A college student becomes so compulsive about cleaning his dorm room that his grades begin
to slip. An executive living in New York has a mortal fear of snakes but lives in Manhattan and rarely goes outside the city where he might encounter one. A computer technician, deeply anxious around strangers, avoids social and company gatherings and is passed over for promotion.
Are these people mentally ill？
In a report released last week, researchers estimated that more than half of Americans would develop mental disorders in their lives, raising questions about where mental health ends and illness begins.
In fact, psychiatrists have no good answer, and the boundary between mental illness and normal mental struggle has become a baffle line dividing the profession into two viscerally opposed camps.
On one side are doctors who say that the definition of mental illness should be broad enough to include mild conditions, which can make people miserable and often lead to more severe problems later. On the other are experts who say that the current definitions should be tightened to ensure that limited resources go to those who need them the most and to preserve the profession's credibility with a public that often scoffs at claims that large numbers of Americans have mental disorders.
The question is not just philosophical: where psychiatrists draw the line may determine not only the willingness of insurers to pay for services, but the future of research on moderate and mild mental disorders. Directly and indirectly, it will also shape the decisions of millions of people who agonize over whether they or their loved ones are in need of help, merely eccentric or dealing with ordinary life struggles.
"This argument is heating up right now, "said Dr. Darrel Regier, director of research at the American Psychiatric Association, "because we're in the process of revising the diagnostic manual, "the catalog of mental disorders on which research, treatment and the profession itself are based.
The next edition of the manual is expected to appear in 2010 or 2011, "and there's going continued debate in the scientific community about what the cut-points of clinical disease are, "Dr. Regier said.
Psychiatrists have been searching for more than a century for some biological marker for mental disease, to little avail. Although there is promising work in genetics and brain imaging, researchers are not likely to have anything resembling a blood test for a mental illness soon, leaving them with what they have always had: observations of behavior, and patients' answers to questions about how they feel and how severe their condition is.
Severity is at the core of the debate. Are slumps in mood bad enough to make someone miss work？ Does anxiety over social situations disrupt friendships and play havoc with romantic relationships？
Insurers have long incorporated severity measures in decisions about what to cover. Dr. Alex Rodriguez, chief medical officer for behavioral health at Magellan Health Services, the country's largest managed mental health insurer, said that Magellan used several standardized tests to rate how much a problem is interfering with someone's life. The com- pany is developing its own scale to track how well people function. "This is a tool that would allow the therapist to monitor a patient's progress from session to session, "he said.
Although the current edition of the American Psychiatric Association's catalog of mental disorders includes severity as a part of diagnosis, some experts say these measures are not tough or specific enough.
Dr. Smart Kirk, a professor of social welfare at the University of California, Los Angeles, who has been critical of the manual, gives examples of what could, under the current diagnostic guidelines, qualify as a substance abuse disorder: a college student who every month or so d
A．the severity of mental illness.
B．the health-keeping of ordinary people.
C．the treatment of mentally impaired people.
D．the dividing line between mental health and illness.
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