Today is the 31st World Mental Health Day. Nowadays, mental/mental health knowledge has been widely disseminated, and more and more people are actively entering psychiatric departments and consulting rooms for help.

Category：psychological

2025-05-10

Today is the 31st World Mental Health Day . Nowadays, mental/mental health knowledge has been widely disseminated, and more and more people are actively entering psychiatric departments and consulting rooms for help. However, the diagnosis of mental/psychological diseases is currently based on symptoms and symptoms, and it is impossible to name and distinguish diseases based on causes and pathology. In this case, is the diagnosis really "accurate"? How targeted and effective are the psychotherapy done based on the diagnosis results?

一个 | Ruohan (Master of clinical psychology and cognitive neuroscience, doctoral student in clinical psychology, University of Munich, Germany)

Today, people have more and more understandings of mental illness or mental illness, but there are still many misunderstandings and confusions in society, as well as various obscure prejudices, avoidance and even discrimination that arise from it. In fact, the fast pace and strong competition of modern social life will bring huge psychological pressure, as well as the various contradictions and conflicts between the personal desire to realize the value of self-existence and the limitations of the interpersonal environment of the family in the context of social change, which also bring many psychological burdens and harms, which make the spiritual/psychological problems of modern people become increasingly prominent. Those who have all kinds of secret but extremely heavy inner pain, on the one hand, have to face their true feelings, and on the other hand, the external confusion and prejudice will once again deepen the pain they have to endure.

In fact, mental/psychological diseases are as normal as physical diseases. They do not come out of thin air, but have a profound physiological foundation, life experience foundation and real triggers. Exploring and understanding the truth behind mental/psychological diseases, and "prepare the right medicine" to maximize the help of patients is the responsibility and mission of researchers and doctors. Although so far, due to the limitations of objective research methods and the level of human knowledge development, our understanding of pathological mechanisms is actually quite limited - in the study of the operation of the brain, the physical and mental (physiological-psychological) interactions of humans as an organic whole, and the interaction between humans and social interpersonal environments, there are still a large number of blank areas waiting for us to explore in depth, which is also the driving force for researchers in related disciplines to continue to move forward.

diagnosis is important but "subjective"

is similar to our daily process of treating the body. When providing help to patients/clients in clinical practice, the first step facing both doctors and patients is to know what happened and make a diagnosis.

We often see visitors eager to know what is called what is happening to them, or they have searched online for their symptoms, and they need to hear the name of a disease, and the sense of certainty brought by this name can make them feel a little relieved, because it also means finding a possible direction to deal with the dilemma. For doctors, the same is true, and career and psychological needs drive them to make a "confirmation".

Objectively speaking, diagnosis is the basis of symptomatic treatment, and its core importance is self-evident.

However, unlike pure physical diseases, the diagnostic criteria and diagnostic processes of mental illnesses and mental illnesses are much more subjective. Whether it is the most common questionnaire scoring in China, simple outpatient question-and-answer, or the more rigorous, standardized detailed interviews and then quantitatively encoded scoring, is based on subjective reports as the main diagnosis based on - of course this is also determined by the nature of mental/psychological diseases itself: the client's expression of his subjective experience is very important. These subjective experiences are usually very individual, and the symptoms shown vary from person to person and are complex. Doctors need to peel off their threads and make identification and judgments among various appearances. Therefore, the doctors themselves have an extremely important role in the subjective understanding and understanding of mental/psychological diseases, the qualitative and quantitative judgment of the disease, and the choice of subsequent treatment methods.

So, as the so-called "professional" or the party representing "authority", to what extent can we give patients/clients a "accurate" answer and provide "accurate" help and services based on this?医者所使用的疾病分类诊断标准，又能在多大程度上“准确”反映出疾病的真相呢？

two authoritative classification and diagnosis systems

Currently, there are two sets of mental/psychological diseases classification and diagnosis systems internationally, namely:

1) ICD-11 ( International Classification of Diseases, International Disease Classification , 11th Revision, 2018) [1] Chapter 6 "Mental, behavioral or neurodevelopmental disorders (Mental, behavioral or neurodevelopmental disorders ), in the previous version of ICD-10[2]. This chapter is called "Mental and Behavioural Disorders (Mental and Behavioural Disorders)";

2) DSM-5 (APA) of the American Society of Mental Diseases (APA) Disorders, Diagnostic and Statistical Manual of Mental Diseases, 5th Edition, 2013) [3]. The first two versions are the fourth edition of DSM-IV issued in 1994 and the fourth edition of the revised edition of DSM-IV-TR[4, 5], respectively.

