Abstract

The concept of psychiatric (mental) disorder became widespread in the late 20th century, as a sometimes literal, sometimes metaphorical, extension of the more general category of physical disease. It has facilitated medicalization of some psychological conditions, such as those listed in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM). At the same time, it has generated controversy about the scope and consequences of its applicability. ‘Psychiatric disorder’ has become a ‘hembig’ concept: one with normative (hegemonic) content, ambiguous meanings, and wide (big) scope. This has led to ongoing uncertainty and disagreement about what falls under the scope of psychiatric disorder. Many proposed definitions are circular. Practical consequences of these ‘hembig’ characteristics include inappropriate stigmatization, patient refusals of diagnoses, uncertain eligibility for healthcare and disability accommodations, concerns about overdiagnosis, and worries about elite capture of resources. I will argue that understanding the evolving meaning of ‘psychiatric disorder’ is helpful as a preliminary to recommendations about how to go forward with (or without) this concept.