October 19, 2005

Classification of Psychiatric Disorders—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294(15):1898-1900. doi:10.1001/jama.294.15.1899-b

In Reply: The central argument by Drs Spitzer and First is that for most psychiatric disorders, the etiology is unknown. I disagree with this assumption.

They restrict their concept of etiology to “pathophysiological processes.” But many mental disorders derive not from brain pathology but from brain-mediated issues of assumption, accident, manner, and choice leading to personal misdirections and misadventures, concepts that form the core of cognitive behavioral therapy and the psychology of personality, motivation, and social learning.

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