Mental illness and psychiatry have seen substantial change - but there is still a long way to go

The spectrum of what can be defined as health and illness has been progressively changed, by both the recognition of diverse diseases and how they are characterised, and the emergence of new patterns of problems. These new, emergent patterns of distress, impairment, ‘strange’ phenomena and suffering may be those associated with, for instance, a new infectious disease arising from viral mutation, or a new pattern of problems resulting from environmental or other hazards, or with socially driven behavioural change, or existing behaviour newly described, for instance, narcissistic personality disorder. Behavioural changes, whether the result of internally driven processes (such as chemical factors, e.g. neurotransmitters) or externally (as with adversity, violence, abandonment) may also lead to consistent patterns of suffering and dysfunction, which become defined as ‘disorder’. Syndromes-patterns of symptoms - may constitute physical or psychiatric disorders that can be recognised and diagnosed as such and treated.