Abstract
The diagnosis of the whole of the patient must explicitly define the suffering dimension of the patient, the illness, and the contributing morphological, physiological, biochemical, genetic disease or conditions, the memes and stresses that interacted with them, and the assets of the patient that protect or mitigate against the noxious forces. Illness is by definition memetic, i.e., how a person experiences suffering and expresses suffering is determined by prevailing belief systems and imitation of those who suffer from ailments. Illness is often the manifestation of a strife and/or revolution within the patient’s memetic brain, caused by stress or other weakening of the dominant selfplexes, resulting in the upsurge of hitherto repressed aspects of the personality. Most psychiatric conditions are syndromes of dysregulation. The dysregulation may be a reflection of memetic conflict or memetic turmoil, or it may reflect an epigenetically unstable limbic structure, which in turn is activated by incoming memes. Major psychiatric syndromes are final common pathway syndromes that reflect a common brain functional pathology with heterogeneous genetic, biochemical, and memetic contributions. Neurosis serves as an intermediate diagnosis between normality and major final common pathway syndromes and would encompass various traits and symptoms that represent gene × meme interaction (interaction includes simple additive effect as well as synergy and mitigation) and early learned behaviors. I suggest a new multiaxial system of psychiatric diagnosis as follows: (Axis 1) Neurophysiomemetic diagnosis – the memetic, suffering, illness dimension of the patient, (Axis 2) the genomic/brain morphological/functional dimension, which we will call the genoneuroscience diagnosis, (Axis 3) medical diseases, (Axis 4) early, recent, and current stress, and (Axis 5) the protective psychosocial assets of the patient as well as global assessment of functioning. In addition, the new system should have a separate (Axis 6) for biopsychosocial and epigenetic formulation, an integration of the entries in all the axes in managing the person who is the patient.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Akiskal, H. S., Hantouche, E. G., Allilaire, J. F. (2003) Bipolar II with and without cyclothymic temperament: “dark” and “sunny” expressions of soft bipolarity. J Affect Disord, 73,49–57.
Brugha, T. S. (1995) Social Support and Psychiatric Disorder Research Findings and Guidelines for Clinical Practice. Cambridge University Press, Cambridge etc.
Caspi, A., McClay, J., Moffitt, T. E., et al. (2002) Role of genotype in the cycle of violence in maltreated children. Science, 297, 851–854.
Caspi, A., Sugden, K., Moffitt, T. E., et al. (2003) Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386–389.
Cheng, R., Juo, S. H., Loth, J. E., et al. (2006) Genome-wide linkage scan in a large bipolar disorder sample from the National Institute of Mental Health genetics initiative suggests putative loci for bipolar disorder, psychosis, suicide, and panic disorder. Mol Psychiatry, 11, 252–260.
Craddock, N., O’Donovan, M. C., Owen, M. J. (2006) Genes for schizophrenia and bipolar disorder? Implications for psychiatric nosology. Schizophr Bull, 32, 9–16.
Feighner, J. P., Robins, E., Guze, S. B., et al. (1972) Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry, 26, 57–63.
Frances, A. J., Egger, H. L. (1999) Whither psychiatric diagnosis. Aust N Z J Psychiatry, 33, 161–165.
Genova, P. (2003) Dump the DSM! In Psychiatric Times.
Goldapple, K., Segal, Z., Garson, C., et al. (2004) Modulation of cortical-limbic pathways in major depression: Treatment-specific effects of cognitive behavior therapy. Arch Gen Psychiatry, 61, 34–41.
Hamshere, M. L., Bennett, P., Williams, N., et al. (2005) Genomewide linkage scan in schizoaffective disorder: Significant evidence for linkage at 1q42 close to DISC1, and suggestive evidence at 22q11 and 19p13. Arch Gen Psychiatry, 62, 1081–1088.
Hippocrates http://duke.usask.ca/∼niallm/233/Hippocra.htm
Kandel, E. R. (1979) Psychotherapy and the single synapse. The impact of psychiatric thought on neurobiologic research. N Engl J Med, 301, 1028–1037.
Kandel, E. R. (1998) A new intellectual framework for psychiatry. Am J Psychiatry, 155, 457–469.
Leigh, H. (2009) A proposal for a new multiaxial model of psychiatric diagnosis. A continuum-based patient model derived from evolutionary developmental gene-environment interaction. Psychopathology, 42, 1–10.
McHugh, P. R. http://www.hopkinsmedicine.org/press/2001/august/McHugh.htm.
McHugh, P. R. (1992) A structure for psychiatry at the century’s turn – the view from Johns Hopkins. J R Soc Med, 85, 483–487.
McHugh, P. R. (2005) Striving for coherence: Psychiatry’s efforts over classification. JAMA, 293, 2526–2528.
McHugh, P. R., Slavney, P. R. (1998) The Perspectives of Psychiatry (2nd edn). Johns Hopkins University Press, Baltimore, MD
Meyer, A., Winters, E. E. (1950) The Collected Papers of Adolf Meyer. Johns Hopkins Press, Baltimore.
Murphy, D. L., Lerner, A., Rudnick, G., et al. (2004) Serotonin transporter: Gene, genetic disorders, and pharmacogenetics. Mol Interv, 4, 109–123.
Nesse, R. M. (2004) Cliff-edged fitness functions and the persistence of schizophrenia. Behav Brain Sci, 27, 862–863.
Norman, R. M., Malla, A. K., Manchanda, R., et al. (2005) Social support and three-year symptom and admission outcomes for first episode psychosis. Schizophr Res, 80, 227–234.
Paquette, V., Levesque, J., Mensour, B., et al. (2003) “Change the mind and you change the brain”: Effects of cognitive-behavioral therapy on the neural correlates of spider phobia. Neuroimage, 18, 401–409.
Prathikanti, S., Weinberger, D. R. (2005) Psychiatric genetics – the new era: Genetic research and some clinical implications. Br Med Bull, 73–74, 107–122.
Roffman, J. L., Marci, C. D., Glick, D. M., et al. (2005) Neuroimaging and the functional neuroanatomy of psychotherapy. Psychol Med, 35, 1385–1398.
Silver, E. J., Heneghan, A. M., Bauman, L. J., et al. (2006) The relationship of depressive symptoms to parenting competence and social support in inner-city mothers of young children. Matern Child Health J, 10, 105–112.
Smith, D. J., Muir, W. J., Blackwood, D. H. (2004) Is borderline personality disorder part of the bipolar spectrum? Harv Rev Psychiatry, 12, 133–139.
Surkan, P. J., Peterson, K. E., Hughes, M. D., et al. (2006) The role of social networks and support in postpartum women’s depression: A multiethnic urban sample. Matern Child Health J, 10, 375–383.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2010 Springer-Verlag New York
About this chapter
Cite this chapter
Leigh, H. (2010). Psychiatric Diagnosis: Toward a Memetic–Epigenetic Multiaxial Model. In: Genes, Memes, Culture, and Mental Illness. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5671-2_14
Download citation
DOI: https://doi.org/10.1007/978-1-4419-5671-2_14
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-5670-5
Online ISBN: 978-1-4419-5671-2
eBook Packages: MedicineMedicine (R0)