Figure 1. The two classification diagnostic systems of ICD-11 and DSM-5

have a certain history. The first version of DSM was released in 1952; and because ICD involves all disease categories, the earliest prototype can be traced back to 1891.两者大致上都是平均每十年修订一次。

Every correction and development of the classification diagnosis system for mental/psychological diseases is based on the new understanding of diseases brought about by a large number of clinical scientific research and a deeper understanding of principles, thus modifying, adjusting, refining and adding classification methods and diagnostic principles; on the other hand, it is also influenced by the broader background of social, political and historical and cultural development [6, 7].

horizontally compares the two classification systems. The biggest commonality between the two is: They mainly use external symptoms as the main basis for disease classification and diagnosis; rather than based on the cause. 因此，“诊断结论和分类”可能并不能真正体现疾病的“本质”。

纵向比较两套分类系统，它们都是“与时俱进”的。这也意味着：此刻的“诊断结论和分类”，只是历史进程中的当前认知，并非最终定论。

Therefore, they are not perfect.事实上，研究者们已经认识到现行诊断系统的许多缺点[7, 10, 11]。 Let's take a look at some of the problems they show.

confusing classification concept

Let’s first take the classification diagnosis of personality disorder as an example:

In the advanced DSM-IV and DSM-IV-TR, 11 specific personality disorder categories are classified into three major groups. The diagnostic criteria for each category are a combination of a series of symptoms:

A. Weird and weird group (including: paranoid, schizoid, schizoid personality disorder )

B. Dramatic/emotional/impulsive group (including: antisocial, borderline, performance, narcissistic personality disorder)

C. Anxiety/fearing group (including: avoidance , dependence, obsessive-compulsive personality disorder)

D. Other unspecified descriptions

latest version of DSM-5 has made new attempts to diagnose personality disorder, but has not completely given up using category as a diagnosis.In the new attempt, the diagnostic criteria no longer simply list the symptoms, but give a specific description of six specific types of personality disorders and corresponding personality functions and personality traits; and allow specific descriptions of any other personality disorder that does not meet these six criteria to be used to describe the two dimensions of "personality function" and "personality traits". Similar changes also occurred in ICD-11.

Antisocial personality disorder
avoidance personality disorder
Borderline personality disorder
Narcissistic personality disorder
Narcissistic personality disorder
Narcissistic personality disorder html l4
obsessive-compulsive personality disorder
schizoid personality disorder
other specific personality disorder

Many people should have heard of some of them.

From the above-mentioned classification naming of personality disorders, you may have found that entries that cannot be clearly classified should be reserved in addition to the types of specific naming. This situation occurs in almost all diagnostic categories, that is, the actual observed symptoms may not meet the diagnostic criteria for any given disease type in . In actual clinical applications, the " comorbidity phenomenon " is inevitable, and the patient's symptoms meet the diagnosis standards of two or more disease types at the same time.

Therefore, with the accumulation of clinical observations, some diagnostic categories list more and more supplementary categories, special cases, additional features, or entries similar to "co-diseases" with typical symptoms of other diagnostic categories, etc., to adapt to clinical use. Here are a few simple examples.

For example, in ICD-11, the diagnostic classification number 6A70 "Single-attack Depression" entry includes:

6A70.0 Single-attack Depression Depression -Military;
6A70.1 Single-attack Depression- Moderate-no psychotic symptoms;
6A70.2 Single-onset depression-moderate-with psychotic symptoms;
6A70.3 Single-onset depression-severe-no psychotic symptoms;
6A70. 4 Single-onset depression - severe - accompanied by psychotic symptoms;
6A70.5 Single-onset depression - not clear severity;
6A70.6 Single-onset depression - currently partially relieved;
6A7 0.7 Single-shot depression - currently completely relieved;
6A70.Y other specific single-shot depression;
and 6A70.Z Single-shot depression - non-specific/undefined

I was dizzy and tired? But this is still just a small part of the diagnostic classification related to depression.

and DSM-5 uses ten "additional instructions" to allow clinical applications to attach symptomatic characteristics outside the main diagnostic criteria to a supplementary description when observing symptomatic characteristics outside the main diagnostic criteria. For example, symptom characteristics of "panic attack" and "tension" are added to many diagnostic categories. For example, the new addition of the characteristics of "anxiety disorder" to the diagnosis of " bipolar disorder " and "major depression"; and the mixed symptom characteristics of "mania and depression" to the diagnosis of "bipolar disorder" and "major depression". The operation method of

facilitates clinical users to classify when diagnosed, but at the same time, also reflects the confusion of its classification concept itself to a considerable extent.

