Psychological disorder

Pincus et al correctly point out that what is often called "the co-morbidity problem" is unavoidable, because it is simply a fact of life in clinical psychiatry. They provide a useful discussion of the topic, but the very use of the conventional term 'co-morbidity' serves to hide the real nature of the problem. This is because 'morbid' means disease, and to have a disease is conceptually very different from suffering from a disorder. Strictly speaking, the terms 'diagnosis' and 'disease' are both best avoided in psychiatric discourse unless they are completely justified. Clinical psychiatrists make few diagnoses in the sense of identifying known abnormalities which underlie the presenting symptoms. Instead, for most patients they have to make do with identifying disorders by assessing the number and severity of individually non-diagnostic symptoms from an agreed list. Most currently recognised disorders are no more than symptom clusters, and there is no particular reason why most patients should be expected to have only one of these. Viewed in this way, it is clear that it would be more honest for psychiatrists to use other terms, such as 'co-existing disorders' or 'multiple disorders'.Disorders are different from diseases. John Cooper1