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Sunday, May 15, 2022

Religious violence in India

From Wikipedia, the free encyclopedia

Religious violence in India includes acts of violence by followers of one religious group against followers and institutions of another religious group, often in the form of rioting. Religious violence in India has generally involved Hindus and Muslims.

Despite the secular and religiously tolerant constitution of India, broad religious representation in various aspects of society including the government, the active role played by autonomous bodies such as National Human Rights Commission of India and National Commission for Minorities, and the ground-level work being done by non-governmental organisations, sporadic and sometimes serious acts of religious violence tend to occur as the root causes of religious violence often run deep in history, religious activities, and politics of India.

Along with domestic organizations, international human rights organisations such as Amnesty International and Human Rights Watch publish reports on acts of religious violence in India. From 2005 to 2009, an average of 130 people died every year from communal violence, or about 0.01 deaths per 100,000 population. The state of Maharashtra reported the highest total number of religious violence related fatalities over that five-year period, while Madhya Pradesh experienced the highest fatality rate per year per 100,000 population between 2005 and 2009. Over 2012, a total of 97 people died across India from various riots related to religious violence.

The US Commission on International Religious Freedom classified India as Tier-2 in persecuting religious minorities, the same as that of Iraq and Egypt. In a 2018 report, USCIRF charged Hindu nationalist groups for their campaign to "Saffronize" India through violence, intimidation, and harassment against non-Hindus. Approximately one-third of state governments enforced anti-conversion and/or anti-cow slaughter laws against non-Hindus, and mobs engaged in violence against Muslims whose families have been engaged in the dairy, leather, or beef trades for generations, and against Christians for proselytizing. "Cow protection" lynch mobs killed at least 10 victims in 2017.

Many historians argue that religious violence in independent India is a legacy of the policy of divide and rule pursued by the British colonial authorities during the era of Britain's control over the Indian subcontinent, in which local administrators pitted Hindus and Muslims against one another, a tactic that eventually culminated in the partition of India.

Ancient India

Ancient text Ashokavadana, a part of the Divyavadana, mention a non-Buddhist in Pundravardhana drew a picture showing the Buddha bowing at the feet of Nirgrantha Jnatiputra (identified with Mahavira, 24th tirthankara of Jainism). On complaint from a Buddhist devotee, Ashoka, an emperor of the Maurya Dynasty, issued an order to arrest him, and subsequently, another order to kill all the Ajivikas in Pundravardhana. Around 18,000 followers of the Ajivika sect were executed as a result of this order. Sometime later, another Nirgrantha follower in Pataliputra drew a similar picture. Ashoka burnt him and his entire family alive in their house. He also announced an award of one dinara (silver coin) for the head of a Nirgrantha. According to Ashokavadana, as a result of this order, his own brother, Vitashoka, was mistaken for a heretic and killed by a cowherd. Their ministers advised that "this is an example of the suffering that is being inflicted even on those who are free from desire" and that he "should guarantee the security of all beings". After this, Ashoka stopped giving orders for executions. According to K. T. S. Sarao and Benimadhab Barua, stories of persecutions of rival sects by Ashoka appear to be a clear fabrication arising out of sectarian propaganda.

The Divyavadana (divine stories), an anthology of Buddhist mythical tales on morals and ethics, many using talking birds and animals, was written in about 2nd century AD. In one of the stories, the razing of stupas and viharas is mentioned with Pushyamitra. This has been historically mapped to the reign of King Pushyamitra of the Shunga Empire about 400 years before Divyavadana was written. Archeological remains of stupas have been found in Deorkothar that suggest deliberate destruction, conjectured to be one mentioned in Divyavadana about Pushyamitra. It is unclear when the Deorkothar stupas were destroyed, and by whom. The fictional tales of Divyavadana is considered by scholars as being of doubtful value as a historical record. Moriz Winternitz, for example, stated, "these legends [in the Divyāvadāna] scarcely contain anything of much historical value".

Colonial Era

Goa Inquisition (1560–1774)

St. Francis Xavier who requested the Inquisition in 1545.

The first inquisitors, Aleixo Dias Falcão and Francisco Marques, established themselves in what was formerly the king of Goa's palace, forcing the Portuguese viceroy to relocate to a smaller residence. The inquisitor's first act was forbidding Hindus from the public practice of their faith through fear of imprisonment. Sephardic Jews living in Goa, many of whom had fled the Iberian Peninsula to escape the excesses of the Spanish Inquisition to begin with, were also targeted. During the Goa Inquisition, described as "contrary to humanity" by anti-clerical Voltaire, conversion efforts were practiced en masse and tens of thousands of Goan people converted to Catholicism between 1561 and 1774. The few records that have survived suggest that around 57 were executed for their religious crime, and another 64 were burned in effigy because they had already died in jail before sentencing.

