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94-632: Other specified paraphilic disorder is the term used by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ) to refer to any of the many other paraphilic disorders that are not explicitly named in the manual. Along with unspecified paraphilic disorder , it replaced the DSM-IV-TR category paraphilia not otherwise specified ( PNOS ). In the revised DSM-5-TR published in 2022 no changes have been made regarding Other specified paraphilic disorder . Examples listed by

188-472: A United States Army manual. Revisions since its first publication in 1952 have incrementally added to the total number of mental disorders , while removing those no longer considered to be mental disorders. Recent editions of the DSM have received praise for standardizing psychiatric diagnosis grounded in empirical evidence, as opposed to the theory-bound nosology (the branch of medical science that deals with

282-438: A category reflected a particular underlying pathology (an approach described as " neo-Kraepelinian "). The psychodynamic view was marginalised, although still influential, in favor of a regulatory or legislative model that emphasised observable symptoms. A new "multiaxial" system attempted to yield a picture more amenable to a statistical population census, rather than a simple diagnosis . Spitzer argued "mental disorders are

376-453: A clinical-significance criterion to almost half of all the categories, which required symptoms causing "clinically significant distress or impairment in social, occupational, or other important areas of functioning". Some personality-disorder diagnoses were deleted or moved to the appendix. The DSM-IV characterizes a mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that

470-984: A congress of the International Statistical Institute (ISI) in Chicago. (The ISI had commissioned him to create it in 1891). A number of countries adopted the ISI's system. In 1898, the American Public Health Association (APHA) recommended that United States registrars also adopt the system. In 1900, an ISI conference in Paris reformed the Bertillion Classification, and created the International List of Causes of Death (ILCD) . Another conference would be held every ten years, and

564-832: A continuation of the Statistical Manual for the Use of Hospitals of Mental Diseases. Each item was given an ICD-6 equivalent code, where applicable. The DSM-I centers on three classes of symptoms: psychotic, neurotic, and behavioral.   Within each class of mental disorder, classifying information is provided to differentiate conditions with similar symptoms.  Under each broad class of disorder (e.g. "Psychoneurotic Disorders" or "Personality Disorders"), all possible diagnoses are listed, generally from least to most severe. The 1952 DSM version also includes sections detailing how to record patients' disorders along with their demographic details.   The form includes information like

658-448: A conversation between consumer and drug company that threatens to cut the doctor out of the loop. Additionally, there is a widespread concern regarding the extent of the pharmaceutical marketing direct to doctors and other healthcare professionals. Examples of this direct marketing are visits by salespeople, funding of journals, training courses or conferences, incentives for prescribing, and the routine provision of "information" written by

752-545: A disorder. For nearly half the disorders, symptoms must be sufficient to cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning", although DSM-IV-TR removed the distress criterion from tic disorders and several of the paraphilias due to their egosyntonic nature. Each category of disorder has a numeric code taken from the ICD coding system , used for health service (including insurance) administrative purposes. The DSM-IV

846-509: A distinction between neurosis and psychosis (roughly, anxiety/depression broadly in touch with reality, as opposed to hallucinations or delusions disconnected from reality). Sociological and biological knowledge was incorporated, under a model that did not emphasize a clear boundary between normality and abnormality. The idea that personality disorders did not involve emotional distress was discarded. A study published in Science in 1973,

940-516: A far wider mandate under the influence and control of Spitzer and his chosen committee members. One added goal was to improve the uniformity and validity of psychiatric diagnosis in the wake of a number of critiques, including the famous Rosenhan experiment . There was also felt a need to standardize diagnostic practices within the United States and with other countries, after research showed that psychiatric diagnoses differed between Europe and

1034-408: A fear of ill-health and a strong notion of individual responsibility has been derided as "health fascism" by some scholars as it objectifies the individual without considering emotional or social factors. Several decades on the definition of medicalization is complicated, if for no other reason than because the term is so widely used. Many contemporary critics position pharmaceutical companies in

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1128-512: A form of "healthism", which is moralistic in nature rather than primarily focused on health. Medical doctors Petr Shkrabanek and James McCormick wrote a series of publications on this topic in the late 1980s and early 1990s criticizing the UK's Health of The Nation campaign. These publications exposed abuse of epidemiology and statistics by public health authorities and organizations to support lifestyle interventions and screening programs. Inculcating