A more intuitive example is that DSM-5 also splits the original "affective disorder" category of (in DSM-IV and DSM-IV-TR mainly include bipolar disorder and depression) into "bipolar and related disorders" and "depression", and combines the two with " schizophrenia lineage and other psychotic disorders" are listed in three general categories at the same time, and bipolar disorder is regarded as the linkage and excessive between psychotic disorders and depression; but at the same time, it also wants to bridge the symptoms of schizophrenia and affective disorders (bipolar disorder and depression) (bipolar disorder and depression) .

Are you dizzy?

Figure 2. These two intertwined and unclear classification concepts exist in DSM-5 at the same time (photographed by the author)

The more important question is: is a complex and lengthy classification that does not reflect the essence of the disease. What is the meaning? Can they really guide us accurately in treating (or even curing) patients/clients’ diseases?

HDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD In July 2019, the journal Psychiatric Research published a quality analysis study on DSM-5 [7], and found that several important diseases (Note 1) The diagnostic criteria of itself has the problem of heterogeneity (Heterogeneity) , that is, diagnostic criteria are very inconsistent . Different types of diseases show very big differences in the reference standards for diagnosis, requirements for the duration, severity and judgment angle. Some diseases have highly specific diagnostic criteria, while others have flexible requirements for symptom manifestations, which leads to surprising consequences - for example, there are a total of 24,000 possible combinations of symptoms that meet DSM-5's diagnostic criteria for panic disorder , but only one combination of symptoms meets social phobia.

Note 1: Including schizophrenia spectrum and other psychotic disorders, bipolar (i.e., depression and mania) and related disorders, depression, anxiety, trauma and stress-related disorders

This heterogeneity is also reflected in the diagnosis of different individuals. Two people with completely different symptoms can get the same diagnosis results - studies show that in DSM-IV-TR and DSM-5, this is the case in 64% and 58.3% of the disease diagnosis types, respectively. For example, the PTSD (PTSD) 's own symptoms combination is more than 600,000. This amazing number means that the diagnosis of PTSD is very confusing. Since PTSD often comorbidities with other disorders, such as comorbidities with depression, there are 2.7 billion (!!!) different combinations of symptoms in the diagnostic criteria of DSM-5, which may meet the diagnostic criteria for PTSD and depression at the same time. If the other 4 common comorbidities are also included, the possibility of the combination of symptoms will exceed the number of stars in Milky Way . Although the possibility of comorbidity in six diseases at the same time is relatively small, these calculations intuitively show how huge differences can be seen in the symptoms of the same category of diseases. Countless different combinations of symptoms, even completely different symptoms, can be judged as the same category of diseases.

At the same time, confusing and repetitive classification standards will inevitably lead to some symptoms that can appear in the diagnostic criteria of different types of diseases at the same time. For example, "depressive attacks" occur simultaneously in major depression, bipolar and related disorders, and emotional schizophrenia; "hedonia" occurs simultaneously in schizophrenia and other psychotic disorders, depression with psychotic characteristics, bipolar and related disorders, and PTSD.

So, we finally see that on the one hand, different, even completely different combinations of symptoms can be diagnosed as the same type of disease; on the other hand, different disease categories are allowed to have the same symptom manifestations; worse, the symptoms listed in the diagnostic criteria do not fully cover all the actually observed symptoms, resulting in the "real" disease of not always fully match the diagnostic criteria of a specific category.

"too original" category diagnosis

If the symptoms themselves can be used as the absolute standard for diagnosing diseases, then what do the above phenomena mean?

This is a question that the existing mental and psychological diseases diagnosis system itself cannot answer, and it also indicates their inevitable dilemma - the types of artificial demarcations that can be listed are limited, while the actual symptoms vary greatly. It is true that "category" makes it convenient for clinical users to draw a conclusion - classify patients into one or several disease categories, but its significance for understanding the essence of the disease is very limited and may even hinder.

Because the classification pattern of disease categories also seems to be a kind of (for the public and even for ordinary users) hint, implying that we have understood the nature of each type of disease and are classified and grouped according to the nature of the disease.

