Disease Entity or Culture-Bound Syndrome? The Troubled History of DSM-IV’s Major Depressive Disorder

The United States is currently gripped by a very controversial political campaign. I am not speaking of the forthcoming election of a new president. Instead, I am speaking of the political battles now being waged to change the content and the character of the forthcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, which is scheduled to appear in print in 2012. The 4th edition of 1994, commonly referred to as DSM-IV, has remained relatively unchanged since the appearance of the third edition in 1980. Most historians of psychiatry regard the appearance of DSM-III some 28 years ago as a fundamental turning point in not only the history and practice of medicine, but also as the engine of a profound cultural change. The new diagnostic classification system and new nomenclature introduced in 1980 has not only framed scientific research on mental disorders since that time; it has also significantly influenced the therapeutic 2 practice of psychiatrists, psychologists, counselors and other mental health professionals. In the medical model, treatment rationally follows from diagnosis. The way in which individual diagnoses are defined, therefore, also defines the type of distress a person i