1222-410: A form of social control in which medical authority expanded into domains of everyday existence, and they rejected medicalization in the name of liberation. This critique was embodied in works such as Conrad's article "The discovery of hyperkinesis: notes on medicalization of deviance", published in 1973 ( hyperkinesis was the term then used to describe what we might now call ADHD ). Nevertheless, opium

1316-427: A global society, not simply those forms linked to the established (bio)medical professions. Looking at "knowledge", beyond the confines of professional boundaries, may help us understand the multiplicity of ways in which medicalization can exist in different times and societies, and allow contemporary societies to avoid such pitfalls as "demedicalization" (through a turn towards complementary and alternative medicine ) on

1410-627: A new edition of the ILCD would be released. Five were ultimately issued. Non-fatal conditions were not included. In 1903, New York's Bellevue Hospital published "The Bellevue Hospital nomenclature of diseases and conditions", which included a section on "Diseases of the Mind". Revisions were released in 1909 and 1911. It was produced with the assistance of the AMA and Bureau of the Census. In 1917, together with

1504-627: A number of phenomena considered "deviant", such as alcoholism , drug addiction , prostitution , pedophilia , and masturbation ("self-abuse"), were originally considered as moral, then legal, and now medical problems. Innumerable other conditions such as obesity, smoking cigarettes, draft malingering, bachelorhood, divorce, unwanted pregnancy, kleptomania, and grief, have been declared diseases by medical and psychiatric authorities. Due to these perceptions, peculiar deviants were subjected to moral, then legal, and now medical modes of social control. Similarly, Conrad and Schneider concluded their review of

1598-415: A patient with a close approximation to the prototype is said to have that disorder. DSM-IV states, "there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries" but isolated, low-grade, and non-criterion (unlisted for a given disorder) symptoms are not given importance. Qualifiers are sometimes used: for example, to specify mild, moderate, or severe forms of

1692-512: A patient's area of residence, admission status, discharge date/condition, and severity of disorder. See Figure 1. for the form that psychiatrists were asked to utilize for recording preliminary diagnostic information. Furthermore, the APA listed homosexuality in the DSM as a sociopathic personality disturbance. Homosexuality: A Psychoanalytic Study of Male Homosexuals , a large-scale 1962 study of homosexuality by Irving Bieber and other authors,

1786-691: A revision of the DSM, which was published in 1968. DSM-II was similar to DSM-I, listed 182 disorders, and was 134 pages long. The term "reaction" was dropped, but the term " neurosis " was retained. Both the DSM-I and the DSM-II reflected the predominant psychodynamic psychiatry, although both manuals also included biological perspectives and concepts from Kraepelin 's system of classification. Symptoms were not specified in detail for specific disorders. Many were seen as reflections of broad underlying conflicts or maladaptive reactions to life problems that were rooted in

1880-452: A specific paraphilic disorder cannot be identified or the clinician chooses not to specify it for some other reason, the unspecified paraphilic disorder diagnosis may be used instead. Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders ( DSM ; latest edition: DSM-5-TR , published in March 2022 ) is a publication by

1974-531: A subset of medical disorders", but the task force decided on this statement for the DSM: "Each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome." Personality disorders were placed on axis II along with "mental retardation". The first draft of DSM-III was ready within a year. It introduced many new categories of disorder, while deleting or changing others. A number of unpublished documents discussing and justifying

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2068-399: A three-step process: first, each group conducted an extensive literature review of their diagnoses; then, they requested data from researchers, conducting analyses to determine which criteria required change, with instructions to be conservative; finally, they conducted multi-center field trials relating diagnoses to clinical practice. A major change from previous versions was the inclusion of

2162-517: A version of Medical 203 specifically for use in the United States, to standardize the diverse and confused usage of different documents. In 1950, the APA committee undertook a review and consultation. It circulated an adaptation of Medical 203, the Standard ' s nomenclature, and the VA system's modifications of the Standard to approximately 10% of APA members. 46% of members replied, with 93% approving