But that's not the case. For example, the "neurodevelopmental disorders" that are both classified systems seem to suggest to the public that only this type of disease occurs in the neurodevelopment stage and is the result of abnormal nervous system development (as the cause) , but the description in the diagnostic manual also admits that other diseases may also occur at this stage. For example, "schizophrenia and other psychotic disorders" seem to imply that only this type of disease is "psychotic", but in fact, diagnostic entries with psychotic symptoms are also attached to other diagnostic categories such as "depression" and "bipolar disorder".

In fact, the current classification diagnosis system has declared from the very beginning that it is "non-theoretical" , that is, classification principle is not based on a theoretical model for explaining diseases. But at the same time, the latest versions of ICD and DSM both classify "stress and trauma-related diseases" into a broad category, which is another clear and etiologic classification method. The name of this category "stress-related obstacles" (ICD-11) or "trauma and stress-related obstacles" (DSM-5) also implies that it seems that other categories of diseases are not related to "stress and trauma".

But existing experimental studies are enough to show that many current categories of diseases are related to high stress and trauma, such as depression, bipolar disorder, anxiety, obsessive-compulsive disorder, eating disorder, schizophrenia and psychotic disorder, dissociation disorder, functional neurological disorder (medical unexplained symptoms) . Moreover, these trauma or stress often occur in childhood . An early individual experience from childhood (including interpersonal experience) , especially those related to stress and trauma, is very critical to understanding a person's mental health status as an adult, understanding a person's susceptibility to mental and psychological illness development. For example, auditory hallucinations in schizophrenia are highly correlated with sexual assault in childhood; while paranoia is mostly related to neglect in childhood. However, the current diagnostic system only understands these symptoms as "abnormal" or "dysregulation", and basically does not put them into a person's overall life history background to understand the causes and mechanisms of their formation.

In fact, all observable symptom phenomena and their interrelationships, including various comorbidities, can themselves convey information and hints about pathological mechanisms - the deeper "biological-psychological-social" mechanism behind it.However, the current dominant classification diagnosis system involves almost no such content. Simply put, the characteristics of the current classification and diagnosis system of can be summarized as: firstly, according to phenomenon classification, not mainly considering pathological mechanisms, and hardly based on theory, and not the explanation model of disease .

Overall, it can be seen that this diagnostic method that hopes to use symptoms as a basis and divides independent disease categories objectively has considerable defects and limitations. This brings many problems to clinical application and scientific research. These "category" diagnosis methods that may be seriously deviated from pathological facts may not only mislead patients, but may also be a false suggestion for clinical applications, causing cognitive preconceptions and solidification, which may make them miss the precious opportunity for first-hand observation, understanding and reflection in clinical practice. From a scientific research perspective, this "separate category" can be said to be "meaningless" [7]. It is precisely because its classification basis is manifest but without a certain theoretical basis that it lacks the unified internal logic and rigor of setting standards. For example, as early as 1968, scientists pointed out that it is "the semantic Titanic , which was doomed to fail before setting sail", and "a concept that is so vague that it is almost impossible to use in scientific research", mainly because "the separate category is logically too primitive for scientific research" [12].

In the past, in an era when scientists were still very basic about the disease, this classification diagnosis method based on intuitive symptoms was of course reasonable. As mentioned earlier, as part of social and cultural development, the development and correction of the disease diagnosis system have corresponding socio-political and historical and cultural roots. However, different stages of social development bring different impacts and limitations, making the development of the diagnostic system a fragmented fragment, which also causes the heterogeneity of diagnostic standards and the confusion of classification concepts that are widely present in the diagnostic system.

With the emergence of more and more clinical and experimental evidence, as our understanding of pathological mechanisms continues to deepen, the entire diagnostic system may need a comprehensive reorganization and update. Here, "a way of disease assessment that can identify and understand individual experiences may be more effective in understanding diseases than insisting on a dishonest category system" [7].

How to understand mental/psychological illness more appropriately?

Although scientists do not fully understand the operating mechanism of mental/psychological phenomena, based on existing knowledge, we can imagine on the whole: the

brain, as the most direct biological basis of all mental/psychological phenomena, first follows the deeper and more microscopic biological ( biochemistry and biophysics ) operation mechanism; secondly, from a relatively macro perspective, it is a super complex and sophisticated network system, containing various complex structures and functional areas. They are relatively independent and have high-density connections in the structural level and functional sense, forming an extremely complex functional network in the brain. The realization of each psychological function and psychological process is usually the result of the coordinated participation of different structures and functional areas; the more advanced and more complex the psychological function and psychological process, the more participation of the structure and functional areas is required.

