Boyce: “Disease” Versus “Disorder”
Around 400 B.C., the Greek physician Hippocrates treated the mentally ill as not having a disorder, but a disease. Though mental illnesses plagued humanity well before diagnosis and record-keeping, their stigma may be rooted in the misconception that symptoms and behaviors are a matter of one’s choosing. This misconception colors the manner in which patients with psychiatric illnesses are treated. For centuries, many afflicted patients have come to be categorized as having mental disorders rather than medical diseases — a difference that may greatly influence the stigma these patients face in the general population as well by some medical practitioners.
The key terms here are “disorder” and “disease.” While most people use these terms interchangeably, there is a significant difference in connotation. A disorder is a disturbance that affects the functioning of mind or body, more akin to disorderly behavior or behaviors related to emotional instability.
A disease, on the other hand, is more appropriately described as a pathological condition of an organ, body part or organ system with biological origins that impairs the normal functioning of that system and is reflected by related symptoms. In short, “disease” suggests a biological origin while disorders do not, and to use the two interchangeably can result in massive inaccuracies. “Disorder” also often connotes that mental illnesses are subject to a patient’s own will, closing the door on possible biological abnormalities that may be causal agents.
When asked, many scientists, non-scientists and physicians alike tend to agree that the stigmatization of mental illness still remains a problem today and often deters patients from seeking out proper treatment options. The scientific community today is far more aware that mental illnesses often have neurobiological origins, so why is depression still referred to as a “mood disorder” rather than a “mood disease”? Similarly, why are people who struggle with addiction referred to as suffering from an “addiction disorder” rather than an “addiction disease”? This seemingly minor difference in nomenclature creates a major difference in the perception of mental illnesses and addictions in comparison to physical diseases, perpetuates stigma and possibly deters some patients from seeking help.
Many medical professionals — including former Director of the National Institute of Mental Health, Dr. Thomas Insel — have argued that the lack of a biological diagnostic method poses some difficulty in regarding mental illness as a disease. Dr. Insel has stated that, “Unlike our definitions of ischemic heart disease, lymphoma or AIDS, [diagnoses of mental illness] are based on consensus about clusters of clinical symptoms, not any objective laboratory measure.” In effect, health professionals diagnose mental illness using a standardized, yet subjective, checklist-like assessment known as the Diagnostic and Statistical Manual of Mental Disorders. Yet DSM reliance for diagnosis should not nullify biological considerations. Numerous advances in neuroscience, including the use of functional Magnetic Resonance Imaging and Western-blotting, have contributed to scientists’ understanding of the neurobiology underlying mental disorders. Though much is still unknown about the biological underpinnings of mental illness and the functioning of the brain in general, most health professionals know enough to recognize the biological mechanisms that can underscore mental disease.
So what’s in a name? Simply put, nomenclature matters — especially in the mental health arena, where stigma is prevalent, effective treatment options remain scarce and the biological basis of the disease is often overlooked. Public misconceptions often affect a lack of empathy for sufferers, who are believed to be able to control their diseases.
Change in public perception will only come when the scientific and medical communities recognize their role in changing perception through improved education and awareness about biological factors that can give root to mental diseases. This may have already begun with the National Institutes of Mental Health’s recent launch of the Research Domain Criteria project, which aims to transform the diagnosis of mental illnesses by incorporating genetics, imaging, cognitive science and other levels of information. In this way, recognition of mental ailments as medical diseases is an important step to removing the stigma surrounding mental health and to ensuring that people with mental health issues get the treatment and support they need.
Jared Boyce is a neuroscience major and has done research internships at Karolinska Institutet in Stockholm, Sweden, at Mt. Sinai Hospital in New York and at Dartmouth-Hitchcock Medical Center in Hanover.