2256-508: Is pharmaceuticalization , the influence of the use of pharmaceutical drugs rather than other interventions. Other components are computerization of parts of healthcare such as public health, the creation of a "biopolitical economy" of private research outside of state, the perception of health as a moral obligation. Medicalization has brought health issues to the fore, so people think more and more about things in terms of health and act to promote health. When it comes to health issues, medicine

2350-515: Is applied to behaviors which are not self-evidently medical or biological. The term medicalization entered the sociology literature in the 1970s in the works of Irving Zola , Peter Conrad and Thomas Szasz , among others. According to Eric Cassell 's book, The Nature of Suffering and the Goals of Medicine (2004), the expansion of medical social control is being justified as a means of explaining deviance. These sociologists viewed medicalization as

2444-452: Is associated with present distress or disability or with a significant increased risk of suffering death, pain, disability, or an important loss of freedom". It also notes that "although this manual provides a classification of mental disorders it must be admitted that no definition adequately specifies precise boundaries for the concept of 'mental disorder." The DSM-IV is a categorical classification system. The categories are prototypes, and

2538-512: Is deemed to be justified in terms of public health." Moreover, the pressure for medicalization now comes from society itself as well as from the government and medical professionals. For many years, marginalized psychiatrists (such as Peter Breggin , Paula Caplan , Thomas Szasz ) and outside critics (such as Stuart A. Kirk ) have "been accusing psychiatry of engaging in the systematic medicalization of normality". More recently these concerns have come from insiders who have worked for and promoted

2632-742: Is low for many disorders in the DSM-5, including major depressive disorder and generalized anxiety disorder . An alternate, widely used classification publication is the International Classification of Diseases (ICD), produced by the World Health Organization (WHO). The ICD has a broader scope than the DSM, covering overall health as well as mental health; chapter 6 of the ICD specifically covers mental, behavioral and neurodevelopmental disorders. Moreover, while

2726-509: Is studied from a sociologic perspective in terms of the role and power of professionals , patients, and corporations, and also for its implications for ordinary people whose self-identity and life decisions may depend on the prevailing concepts of health and illness. Once a condition is classified as medical, a medical model of disability tends to be used in place of a social model . Medicalization may also be termed pathologization or (pejoratively) " disease mongering ". Since medicalization

2820-426: Is the social process through which a condition becomes a medical disease in need of treatment, medicalization may be viewed as a benefit to human society. According to this view, the identification of a condition as a disease will lead to the treatment of certain symptoms and conditions, which will improve overall quality of life. The concept of medicalization was devised by sociologists to explain how medical knowledge

2914-399: Is there any credible evidence that any version of the manual has greatly increased its reliability beyond the previous version. There are important methodological problems that limit the generalizability of most reliability studies. Each reliability study is constrained by the training and supervision of the interviewers, their motivation and commitment to diagnostic accuracy, their prior skill,

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3008-416: Is uniformly high. Reliability appears to be only satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories". As described by Ronald Bayer, a psychiatrist and gay rights activist, specific protests by gay rights activists against

3102-558: The Psychodynamic Diagnostic Manual . However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world, and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. It is used by researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies ,

3196-627: The American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is an internationally accepted manual on the diagnosis and treatment of mental disorders, though it may be used in conjunction with other documents. Other commonly used principal guides of psychiatry include the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and

3290-459: The American Psychiatric Association (e.g., Robert Spitzer , Allen Frances ). Benjamin Rush , the father of American psychiatry, claimed that Black people had black skin because they were ill with hereditary leprosy. Consequently, he considered vitiligo as a "spontaneous cure". According to Franco Basaglia and his followers, whose approach pointed out the role of psychiatric institutions in

3384-668: The New York State Psychiatric Institute . However, the influence of clinical psychiatrists, themselves often working with psychoanalytic ideas, were still strong. Other criteria, and potential new categories of disorder, were established by debate, argument and consensus during meetings of the committee chaired by Spitzer. A key aim was to base categorization on colloquial English (which would be easier to use by federal administrative offices), rather than by assumption of cause, although its categorical approach still assumed each particular pattern of symptoms in

