised underlying conflicts that could not be expressed directly." By the time the DSM III came along in the early 80's with a revision in 1987, a school of thought had emerged that objected to categories of diseases.

Karl Menninger