Mental Health and Wellness

The Origin of Mental Illness Classification

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German Psychiatrist Emil Kraepelin, photo courtesy.

Due to the complex nature of mental illnesses, mental health professionals diagnose illnesses based on classifications. Classification in this context means placing a clinical condition into a category based on shared characteristics.

Classification in psychiatry attempts to bring some order into the great diversity of phenomena encountered in clinical practice. It enables health professionals to communicate easily about the nature of a patient’s problem, prognosis and treatment.

Over the years, there have been numerous attempts to classify mental illnesses with the earliest known attempt being in 1796 by English physician William Cullen, who attempted to classify mental illnesses by using an approach based on biologist’s systems for classifying plants and animals.

Almost a century later, German psychiatrist Emil Kraepelin, published the first recognized textbook of psychiatry titled Compendium of Psychiatry: For the Use of Students and Physicians in 1883, claiming that there’s an underlying physical cause of mental illness just as a physical disease may be attributed to a physiological dysfunction.

He regarded each mental illness as distinct from all others, with it’s own origins, symptoms, course, and outcome.

He proposed two major groups of serious mental diseases: dementia praecox (the original term for schizophrenia), caused by a chemical imbalance and manic-depressive psychosis (caused by a faulty metabolism).

Kraepelin’s classification helped establish the organic nature of mental disorders, andformed the basis for the Diagnostic and Statistical Manual of Mental Disorders(DSM) , the American Psychiatric Association’s (APA) official classificationsystem and the International Classification of Diseases (ICD) (Chapter 5:Mental and behavioural disorders) published by the World Health Organization (WHO).

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The first DSM manual was published in America in 1952 with subsequent revisions in 1968 (II), 1980 (III), 1987 (III-R), 1994 (IV), 2000 (IV-TR-text revision) and the latest manual DSM-V published in 2013.

As for ICD, mental disorders were first included for the first time in 1948 (ICD-6) and from 1955,the WHO produced ICD-7, 8 and 9 approximately every ten years. ICD-10 currentlyin use was published in 1992, with an expected revision due in 2018.  

There have been disagreements in the past over which manual was better but with each successive revision, they have deliberately converged their codes in recent revisions so that the manuals are more similar, although significant differences remain.

ICD-10 has nine broad categories, while DSM-V has up to seventeen different groupings of mental disorders.

Common groupings in both manuals include mood disorders – depression, schizophrenia, and psychotic disorders, substance-related disorders- drug abuse, childhood developmental disorders such as autism and mental disorders due to a general medical condition e.g. AIDS-related psychosis.

The DSM also states that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from othermental disorders or from no mental disorders.”

Nevertheless, the two major classification systems used by psychiatrists today, DSM and ICD, are based largely on the abnormal experiences and beliefs reported by patients, because we have no objective or biological markers for most neurotic or psychotic disorders.

Consultant PsychiatristProfessor Otieno Omollo at Jaramogi Oginga Odinga Teaching and Referral Hospital contends that although we officially use ICD-10, in clinical practice both are used.

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‘In Kenya, we officially subscribe to the WHO’s ICD manual as per the Ministry of Health’s guideline but as clinicians we do combine both systems to achieve a better outcome,’he says.

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