How Many Strange Things There Are in the World—All Found in One "DSM"

The DSM (Diagnostic and Statistical Manual of Mental Disorders) is known as the "bible" of psychiatry and is a well-deserved authoritative textbook in the field. Counselors and physicians worldwide who study psychological and mental disorders treat it as their most important reference. The DSM is a diagnostic and treatment guide jointly produced by psychiatric experts of the American Psychiatric Association (APA); it has been revised and reprinted many times. The latest edition is DSM-5-TR, whose Chinese translation is published by Peking University Medical Press; the hardcover is priced at 358 yuan. Medical monographs are not cheap, but such works are indeed of high practical value.

If you are a medical student or a working clinician, I personally recommend buying a copy of DSM-5-TR to keep at your desk and consult often. If you are someone interested in the humanities—especially in human thought and psychology—I also recommend owning a copy of DSM-5-TR. Reading such professional books alongside works in the humanities and social studies yields very different rewards. Almost every strange thing we see in the world can find an answer in the DSM.

The DSM deepens our understanding of human nature. Behind all the distorted social phenomena we observe lies the shadow of mental disorder. Many of the things that leave us "unable to let go" are probably related, for the most part, to mental disorders. Even some major historical events are connected to mental disorders. Once we understand mental disorders, our view of the world changes, and when we encounter extreme events we are better able to calm down quickly.

The DSM defines mental disorder as follows: "A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a psychological, biological, or developmental process underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expected or culturally sanctioned response to a particular event, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."

Public understanding of psychiatry is limited, and this is wildly out of proportion to the reality we face. In fact, very large numbers of people have mental disorders of varying degrees. Since the beginning of the 21st century, China has conducted a number of large-scale local epidemiological surveys of mental illness in Beijing, Shanghai, Hebei, Zhejiang, Shandong, Guangzhou, Wuhan, Xi'an, Jinan, Kunming, Shenzhen, Qingdao, and other provinces and cities. The reported prevalence rates (annual/monthly prevalence ranging from 7.0% to 17.5%) are all far higher than those of the nationwide multi-region surveys of the 1980s and 1990s (when prevalence was around 3%-4%). Data from the Shenzhen arm of the WHO World Mental Health Survey Initiative (2005) show a lifetime prevalence of mental disorders of 21.87% in Shenzhen and a current prevalence of 13.42%. This is a very high figure; it means that China has roughly 100 million people with mental disorders.

Many people suffer from mental disorders without knowing it. They live for years with anxiety, depression, obsessive-compulsive behaviors, an inability to trust others, persecutory delusions, high sensitivity, and irritability; they easily fall into conflict with those around them, find it hard to form normal romantic relationships, and their interpersonal bonds break easily. Many also have somatic symptoms brought on by their mental disorders—migraine, tachycardia, dysmenorrhea, and so on. They readily seek hospital care for these symptoms, and even physicians easily misdiagnose them.

WHO sampling surveys across 15 countries and regions found that among general-hospital patients, the prevalence of all types of mental disorders reaches 25%-35%, far above the social average; among patients with major chronic diseases (such as cancer or lupus erythematosus) the prevalence is even higher. I once mediated doctor-patient disputes in a hospital and found in practice that the great majority of patients or families involved in disputes had various mental disorders to varying degrees. Statistics from U.S. medical institutions show that about 15% of visitors are "difficult patients"—people with paranoid, suspicious, or irritable traits; they are the high-risk group most feared by medical staff for triggering major incidents of violence against doctors. It is therefore very necessary for medical personnel to read the DSM, to improve their ability to recognize mental disorders and communicate with patients who have them; this can help us avoid a great deal of unnecessary conflict at work.

Social workers who deal closely with large numbers of people also have good reason to read the DSM, to understand the various types of mental disorder and improve their ability to recognize them, while sharpening their communication skills with special populations, so that they are not at a loss when emotionally charged incidents arise. If someone before us displays schizoid personality traits or irritability, we should be on guard immediately and avoid provoking their emotions. Emotions in people with mental disorders shift extremely fast—one second serene, the next lightning and thunder—and they take longer than average to return to baseline. If we want to avoid fierce conflict, the best course is not to provoke them and let them calm down on their own.

Of course, we should not stigmatize mental disorders; like other organic lesions, they are physical illnesses. People with mental disorders deserve our sympathy and the care of society and family. But our care must respect scientific reality. Certain predisposed individuals, under life stress or a trigger event (such as a broken relationship, bankruptcy, or exam failure), can easily suffer a mental collapse and suddenly display baffling manic behavior; some even harm or mutilate themselves or attempt suicide. In such cases, the most important thing family can do is get the person to a mental health center for necessary restraint and treatment until they calm down.

Physical and mental health are the wellsprings of happiness. Falling ill is a misfortune, and scientific treatment can minimize it. When a family member has a mental disorder, the rest of the household lives under great strain; such caregivers also need medical support and professional guidance. I hope that all of us will come to understand psychiatry better, understand these special groups, see them, understand them, and help them. Mental disorders, like other illnesses, are best treated when found early; the earlier the detection, the better the treatment outcome and prognosis. We must shed the stigma of disease, face illness bravely, and overcome it.