Are We Able to Differentiate between True Mental Disorders and Homeostatic Reactions to Adverse Life Events?
Authors: Mario Maj
Journal: Psychotherapy and Psychosomatics (2007)

from a very authoritative source [3] . Perhaps at this point the average psychiatrist will have realized that the problem is a real one: at the moment we do not have a clear idea of how to fix the threshold for the diagnosis of some mental disorders (in particular of those with the highest prevalence in the community, i.e. mood and anxiety disorders), and of how to differentiate between these disorders and homeostatic reactions to adverse life events. We have to address this situation urgently, because it may damage the credibility of our discipline and our profession. Why is this problem becoming so visible only now? One contributing factor has certainly been the recent broadening of the scope of psychiatric intervention from traditional hospital settings, where the issue whether admitted patients had or did not have a mental disorder was not really relevant, to community settings, where this issue is a sensitive one in several cases. A second factor has been the increased presence and influence in the mental health field of several other professions, whose perception of mental health problems is often different from that of psychiatrists. A third factor has been the higher level of information and awareness of users, families and the public opinion. A fourth factor has probably been the translation of traditional descriptive definitions of mental disorders into current operational diagnostic criteria. Traditional definitions seemed to convey a gestalt, a structure of the various disorders, while current operational definitions seem to be less able to do so. Whether ‘Determining when relatively common experiences such as anxiety or sadness... should be considered evidence of some disorder requires the setting of boundaries that are largely arbitrary, not scientific, unlike setting the boundaries for what constitutes cancer or pneumonia.’ This is a statement which appeared a few years ago in a vitriolic book entitled Making Us Crazy. DSM: The Psychiatric Bible and the Creation of Mental Disorders [1] . To the average psychiatrist, this statement will probably appear incorrect and ideologically biased. He has learnt to believe that our current systems for the diagnosis and classification of mental disorders have received a convincing empirical validation and that these systems differentiate reliably between true mental disorders and common hassles of everyday life. ‘It is not always easy to establish a threshold for a mental disorder, particularly in light of how common symptoms of mental distress are and the lack of objective, physical symptoms.’ This is a statement by the US Surgeon General [2] . Here, ignorance and ideological bias are not likely to be involved. However, this view from outside the psychiatric field could still reflect to some degree a prejudice against our profession. ‘Based on the high prevalence rates identified in both the ECA and the NCS, it is reasonable to hypothesize that some syndromes in the community represent transient homeostatic responses to internal or external stimuli that do not represent true psychopathologic disorders.’ This is a statement coming from within the psychiatric field, and