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Modern-Day Relics of Psychiatry

Tripathi, Samidha MD; Messias, Erick MD; Spollen, John MD; Salomon, Ronald M. MD

The Journal of Nervous and Mental Disease: September 2019 - Volume 207 - Issue 9 - p 701–704
doi: 10.1097/NMD.0000000000001059
Original Article

Constantly shifting cultural views influence public perceptions of psychiatric diagnoses, sometimes accommodated by changes in diagnostic terminology. Evolving scientific knowledge of the era is at times used to justify and support mental illnesses. Too often, however, remasked nomenclatures fail to alter social stigma, in part because political arguments are used. Scientific validations of variant behaviors as symptoms with a pathologic status are unfortunately overshadowed. Examples of cultural bias effects on recurring diagnostic challenges illustrate a need for scientific validation. Renaming fails to improve stigma or diagnostic clarity. For example, neurasthenia, or nervous exhaustion, was attributed to fast-paced urban life through the late 1970s. Its symptoms are now largely, to no real advantage, retitled as chronic fatigue syndrome. Diagnoses like “hysteria” have evolved into histrionic personality disorder and somatoform spectrum disorders, although less as a result of demonic possession or a “wandering uterus.” Decriminalized and depathologized homosexuality remains a political football, where religious “sin” conceptualizations have not been displaced by studies documenting healthy adjustments among groups with diverse sexual orientations and preferences. Each of these remains severely socially stigmatized. The pseudoscience of “drapetomania,” once used to rationalize and pathologize a slave's freedom, is perceived now as psychiatric incarcerations of mentally healthy individuals, more commonly in totalitarian regimes—a politicization of stigma. Research reviews and funding efforts need to emphasize a sound basis for individuals caught in perpetuated diagnostic challenges, not remedied by simple shifts in nomenclature.

University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Send reprint requests to Samidha Tripathi, MD, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 554, Little Rock, AR 72205. E-mail:

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