what is a mental disability definition
What is a mental disorder? This is a question the American Psychiatric Association (2012) has been contemplating as it prepares the DSM-5, the soon-to-be-published revision of its Diagnostic and Statistical Manual of Mental Disorders. The DSM-5 development website proposes the following new definition of mental disorder (APA, 2012):
- A behavioral or psychological syndrome or pattern that occurs in an individual
- That reflects an underlying psychobiological dysfunction
- The consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)
- Must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals)
- That is not primarily a result of social deviance or conflicts with society
To many people, this sounds pretty good on first read. But how readily does this definition allow us to truly distinguish what is or isn’t a disorder? What are the underlying assumptions that this definition implies? Let’s consider the first two definitional criteria, which when combined hold that a mental disorder is “a behavioral or psychological syndrome or pattern that occurs in an individual that reflects an underlying psychobiological dysfunction” (APA, 2012).
The DSM has long claimed to be “atheoretical” about the causes of mental disorders (APA, 1980, 1987, 1994, 2000). This makes sense if you think about all the constituencies the DSM has to please. Mental health professionals have a lot of different (often conflicting) ideas about what causes people to experience problems in living. They also often disagree on how best to alleviate such problems. Should they rely on medication, psychoanalysis, behavioral conditioning, rational argument, extended family discussions, sociopolitical consciousness raising, or any number of other possible intervention strategies to help those they serve? In order to avoid alienating any particular constituency of mental health professionals, the DSM has strategically adopted an atheoretical stance on the etiology (causes) of mental disorders. At the same time, the DSM hews to a medical model by organizing mental disorders into discrete categories, just as medicine does with diseases. That is, DSM is a medical-model manual that is nonetheless atheoretical about the causes of the disorders it catalogs. This is kind of confusing, but important to keep in mind.
Trying to be atheoretical about causes makes defining disorders difficult. This is readily apparent in the DSM-5’s proposed definition, which says that a mental disorder is “a behavioral or psychological syndrome or pattern that occurs in an individual” (APA, 2012). What does this mean? To start with, it means that disorders are inside people. They are things people “have.” Can I have a psychological syndrome or pattern inside me? Even though we can’t observe it directly, the idea that our “psychology” is inside us seems commonsensical to most people. But what about our behavior? Is it also inside us? No. Behavior is something people do. It is observable, not inside us. Thus, to say that behavior is something that occurs in an individual doesn’t quite hang together theoretically. At the very least, it might irritate died-in-the-wool behaviorists, who discourage us from relying on abstract mental concepts to explain behavior.
However, things get really hairy when we shift to the second definitional criterion, which holds that these “behavioral or psychological syndromes or patterns” reflect an “underlying psychobiological dysfunction” (APA, 2012). First, this marks a clear shift away from the aforementioned “atheoretical” position that has been a hallmark of the DSM for the past 30-plus years. Second, in claiming that mental disorders are psychobiological, the DSM’s reach clearly exceeds its grasp. Let me take these two points one at a time.
The first point concerns the move away from an atheoretical stance on the causes of disorders. As already noted, the DSM has long sought to keep the peace among professionals of varying theoretical orientations by remaining mute when it comes to specifying the causes of mental disorder. It has prided itself on sticking to descriptions of disorders and avoiding speculation about causes. Discovering etiology, according to past DSMs, is best left to researchers. Given this longstanding commitment to an atheoretical position on etiology, the prospect of changing the definition of mental disorder to one that explicitly defines disorders as “psychobiological dysfunctions” is big news indeed because doing so is overtly theoretical. Psychobiology conceptualizes human psychology as something that can be reduced to and explained exclusively in biological terms. As such, the proposed new definition of mental disorder contends that all DSM disorders have biological causes. 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