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Published in: BMC Psychiatry 1/2023

Open Access 01-12-2023 | Research

What is a mental disorder? Evaluating the lay concept of Mental Ill Health in the United States

Authors: Jesse S. Y. Tse, Nick Haslam

Published in: BMC Psychiatry | Issue 1/2023

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Abstract

Purpose

How “mental disorder” should be defined has been the focus of extensive theoretical and philosophical debate, but how the concept is understood by laypeople has received much less attention. The study aimed to examine the content (distinctive features and inclusiveness) of these concepts, their degree of correspondence to the DSM-5 definition, and whether alternative concept labels (“mental disorder”, “mental illness”, “mental health problem”, “psychological issue”) have similar or different meanings.

Methods

We investigated concepts of mental disorder in a nationally representative sample of 600 U.S. residents. Subsets of participants made judgments about vignettes describing people with 37 DSM-5 disorders and 24 non-DSM phenomena including neurological conditions, character flaws, bad habits, and culture-specific syndromes.

Results

Findings indicated that concepts of mental disorder were primarily based on judgments that a condition is associated with emotional distress and impairment, and that it is rare and aberrant. Disorder judgments were only weakly associated with the DSM-5: many DSM-5 conditions were not judged to be disorders and many non-DSM conditions were so judged. “Mental disorder”, “mental illness”, and “mental health problem” were effectively identical in meaning, but “psychological issue” was somewhat more inclusive, capturing a broader range of conditions.