All observable or unobservable, conscious or unconscious, mental/psychological phenomena that are controlled by will or are not controlled by will are integration results presented after different structures and functional areas in this large network are activated with different specific gravity. Correspondingly, any one or several nodes in this network and the region or functional network associated with it, for any intrinsic or external reasons, in any breadth and degree, will trigger the expression of different combinations of symptoms. It is conceivable that the possibilities of this combination of symptoms are endless.

In addition, stress and trauma are key pathological factors in the emergence and development of mental and psychological diseases. Whether it is the current reality or the huge stress and traumatic events experienced in childhood, it can have an impact on the brain, or even irreversible damage. The earlier this effect occurs, the deeper and more difficult it is to reverse. As scientists continue to understand the working mechanism of the brain, such as how human experience affects the brain; how dysregulation of stress or trauma processing systems and other related systems in the brain is associated with different clinical symptoms;... We will increasingly understand the deep causes of each symptom manifestation and the inherent connection between different symptoms, and understand the psychological logic and corresponding physiological basis for the generation and development of each symptom, that is, their true pathological mechanisms. What’s special about related disciplines such as

Psychology, Neuroscience, psychiatry, etc. is that they are disciplines that study the operation of the human mind based on the human mind. Pure literature and art only need to focus on expressing the subjective spiritual world of human beings. Pure science and engineering fields only explore and apply the objective material world. Pure biology only explores the physiological basis of life. Psychology and its related sciences discuss the spiritual world on the material basis of life - the world that transitions from material basis to spiritual content - which may not be easier than exploring the universe.

Countless questions do not have (accurate) answers. Everything is being explored. In addition to understanding the disease, there is also the optimization and development of treatment methods. If you have some needs and expectations for them, please understand their current objective shortcomings; if you have any doubts about them, please be patient with them. With the rapid progress of research technology, these fields can be expected to develop and improve in the future.

How do you view psychotherapy/counseling as more beneficial?

Enough clinical and experimental studies have shown that for the formation and treatment of mental illness, the "relationship" itself plays a very core role . Those psychological disorders that are closely related to stress and traumatic events in individual interpersonal life, especially.

People's behaviors and experience are dominated by the brain, and experience itself is also reshaping the brain from time to time. Human experience is essentially the experience of relationships. In the experience and experience of relationships, the brain can adapt to self-regulation and change - humans are social existences, and interpersonal relationships are another key risk factor for the formation of psychological diseases and a key protective factor for treatment . The quality of the doctor-patient/counseling relationship is the most important factor in onset of psychotherapy across all schools and methods of psychotherapy (one of which) . Therefore, it will be very beneficial for patients to form a stable, trusted and cooperative treatment/counseling alliance between doctors and patients.

Just as a natural ecosystem has a certain self-purification ability, when the level of pollution exceeds the system's self-regulation ability, it will cause irreversible damage to the system. At this time, external forces need to be used to remove pollution, in order to help the system slowly restore its normal state and adjustment function. The same is true for our brains. Stress or trauma is like a pollutant that destroys the healthy balance state of the brain's physiological environment. If is in chronic high pressure for a long time, the brain's pressure response system may lose its normal self-regulation ability and undergo pathological changes and damage. Therefore, it is very necessary to relieve stress in a timely manner. Once the pressure exceeds the level of our own ability to regulate and load, we should turn to others in time.

Psychological problems are often formed over time; accordingly, the onset of psychotherapy or psychological counseling is usually not too fast - this is an expectation that conforms to objective laws. With the gradual establishment of a work alliance between doctors and patients, counselors and clients, patients/clients face themselves honestly and express themselves in depth, which will play a very important role in understanding their own spiritual difficulties and treating diseases.

Doctors and consultants, although they have knowledge tools, are not wizards holding crystal balls in their hands, can directly see others' minds and change others' experiences. Their full understanding of the patient/client mainly comes from the interaction between the two parties. They cannot directly (or even force) to change the patient/client's thoughts and feelings, but instead, through the real interaction between the two parties, gradually triggering the other party to make active adjustments and changes. At the same time, patients/clients are actually helping doctors/counselors to deeply understand the essence of the disease from various symptoms through different cases, in order to better help more people in the future. Every little clinical accumulation is very precious. Obtaining these most direct first-hand observation and research materials is inseparable from the contribution of the patient/client.