3478-634: The Rosenhan experiment , received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis. An influential 1974 paper by Robert Spitzer and Joseph L. Fleiss demonstrated that the second edition of the DSM (DSM-II) was an unreliable diagnostic tool. Spitzer and Fleiss found that different practitioners using the DSM-II rarely agreed when diagnosing patients with similar problems. In reviewing previous studies of eighteen major diagnostic categories, Spitzer and Fleiss concluded that "there are no diagnostic categories for which reliability

3572-741: The Standard), was released. Along with the New York Academy of Medicine , the APA provided the psychiatric nomenclature subsection. It became well adopted in the US within two years. A major revision of the Statistical Manual was made in 1934, to bring it in line with the new Standard. A number of revisions of the Standard were produced, with the last in 1961. World War II saw the large-scale involvement of U.S. psychiatrists in

3666-436: The U.S. House of Representatives , stating that "the most glaring and remarkable errors are found in the statements respecting nosology , prevalence of insanity, blindness, deafness, and dumbness, among the people of this nation", pointing out that in many towns African Americans were all marked as insane, and calling the statistics essentially useless. The Association of Medical Superintendents of American Institutions for

3760-472: The classification of diseases ) used in DSM-III. However, it has also generated controversy and criticism , including ongoing questions concerning the reliability and validity of many diagnoses; the use of arbitrary dividing lines between mental illness and " normality "; possible cultural bias ; and the medicalization of human distress. The APA itself has published that the inter-rater reliability

3854-478: The clinical , involving serious side effects worse than the original condition; the social , whereby the general public is made docile and reliant on the medical profession to cope with life in their society; and the structural , whereby the idea of aging and dying as medical illnesses effectively "medicalized" human life and left individuals and societies less able to deal with these "natural" processes. The concept of medicalization dovetailed with some aspects of

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3948-432: The 1970s feminist movement. Critics such as Ehrenreich and English (1978) argued that women's bodies were being medicalized by the predominantly male medical profession. Menstruation and pregnancy had come to be seen as medical problems requiring interventions such as hysterectomies . Marxists such as Vicente Navarro (1980) linked medicalization to an oppressive capitalist society. They argued that medicine disguised

4042-548: The APA began in 1970, when the organization held its convention in San Francisco . The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. In 1971, gay rights activist Frank Kameny worked with the Gay Liberation Front collective to demonstrate at the APA's convention. At the 1971 conference, Kameny grabbed

4136-480: The Armed Forces nomenclature [were] introduced into many clinics and hospitals by psychiatrists returning from military duty." The Veterans Administration also adopted a slightly modified version of the standard in 1947. The further developed Joint Armed Forces Nomenclature and Method of Recording Psychiatric Conditions was released in 1949. In 1948, the newly formed World Health Organization took over

4230-498: The DSM and the ICD manuals, which may not systematically match because revisions are not simultaneously coordinated. Though recent editions of the DSM and ICD have become more similar due to collaborative agreements, each one contains information absent from the other. For instance, the two manuals contain overlapping but substantially different lists of recognized culture-bound syndromes . The ICD also tends to focus more on primary-care and low and middle-income countries, as opposed to

4324-533: The DSM is the most popular diagnostic system for mental disorders in the US, the ICD is used more widely in Europe and other parts of the world, giving it a far larger reach than the DSM. An international survey of psychiatrists in sixty-six countries compared the use of the ICD-10 and DSM-IV. It found the former was more often used for clinical diagnosis while the latter was more valued for research. This may be because

4418-616: The DSM tends to put more emphasis on clear diagnostic criteria, while the ICD tends to put more emphasis on clinician judgement and avoiding diagnostic criteria unless they are independently validated. That is, the ICD descriptions of psychiatric disorders tend to be more qualitative information, such as general descriptions of what various disorders tend to look like. The DSM focuses more on quantitative and operationalized criteria; e.g., to be diagnosed with X disorder, one must fulfill 5 of 9 criteria for at least 6 months. The DSM-IV-TR (4th ed.) contains specific codes allowing comparisons between

4512-492: The DSM's focus on secondary psychiatric care in high-income countries. The initial impetus for developing a classification of mental disorders in the United States was the need to collect statistical information. The first official attempt was the 1840 census , which used a single category: " idiocy / insanity ". Three years later, the American Statistical Association made an official protest to

