Psychiatric Diagnosis and Classification - ResearchGate

EVOLUTIONARY THEORY, CULTURE AND PSYCHIATRIC DIAGNOSIS 109
care and treatment of mental illness. In some societies, the central government
played an influential role in spearheading treatment, education, and
research; in others, universities and faculties of medicine; and in still others,
local municipalities.
The evolution of actual knowledge of clinical psychiatry is largely a
product of developments during the nineteenth century. It involved two
empirically interconnected trends that can be separated only analytically.
One development culminated in the refinement of a system of concepts
about and terms referring to disturbances of human psychology and behavior
along with the criteria and principles pertaining to how this descriptive
system was to be used. The other one involved the creation of a science
about the many psychiatric disorders that came to be named and described,
disorders that were delineated by means of the descriptive system and
which came to be studied by means of the new science of medicine prevalent
in the nineteenth century, involving diagnosis and explanation pertaining
to causes, lesions, and natural history. The former development
involved the evolution of a science of descriptive psychopathology and the
latter the scientific knowledge linked to the historiography of clinical psychiatry
[4, 5].
In summary, it was in groups of physicians involved in the study and care
of mentally ill patients, in both private and public institutions, that the
modern approach to mental illness evolved. Different national conceptualizations
about psychopathology evolved reflecting linguistic, cultural, and
societal experiences and traditions. However, to improve communication
and promote research, there arose a need for the discernment of commonalities.
A conviction grew that the various syndromes, disorders, and illnesses
that had emerged in national classification systems exhibited common features
and conformed to a smaller set of conditions that transcended national
boundaries and cultural experience. The members of this class of disorders
are assumed to be amenable to careful scientific definition and description
in a general language of psychopathology. The traditional view holds that
human populations show different vulnerabilities to disease linked to differences
in geography, social ecology, and culture, but it does not undermine
the official position about universals in the pathology and clinical
presentation that underpin the international approach to psychiatric diagnosis
and classification.
An emphasis on the development of psychiatric knowledge and mental
health services in European and Anglo-American societies is important to
emphasize, because it gained international eminence and now claims allegiance
across the world. The imperialism and colonialism of the nineteenth
and twentieth centuries had many obvious political and economic repercussions.
One of them was the exportation of biomedical knowledge that
initially came to be applied to improve general public health. As the modern