Historical Overview of Psychiatric Diagnostics in Japan

Abstract

When Japanese psychiatry was in its infancy, the disease concepts held by individual physicians varied, and even the same diagnosis could sometimes refer to a completely different group of symptoms. Based on such reliability problems of psychiatric diagnostics, DSM-III (Diagnostic and Statistical Manual of Mental Disorders – Third Edition) was introduced to Japan in 1982. Since then, the reliability of psychiatric diagnostics has increased. Fields such as clinical practice, education, and research in Japan have also benefited from DSM. However, it is also true that the misuse of DSM by inexperienced users has caused adverse effects. The misuse of DSM is attributed mainly to the misunderstanding that “it’s a disease simply because it’s specified in DSM diagnostic criteria.” DSM diagnostic criteria have been created to stipulate the core of each disease. Thus, in using those criteria, sufficient understanding of the ideal type of the disease, the characteristics and symptoms including those not stated in DSM, is a prerequisite. Attempting to extract a homogeneous population based on such an appropriate use has been a challenge of DSM to date. Reaffirming this basic idea of DSM is necessary for the future development of psychiatric diagnostics. In addition, we must not forget that psychiatric diagnostics strive not only to provide diagnosis of a disease but also to understand human beings from a multifaceted viewpoint, bearing in mind each patient’s personality as well as the social and environmental background.