4606-470: The DSM-5 are telephone scatologia , necrophilia , zoophilia , coprophilia , klismaphilia , and urophilia . Partialism was considered a Paraphilia NOS in the DSM-IV, but was subsumed into fetishistic disorder by the DSM-5. In order to be diagnosable, the interest must be recurrent and intense, present for at least six months, and cause marked distress or impairment in important areas of functioning. When

4700-615: The Insane ("The Superintendents' Association") was formed in 1844. In 1860, during the international statistical congress held in London, Florence Nightingale made a proposal that was to result in the development of the first international model of systematic collection of hospital data. In 1872, the American Medical Association (AMA) published its Nomenclature of Diseases , which included various "Disorders of

4794-786: The Intellect". Its use was short-lived however. Edward Jarvis and later Francis Amasa Walker helped expand the census, from two volumes in 1870 to twenty-five volumes in 1880. In 1888, the Census Office published Frederick H. Wines' 582-page volume called Report on the Defective, Dependent, and Delinquent Classes of the Population of the United States, As Returned at the Tenth Census (June 1, 1880) . Wines used seven categories of mental illness, which were also adopted by

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4888-633: The National Commission on Mental Hygiene (now Mental Health America ), the American Medico-Psychological Association developed a new guide for mental hospitals called the Statistical Manual for the Use of Institutions for the Insane . This guide included twenty-two diagnoses. It would be revised several times by the Association, and by the tenth edition in 1942, was titled Statistical Manual for

4982-749: The Superintendents: dementia , dipsomania (uncontrollable craving for alcohol), epilepsy , mania , melancholia , monomania , and paresis . In 1892, the Superintendents' Association expanded its membership to include other mental health workers, and renamed to the American Medico-Psychological Association (AMPA). In 1893, a French physician, Jacques Bertillon , introduced the Bertillon Classification of Causes of Death at

5076-495: The United States. The establishment of consistent criteria was an attempt to facilitate the pharmaceutical regulatory process. The criteria adopted for many of the mental disorders were influenced by the Research Diagnostic Criteria (RDC) and Feighner Criteria , which had just been developed by a group of research-orientated psychiatrists based primarily at Washington University School of Medicine and

5170-597: The Use of Hospitals of Mental Diseases . In 1921, the AMPA became the present American Psychiatric Association (APA). The first edition of the DSM notes in its foreword: "In the late twenties, each large teaching center employed a system of its own origination, no one of which met more than the immediate needs of the local institution." In 1933, the AMA's general medical guide the Standard Classified Nomenclature of Disease , (referred to as

5264-625: The basic outline of the Standard and attempting to express present-day concepts of mental disturbance." Under the direction of James Forrestal , a committee headed by psychiatrist Brigadier General William C. Menninger , with the assistance of the Mental Hospital Service, developed a new classification scheme in 1944 and 1945. Issued in War Department Technical Bulletin, Medical, 203 (TB MED 203); Nomenclature and Method of Recording Diagnoses

5358-433: The changes have recently come to light. Field trials sponsored by the U.S. National Institute of Mental Health (NIMH) were conducted between 1977 and 1979 to test the reliability of the new diagnoses. A controversy emerged regarding deletion of the concept of neurosis, a mainstream of psychoanalytic theory and therapy but seen as vague and unscientific by the DSM task force. Faced with enormous political opposition, DSM-III

5452-630: The changes. After some further revisions, the Diagnostic and Statistical Manual of Mental Disorders was approved in 1951 and published in 1952. The structure and conceptual framework were the same as in Medical 203, and many passages of text were identical. The manual was 130 pages long and listed 106 mental disorders. These included several categories of "personality disturbance", generally distinguished from "neurosis" (nervousness, egodystonic ). The foreword to this edition describes itself as being

5546-461: The control and medicalization of deviant behaviors and social problems, psychiatry is used as the provider of scientific support for social control to the existing establishment, and the ensuing standards of deviance and normality brought about repressive views of discrete social groups. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances. According to Kittrie,