On the other hand, it is more important for doctors, therapists or consultants to continuously improve their professional knowledge and abilities and strengthen ethical self-discipline. Especially in the domestic environment where the field of psychotherapy is still in its early stages, the self-requirement of doctors is particularly valuable and important. Given that all the disease interpretation models, diagnostic tools and treatment methods currently used are far from perfect, it is also very necessary to break out of the habitual thinking framework and examine the knowledge "tools" they use from a broader perspective.

Although doctors are not omnipotent, they should and must be the group of people who constantly explore how to understand and assist patients/clients in reducing pain and getting out of difficulties.

Finally, good treatment and consulting results, always depends on the joint efforts of both parties , and also requires considerable persistence and patience.

There is nothing small in the mind

Mental/psychological illness is as "normal" and equally important as physical illness. Fundamentally, the diagnosis and treatment system for psychological diseases and the medical insurance system for mental health should be standardized and improved as much as possible, so that both doctors and patients can enter professional treatment without worries and focus on solving problems with peace of mind and full attention. These are being gradually tried and promoted.

Of course, prevention is the most important thing. Professionally and effectively promote relevant scientific knowledge , especially in the process of children's growth, to popularize and guide parents' knowledge, establish a sufficient social support system (also including families and families) , so that individuals can grow in a healthy and nourishing family interpersonal environment as possible; to make individuals susceptible personality traits "stronger" early through consultation with the goal of "personal growth"; to make stress or trauma can be promptly guided and bridged without further development; to intergenerational transmission of many harmful bad models interfere and block... There are no trivial things in the mind, but there are many things that can be done.

Just as my country has made great progress in many fields, we actually have the resources and capabilities to (including social and cultural, thinking style, and even institutional advantages) has established a complete service guarantee system that meets our own cultural atmosphere and the psychological needs of the masses, and provides citizens with better mental health services.

At the same time, my country has a large population base and is in the stage of continuous and great transformation of society, and there are a variety of cases available. Under the premise of professionalism, standardization and rigor, clinical practice and scientific research have huge resource advantages. By cherishing and making good use of these resources, our understanding of the entire mental/psychological disease model and the expansion and improvement of diagnostic systems and treatment methods may all be of great significance.

Whether you are a doctor, a researcher, a patient in need of help, or someone who is not relevant for the time being, after reading this article, you may be disappointed in your field, but you also hope that you will see hope in it. At least, not blindly superstitious or arbitrary denial, and objectively and rationally viewing and understanding the current development status of related disciplines may be the best attitude to directly or indirectly promote the discipline to develop forward. Of course, professional practitioners will never give up on their efforts to improve them.

sincerely hope that those sad and regretful stories will become fewer and fewer.

Finally, I wish you all good health in body and mind.

References

[1] World Health Organisation. (2018). ICD-11, the 11th Revision of the International Classification of Diseases. Geneva: World Health Organisation; Available at: https://icd.who.int/.

[2] World Health Organisation. (1989). ICD-10, the 10th Revision of the International Classification of Diseases. Geneva: World Health Organisation; Available at: https://icd.who.int/.

[3] American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders, 5th ed. Washington: American Psychiatric Association.

[4] American Psychiatric Association (APA). (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington: American Psychiatric Association.

[5] American Psychiatric Association (APA). (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR®. Washington: American Psychiatric Association.

[6] Foucault, M. (1967). Madness and Civilization: A History of Insanity in the Age of Reason. Pantheon Books, New York.

[7] Allsopp, K., Read, J., Corcoran, R. & Kinderman, P. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research, 279, 15-22.

[8] Rounsaville, B.J., Alarcon, R.D., Andrews, G., et al. (2002). Basic nomenclature issues for DSM-V. In: Kupfer, D.J., First, M.B. & Regier, D.E. (eds). A research agenda for DSM-V, (1-29). Washington: American Psychiatry Association.

[9] Oldham, J.M. (2015). The alternative DSM-5 model for personality disorders. World Psychiatry, 14(2), 234-236.

[10] Krueger, R.F., Hopwood, C.J., Wright, A.G.C., et al. (2014). Challenges and strategies in helping the DSM becomes more dimensional and empirically based. Curr Psychiatr Rep, 16, 515.

[11] Skodol, A.E. (2014). Personality disorder classification: stuck in neutral, how to move forward? Curr Psychiatr Rep, 16, 480.

[12] Bannister, D. (1968). The logical requirements o f research into schizophrenia. Br. J. Psychiatry, 114, 181–188.

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