Since
I was in medical school in 1968, I have been seeing African-American
children who have bad tempers, poor educational achievement, poor social
skills, and poor judgment. In medical school these problems were referred to as
mild mental retardation and Minimal Brain Dysfunction. A little more than ten
years later, while working at the Chicago Board of Education, I saw 274children who had these same problems to varying degrees, and by then these
children were characterized by various labels, e.g., Trainably Mentally
Handicapped (TMH), Educationally Mentally Handicapped (EMH), Minimal Brain
Dysfunction, Neurosis, etc. because child psychiatric diagnosis was, like adult
psychiatric diagnosis, becoming more descriptive in nature.
The trend for
descriptive diagnoses was relevant at the time because it is rare in psychiatry
to find a specific etiology for psychiatric illnesses and most problem
behaviors were and still is caused by multiple factors. In psychiatry, we frequently
do not know the etiology of the behaviors we observe that may constitute signs
of mental illness or behavioral disturbances, yet we have to try to figure out
medications and social or psychological interventions that ameliorate the
mental illness or problem behaviors.
However, as science progresses, as was done for cretinism and
phenylketonuria, psychiatry’s goal is to develop an etiologic understanding of
as many psychiatric disorders as possible, because, it puts our profession in a
better position to help the patients who come to us for treatment of their
difficulties in life.
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