5640-475: The criticism it has faced, and to protect its value in contemporary sociological debates. Building on Gadamer 's hermeneutical view of medicine, he focuses on medicine's common traits, regardless of empirical differences in both time and space. Medicalization and social control are viewed as distinct analytical dimensions that in practice may or may not overlap. Correia contends that the idea of "making things medical" needs to include all forms of medical knowledge in

5734-579: The decisions that led to the production of DSM-IV, and the scientific credibility of contemporary psychiatric classification. A text revision of DSM-IV, titled DSM-IV-TR, was published in 2000. The diagnostic categories were unchanged as were the diagnostic criteria for all but nine diagnoses. The majority of the text was unchanged; however, the text of two disorders, pervasive developmental disorder not otherwise specified and Asperger's disorder, had significant and/or multiple changes made. The definition of pervasive developmental disorder not otherwise specified

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5828-509: The healthcare sector. This has been attributed to the commodification of healthcare and the role of parties other than doctors such as insurance companies, the pharmaceutical industry, and the government, referred to collectively as countervailing powers. The doctor remains an authority figure who prescribes pharmaceuticals to patients . However, in some countries, such as the US, ubiquitous direct-to-consumer advertising encourages patients to ask for particular drugs by name, thereby creating

5922-542: The homogeneity of the clinical setting in regard to patient mix and base rates, and the methodological rigor achieved by the investigator ... In 1987, DSM-III-R was published as a revision of the DSM-III, under the direction of Spitzer. Categories were renamed and reorganized, with significant changes in criteria. Six categories were deleted while others were added. Controversial diagnoses, such as Premenstrual Dysphoric Disorder and Masochistic Personality Disorder , were considered and discarded. (Premenstrual Dysphoric Disorder

6016-634: The introductory text stated for at least some disorders, "particularly the Personality Disorders, the criteria require much more inference on the part of the observer"[page xxiii]. In 1994, DSM-IV was published, listing 410 disorders in 886 pages. The task force was chaired by Allen Frances and was overseen by a steering committee of twenty-seven people, including four psychologists. The steering committee created thirteen work groups of five to sixteen members, each work group having about twenty advisers in addition. The work groups conducted

6110-484: The legal system, and policymakers. Some mental health professionals use the manual to determine and help communicate a patient's diagnosis after an evaluation. Hospitals, clinics, and insurance companies in the United States may require a DSM diagnosis for all patients with mental disorders. Health-care researchers use the DSM to categorize patients for research purposes. The DSM evolved from systems for collecting census and psychiatric hospital statistics, as well as from

6204-549: The maintenance of the ILCD. They greatly expanded it, included non-fatal conditions for the first time, and renamed it the International Statistical Classification of Diseases (ICD). The foreword to the DSM-I states the ICD-6 "categorized mental disorders in rubrics similar to those of the Armed Forces nomenclature." The APA Committee on Nomenclature and Statistics was empowered to develop

6298-609: The market for medications. The authors noted: Inappropriate medicalisation carries the dangers of unnecessary labelling, poor treatment decisions, iatrogenic illness, and economic waste, as well as the opportunity costs that result when resources are diverted away from treating or preventing more serious disease. At a deeper level it may help to feed unhealthy obsessions with health, obscure or mystify sociological or political explanations for health problems, and focus undue attention on pharmacological, individualised, or privatised solutions. Public health campaigns have been criticized as

6392-417: The medical community and made her a heroine to many gay men and lesbians, but homosexuality remained in the DSM until May 1974. In the 1960s, there were many challenges to the concept of mental illness itself. These challenges came from psychiatrists like Thomas Szasz , who argued mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman , who said mental illness

6486-401: The medicalization of deviance by identifying three major paradigms that have reigned over deviance designations in different historical periods: deviance as sin; deviance as crime; and deviance as sickness. According to Thomas Szasz , "the therapeutic state swallows up everything human on the seemingly rational ground that nothing falls outside the province of health and medicine, just as

6580-409: The microphone and yelled: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you." This gay activism occurred in the context of a broader anti-psychiatry movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at

6674-467: The most common criticisms being that the biological reductionism and other tenets of medicalisation, individualism and naturalism, generally fail to take into account sociocultural factors contributing to human sexuality . The HIV/AIDS pandemic allegedly caused from the 1980s a "profound re-medicalization of sexuality ". The diagnosis of premenstrual dysphoric disorder (PMDD) has caused some controversy when fluoxetine (also known as Prozac)

