Descriptive Psychopathology: The Signs and Symptoms of ...

2A history of psychiatric classificationThe study of history is the best medicine for a sick mind; for in history you have a record of theinfinite variety of human experience plainly set out for all to see; and in that record you canfind yourself and your country both examples and warnings; fine things to take as models, basethings rotten through and through, to avoid. 1Livy’s awareness of the value of a historical perspective of human experience isechoed by modern medical historians. 2 In the preface to The Origins of ModernPsychiatry, Thompson writes:A study of the history of ideas in any subject is important not only as an abstract field of enquiry,but as a method of retaining an appropriate perspective on the current status of the subject andproposed developments. In most cases “new” ideas have been thought of before ...Psychiatry isa subject which is still developing and in order to understand present controversies and assessthe adequacy of proposed changes an historical perspective is essential. 3The historical perspective reveals that changes in psychiatric classificationsresult from societal and theoretic processes more than from science. Demons,body humors, archetypes, and unconscious psychic forces dominated explanationsfor psychiatric illness for centuries. Social and political pressures buttressedsome conditions (e.g. promoting posttraumatic stress disorder after the Vietnamwar) while eliminating others (e.g. psychiatrists in the USA emerging from theturmoil of the 1960s voted to eliminate homosexuality as a diagnosis, defining itas a lifestyle choice). The notion of a mind–body dichotomy continues to influencepresent thinking (e.g. conversion disorder, shared psychotic disorder).Throughout much of the second millennia CE, 4 classification also reflectedexperience with patients confined to asylums, focusing attention on severe illnesses.Marked deviations in personality were thus considered reflections ofchronic mental deterioration.Lastly, the clinical predisposition of the classifiers impacted the evolvingclassification, as some envisioned substantial heterogeneity among patients and22