Conclusion

These findings clarify important issues surrounding how laypeople conceptualize mental disorder. Our findings point to some significant points of disagreement between professional and public understandings of disorder, while also establishing that laypeople’s concepts of mental disorder are systematic and structured.
Literature
2.
go back to reference Wakefield JC. Disorder as harmful dysfunction: a conceptual critique of DSM-III-R’s definition of mental disorder. Psychol Rev. 1992;99(2):232–47.CrossRefPubMed Wakefield JC. Disorder as harmful dysfunction: a conceptual critique of DSM-III-R’s definition of mental disorder. Psychol Rev. 1992;99(2):232–47.CrossRefPubMed
3.
go back to reference Bolton D. What is mental disorder?: an essay in philosophy, science, and values. Oxford University Press; 2008. Bolton D. What is mental disorder?: an essay in philosophy, science, and values. Oxford University Press; 2008.
4.
go back to reference Lilienfeld SO, Marino L. Essentialism revisited: evolutionary theory and the concept of mental disorder. J Abnorm Psychol. 1999;108(3):400–11.CrossRefPubMed Lilienfeld SO, Marino L. Essentialism revisited: evolutionary theory and the concept of mental disorder. J Abnorm Psychol. 1999;108(3):400–11.CrossRefPubMed
6.
go back to reference American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 5th ed. 2013, Washington, DC. American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 5th ed. 2013, Washington, DC.
7.
go back to reference Frances A. Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma and the medicalization of ordinary life. Psychother Australia. 2013;19(3):14–8. Frances A. Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma and the medicalization of ordinary life. Psychother Australia. 2013;19(3):14–8.
8.
go back to reference Horwitz AV, Wakefield JC. The loss of sadness: how psychiatry transformed normal sorrow into depressive disorder. Oxford University Press; 2007. Horwitz AV, Wakefield JC. The loss of sadness: how psychiatry transformed normal sorrow into depressive disorder. Oxford University Press; 2007.
9.
10.
go back to reference Brinkmann S. Diagnostic cultures: a cultural approach to the pathologization of modern life. Routledge; 2016. Brinkmann S. Diagnostic cultures: a cultural approach to the pathologization of modern life. Routledge; 2016.
11.
go back to reference Conrad P, Slodden C. The medicalization of mental disorder, Handbook of the sociology of mental health. 2013,Springer.pp. 61–73. Conrad P, Slodden C. The medicalization of mental disorder, Handbook of the sociology of mental health. 2013,Springer.pp. 61–73.
12.
go back to reference Haslam N. Concept creep: psychology’s expanding concepts of harm and pathology. Psychol Inq. 2016;27(1):1–17.CrossRef Haslam N. Concept creep: psychology’s expanding concepts of harm and pathology. Psychol Inq. 2016;27(1):1–17.CrossRef
13.
go back to reference Bolton D. Conceptualisation of mental disorder and its personal meanings. J Mental Health. 2010;19(4):328–36.CrossRef Bolton D. Conceptualisation of mental disorder and its personal meanings. J Mental Health. 2010;19(4):328–36.CrossRef
14.
go back to reference Jaspers K. General psychopathology. Volume 2. JHU Press; 1997. Jaspers K. General psychopathology. Volume 2. JHU Press; 1997.
15.
go back to reference Nichter M. Idioms of distress: Alternatives in the expression of psychosocial distress: a case study from South India. Cult Med Psychiatry. 1981;5(4):379–408.CrossRefPubMed Nichter M. Idioms of distress: Alternatives in the expression of psychosocial distress: a case study from South India. Cult Med Psychiatry. 1981;5(4):379–408.CrossRefPubMed
16.
go back to reference Kleinman A. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Volume 3. University of California Press; 1980. Kleinman A. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Volume 3. University of California Press; 1980.
17.
go back to reference Furnham A, Chan E. Lay theories of schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2004;39(7):543–52.CrossRefPubMed Furnham A, Chan E. Lay theories of schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2004;39(7):543–52.CrossRefPubMed
18.
19.
go back to reference Haslam N, Giosan C. The lay concept of “mental disorder” among american undergraduates. J Clin Psychol. 2002;58(4):479–85.CrossRefPubMed Haslam N, Giosan C. The lay concept of “mental disorder” among american undergraduates. J Clin Psychol. 2002;58(4):479–85.CrossRefPubMed
20.
go back to reference American Psychiatric Association, Diagnostic statistical manual of mental disorders 4th ed. 1994, Washington, DC. 535. American Psychiatric Association, Diagnostic statistical manual of mental disorders 4th ed. 1994, Washington, DC. 535.
21.
go back to reference Giosan C, Glovsky V, Haslam N. The lay concept of ‘mental disorder’: a cross-cultural study. Transcult Psychiatry. 2001;38(3):317–32.CrossRef Giosan C, Glovsky V, Haslam N. The lay concept of ‘mental disorder’: a cross-cultural study. Transcult Psychiatry. 2001;38(3):317–32.CrossRef
22.