6768-885: The one hand, or the over-rapid and unregulated adoption of biomedical medicine in non-western societies on the other. The challenge is to determine what medical knowledge is present, and how it is being used to medicalize behaviors and symptoms. Many aspects of human sexuality have been medicalized and pathologised by psychiatry, psychology and the pharmaceutical industry . This includes masturbation, homosexuality, erectile dysfunction and female sexual dysfunction. Medicalization has also been used to justify sexualisation of transgender people, intersex people and those diagnosed with HIV/AIDS . The medicalization of sexuality has resulted in increased social control , disease mongering , surveillance, and increased funding in some research areas of sexology and human physiology. The practice of medicalizing sexuality has been widely criticized, with one of

6862-483: The pharmaceutical company. The role of patients in this economy has also changed. Once regarded as passive victims of medicalization, patients can now occupy active positions as advocates , consumers , or even agents of change. In response to theory based on medicalisation being insufficient to explain social processes, some scholars have developed a concept of biomedicalization which argues that technical and scientific interventions are transforming medicine. One aspect

6956-500: The potential reach of medicalization as a form of social control, especially in terms of "psychotechnology" (Chorover,1973). In the 1975 book Limits to medicine: Medical nemesis (1975), Ivan Illich put forth one of the earliest uses of the term "medicalization". Illich, a philosopher, argued that the medical profession harms people through iatrogenesis , a process in which illness and social problems increase due to medical intervention. Illich saw iatrogenesis occurring on three levels:

7050-405: The prevailing biomedical ideology , resulting in a disregard for overarching social causes such as unequal distribution of power and resources. A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise. Scholars argue that in the late 20th century transformation within the health sector in the US altered the relationship between people in

7144-414: The reliability of the radically new diagnostic system they had devised, which relied on data from special field trials. However, according to a 1994 article by Stuart A. Kirk : Twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliably by regular mental health clinicians. Nor

7238-399: The same APA conventions, with some shared slogans and intellectual foundations as gay activists. Taking into account data from researchers such as Alfred Kinsey and Evelyn Hooker , the seventh printing of the DSM-II, in 1974, no longer listed homosexuality as a category of disorder. After a vote by the APA trustees in 1973, and confirmed by the wider APA membership in 1974, the diagnosis

7332-469: The selection, processing, assessment, and treatment of soldiers. This moved the focus away from mental institutions and traditional clinical perspectives. The U.S. armed forces initially used the Standard, but found it lacked appropriate categories for many common conditions that troubled troops. The United States Navy made some minor revisions but "the Army established a much more sweeping revision, abandoning

7426-458: The societal implications of brand-name drugs generally remain open to these drugs' curative effects – a far cry from earlier calls for a revolution against the biomedical establishment. The emphasis in many quarters has come to be on "overmedicalization" rather than "medicalization" in itself. Others, however, argue that in practice the process of medicalization tends to strip subjects of their social context, so they come to be understood in terms of

7520-545: The space once held by doctors as the supposed catalysts of medicalization. Titles such as "The making of a disease" or "Sex, drugs, and marketing" critique the pharmaceutical industry for shunting everyday problems into the domain of professional biomedicine . At the same time, others reject as implausible any suggestion that society rejects drugs or drug companies and highlight that the same drugs that are allegedly used to treat deviances from societal norms also help many people live their lives. Even scholars who critique

7614-510: The theological state had swallowed up everything human on the perfectly rational ground that nothing falls outside the province of God and religion". A 2002 editorial in the British Medical Journal warned of inappropriate medicalization leading to disease mongering, where the boundaries of the definition of illnesses are expanded to include personal problems as medical problems or risks of diseases are emphasized to broaden

7708-463: The underlying causes of disease, such as social inequality and poverty, and instead presented health as an individual issue. Others examined the power and prestige of the medical profession, including the use of terminology to mystify and of professional rules to exclude or subordinate others. Tiago Correia (2017) offers an alternative perspective on medicalization. He argues that medicalization needs to be detached from biomedicine to overcome much of

