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April 1988

What Is a Case?Food for Thought for Epidemiologists

Author Affiliations

From the University of Edinburgh Department of Psychiatry, Royal Edinburgh Hospital.

Arch Gen Psychiatry. 1988;45(4):374-376. doi:10.1001/archpsyc.1988.01800280090012

The title of Vaillant and Schnurr's1 article in this issue of the Archives highlights the most important problem that has confronted psychiatric epidemiology for much of the past decade. We have learned how to make reliable diagnoses, but we still have no adequate criterion of their validity, and the achievement focuses attention on the failure. We draw the boundaries between one syndrome and another, and between illness and normality, in widely differing places and using a variety of different criteria and we have no adequate means of deciding which is right, or even which is preferable for a given purpose. The main reasons for this state of affairs are now well understood. Our ignorance of etiology forces us to define most disorders by their symptoms, and syndromes merge insensibly into one another, and into "normal distress," with no obvious natural boundaries or "points of rarity" to separate them. Many