go back to reference Glovsky V, Haslam N. Acculturation and changing concepts of mental disorder: brazilians in the USA. Transcult Psychiatry. 2003;40(1):50–61.CrossRefPubMed Glovsky V, Haslam N. Acculturation and changing concepts of mental disorder: brazilians in the USA. Transcult Psychiatry. 2003;40(1):50–61.CrossRefPubMed
23.
go back to reference Giummarra MJ, Haslam N. The lay concept of childhood mental disorder. Child Psychiatry Hum Dev. 2005;35(3):265–80.CrossRefPubMed Giummarra MJ, Haslam N. The lay concept of childhood mental disorder. Child Psychiatry Hum Dev. 2005;35(3):265–80.CrossRefPubMed
24.
go back to reference Rusch N, Evans-Lacko S, Thornicroft G. What is a mental illness? Public views and their effects on attitudes and disclosure. Australian & New Zealand Journal of Psychiatry. 2012;46(7):641–50.CrossRef Rusch N, Evans-Lacko S, Thornicroft G. What is a mental illness? Public views and their effects on attitudes and disclosure. Australian & New Zealand Journal of Psychiatry. 2012;46(7):641–50.CrossRef
25.
go back to reference Tikkinen KA, et al. Public, health professional and legislator perspectives on the concept of psychiatric disease: a population-based survey. BMJ Open. 2019;9(6):e024265.CrossRefPubMedPubMedCentral Tikkinen KA, et al. Public, health professional and legislator perspectives on the concept of psychiatric disease: a population-based survey. BMJ Open. 2019;9(6):e024265.CrossRefPubMedPubMedCentral
26.
go back to reference Fountoulakis KN. The concept and definition of mental illness, Psychiatry: From its historical and philosophical roots to the modern face. 2022,Springer.pp. 333–383. Fountoulakis KN. The concept and definition of mental illness, Psychiatry: From its historical and philosophical roots to the modern face. 2022,Springer.pp. 333–383.
27.
go back to reference Goodman JK, Cryder CE, Cheema A. Data collection in a flat world: the strengths and weaknesses of Mechanical Turk samples. J Behav Decis Mak. 2013;26(3):213–24.CrossRef Goodman JK, Cryder CE, Cheema A. Data collection in a flat world: the strengths and weaknesses of Mechanical Turk samples. J Behav Decis Mak. 2013;26(3):213–24.CrossRef
28.
go back to reference Zhang C, Conrad F. Speeding in web surveys: the tendency to answer very fast and its association with straightlining. Surv Res Methods. 2014;8(2):127–35. Zhang C, Conrad F. Speeding in web surveys: the tendency to answer very fast and its association with straightlining. Surv Res Methods. 2014;8(2):127–35.
29.
go back to reference Fox AB, et al. Mental illness, problem, disorder, distress: does terminology matter when measuring stigma? Stigma and Health. 2021;6(4):419–29.CrossRef Fox AB, et al. Mental illness, problem, disorder, distress: does terminology matter when measuring stigma? Stigma and Health. 2021;6(4):419–29.CrossRef
30.
go back to reference Wakefield JC. The concept of mental disorder: on the boundary between biological facts and social values. Am Psychol. 1992;47(3):373–88.CrossRefPubMed Wakefield JC. The concept of mental disorder: on the boundary between biological facts and social values. Am Psychol. 1992;47(3):373–88.CrossRefPubMed
31.
go back to reference American Psychiatric Association, Diagnostic statistical manual of mental disorders. 1987, Washington, DC. American Psychiatric Association, Diagnostic statistical manual of mental disorders. 1987, Washington, DC.
32.
go back to reference Wakefield JC, et al. The lay concept of conduct disorder: do nonprofessionals use syndromal symptoms or internal dysfunction to distinguish disorder from delinquency? Can J Psychiatry. 2006;51(4):210–7.CrossRefPubMed Wakefield JC, et al. The lay concept of conduct disorder: do nonprofessionals use syndromal symptoms or internal dysfunction to distinguish disorder from delinquency? Can J Psychiatry. 2006;51(4):210–7.CrossRefPubMed
33.
go back to reference Robinson WS. Ecological correlations and the behavior of individuals. Int J Epidemiol. 2009;38(2):337–41.CrossRefPubMed Robinson WS. Ecological correlations and the behavior of individuals. Int J Epidemiol. 2009;38(2):337–41.CrossRefPubMed
34.
go back to reference McGrath MJ, et al. Concept creepers: individual differences in harm-related concepts and their correlates. Pers Indiv Differ. 2019;147:79–84.CrossRef McGrath MJ, et al. Concept creepers: individual differences in harm-related concepts and their correlates. Pers Indiv Differ. 2019;147:79–84.CrossRef
35.
go back to reference Tse JSY, Haslam N. Inclusiveness of the concept of mental disorder and differences in help-seeking between Asian and White Americans. Front Psychol. 2021;12:699750.CrossRefPubMedPubMedCentral Tse JSY, Haslam N. Inclusiveness of the concept of mental disorder and differences in help-seeking between Asian and White Americans. Front Psychol. 2021;12:699750.CrossRefPubMedPubMedCentral
Metadata
Title
What is a mental disorder? Evaluating the lay concept of Mental Ill Health in the United States
Authors
Jesse S. Y. Tse
Nick Haslam
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2023
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-023-04680-5

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