7802-437: Was another example of how society labels and controls non-conformists; from behavioural psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticised the APA's listing of homosexuality as a mental disorder. The APA was closely involved in the next significant revision of the mental disorder section of the ICD (version 8 in 1968). It decided to go ahead with

7896-582: Was being repackaged as a PMDD therapy under the trade named Sarafem . The psychologist Peggy Kleinplatz has criticized the diagnosis as the medicalization of normal human behavior. Other medicalized aspects of women's health include infertility , breastfeeding , the childbirth process, and postpartum depression . Although it has received less attention, it is claimed that masculinity has also faced medicalization, being deemed damaging to health and requiring regulation or enhancement through drugs, technologies or therapy. Specifically, erectile dysfunction

7990-478: Was changed back to what it was in DSM-III-R and the text for Asperger's disorder was practically entirely rewritten. Most other changes were to the associated features sections of diagnoses that contained additional information such as lab findings, demographic information, prevalence, and course. Also, some diagnostic codes were changed to maintain consistency with ICD-9-CM. Medicalization Medicalization

8084-459: Was in serious danger of not being approved by the APA Board of Trustees unless "neurosis" was included in some form; a political compromise reinserted the term in parentheses after the word "disorder" in some cases. Additionally, the diagnosis of ego-dystonic homosexuality replaced the DSM-II category of "sexual orientation disturbance". The gender identity disorder in children (GIDC) diagnosis

8178-420: Was introduced in the DSM-III; prior to the DSM-III's publication in 1980, there was no diagnostic criteria for gender dysphoria . Finally published in 1980, DSM-III listed 265 diagnostic categories and was 494 pages long. It rapidly came into widespread international use and has been termed a revolution, or transformation, in psychiatry. When DSM-III was published, the developers made extensive claims about

8272-419: Was later reincorporated in the DSM-5, published in 2013). "Ego-dystonic homosexuality" was also removed and was largely subsumed under "sexual disorder not otherwise specified", which could include "persistent and marked distress about one's sexual orientation." Altogether, the DSM-III-R contained 292 diagnoses and was 567 pages long. Further efforts were made for the diagnoses to be purely descriptive, although

8366-400: Was once considered a natural part of the aging process in men, but has since been medicalized as a problem, late-onset hypogonadism . According to Mike Fitzpatrick, resistance to medicalization was a common theme of the gay liberation , anti-psychiatry , and feminist movements of the 1970s, but now there is "virtually no resistance to the advance of government intrusion in lifestyle if it

8460-401: Was organized into a five-part axial system: The DSM-IV does not specifically cite its sources, but there are four volumes of "sourcebooks" intended to be APA's documentation of the guideline development process and supporting evidence, including literature reviews, data analyses, and field trials. The sourcebooks have been said to provide important insights into the character and quality of

8554-695: Was released shortly after the war in October 1945 under the auspices of the Office of the Surgeon General . It was reprinted in the Journal of Clinical Psychology for civilian use in July 1946 with the new title Nomenclature of Psychiatric Disorders and Reactions . This system came to be known as "Medical 203". This nomenclature eventually was adopted by all the armed forces, and "assorted modifications of

8648-451: Was replaced with the category of "sexual orientation disturbance". The emergence of DSM-III represented a "quantum leap" in terms of the scale and reach of the manual. In 1974, the decision to revise the DSM was made, and psychiatrist Robert Spitzer was selected as chair of the task force. The initial impetus was to make the DSM nomenclature consistent with that of the International Classification of Diseases (ICD). The revision took on

8742-424: Was used to justify inclusion of the disorder as a supposed pathological hidden fear of the opposite sex caused by traumatic parent–child relationships. This view was influential in the medical profession. In 1956, however, the psychologist Evelyn Hooker performed a study comparing the happiness and well-adjusted nature of self-identified homosexual men with heterosexual men and found no difference. Her study stunned

8836-403: Was used to pacify children in ancient Egypt before 2000 BC. These sociologists did not believe medicalization to be a new phenomenon, arguing that medical authorities had always been concerned with social behavior and traditionally functioned as agents of social control (Foucault, 1965; Szasz,1970; Rosen). However, these authors took the view that increasingly sophisticated technology had extended

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