The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines “mental disorder” as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress...or disability...or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one...Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above” (xxxi, my emphases).
The American Psychiatric Association currently proposes to change this definition in DSM-V to a “behavioral or psychological syndrome or pattern that occurs in an individual, that is based in a decrement or problem in one or more aspects of mental functioning, including but not limited to global functioning (e.g., consciousness, orientation, intellect, or temperament) or specific functioning (e.g., attention, memory, emotion, psychomotor, perception, thought); that is not 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); and that is not primarily a consequence of social deviance or conflict with society” (my emphases and semicolons).
The APA explains that the proposed changes in the definition are meant mainly to shift the focus to the underlying cause and symptoms of a mental condition, leaving the condition’s consequences to the treatment-planning rather than to the diagnostic stage. But as I’ve emphasized, both definitions (1) use quasi-normative language of “disability,” “dysfunction,” “loss,” “decrement” (that is, loss from diminution or decrease), or “problem,” and (2) specifically rule out socially deviant behaviour as mentally disordered unless that behaviour is caused by a dysfunction. These two parts of the definitions conflict with each other.