The adverse effects of the inquisition forced hundreds of Hindus, Muslims and Catholics to escape Portuguese hegemony by migrating to other parts of the subcontinent. Though officially repressed in 1774, it was nominally reinstated by Queen Maria I in 1778.

Indian Rebellion of 1857

In 1813, the East India Company charter was amended to allow for government sponsored missionary activity across British India. The missionaries soon spread almost everywhere and started denigrating Hindu and Islamic practices like Sati and child marriage, as well as promoting Christianity. Many officers of the British East India Company, such as Herbert Edwardes and Colonel S.G. Wheeler, openly preached to the Sepoys. Such activities caused a great deal of resentment and a fear of forced conversions among Indian soldiers of the Company and civilians alike.

There was a perception that the company was trying to convert Hindus and Muslims to Christianity, which is often cited as one of the causes of the revolt. The revolt is considered by some historians as a semi-national and semi-religious war seeking independence from British rule though Saul David questions this interpretation. The revolt started, among the Indian sepoys of British East India Company, when the British introduced new rifle cartridges, rumoured to be greased with pig and cow fat—an abhorrent concept to Muslim and Hindu soldiers, respectively, for religious reasons. 150,000 Indians and 6,000 Britons were killed during the 1857 rebellion.

Partition of Bengal (1905)

The British colonial era, since the 18th century, portrayed and treated Hindus and Muslims as two divided groups, both in cultural terms and for the purposes of governance. The British favoured Muslims in the early period of colonial rule to gain influence in Mughal India, but underwent a shift in policies after the 1857 rebellion. A series of religious riots in the late 19th century, such as those of 1891, 1896 and 1897 religious riots of Calcutta, raised concerns within British Raj. The rising political movement for independence of India, and colonial government's administrative strategies to neutralize it, pressed the British to make the first attempt to partition the most populous province of India, Bengal.

Bengal was partitioned by the British colonial government, in 1905, along religious lines—a Muslim majority state of East Bengal and a Hindu majority state of West Bengal. The partition was deeply resented, seen by both groups as evidence of British favoritism to the other side. Waves of religious riots hit Bengal through 1907. The religious violence worsened, and the partition was reversed in 1911. The reversal did little to calm the religious violence in India, and Bengal alone witnessed at least nine violent riots, between Muslims and Hindus, in the 1910s through the 1930s.

Moplah Rebellion (1921)

Moplah Rebellion was an Anti Jenmi rebellion conducted by the Muslim Moplah (Mappila) community of Kerala in 1921. Inspired by the Khilafat movement and the Karachi resolution; Moplahs murdered, pillaged, and forcibly converted thousands of Hindus. 100,000 Hindus were driven away from their homes forcing to leave their property behind, which were later taken over by Moplahs. This greatly changed the demographics of the area, being the major cause behind today's Malappuram district being a Muslim majority district in Kerala.

According to one view, the reasons for the Moplah rebellion was religious revivalism among the Muslim Moplahs, and hostility towards the landlord Hindu Nair, Nambudiri Jenmi community and the British administration that supported the latter. Adhering to view, British records call it a British-Muslim revolt. The initial focus was on the government, but when the limited presence of the government was eliminated, Moplahs turned their full attention on attacking Hindus. Mohommed Haji was proclaimed the Caliph of the Moplah Khilafat and flags of Islamic Caliphate were flown. Ernad and Walluvanad were declared Khilafat kingdoms.

Annie Besant wrote about the riots: "They Moplahs murdered and plundered abundantly, and killed or drove away all Hindus who would not apostatise. Somewhere about a lakh (100,000) of people were driven from their homes with nothing but their clothes they had on, stripped of everything. Malabar has taught us what Islamic rule still means, and we do not want to see another specimen of the Khilafat Raj in India."

Partition of British India (1947)

As colonial rule in the Indian subcontinent was ending, there was large-scale religious violence. Corpses with vultures in Kolkata after the 1946 riots (left), a Jain neighborhood and Hindu temple after arson attacks in Ahmedabad in 1946 (middle) and Sikhs escaping violence across the Indo-Pakistani Punjab border in 1947.

Direct Action Day, which started on 16 August 1946, left approximately 3,000 Hindus dead and 17,000 injured.

After the Indian Rebellion of 1857, the British colonial government followed a divide-and-rule policy, exploiting existing differences between communities, to prevent similar revolts from taking place. In that respect, Indian Muslims were encouraged to forge a cultural and political identity separate from the Hindus. In the years leading up to Independence, Mohammad Ali Jinnah became increasingly concerned about minority position of Islam in an independent India largely composed of a Hindu majority.

Although a partition plan was accepted, no large population movements were contemplated. As India and Pakistan become independent, 14.5 million people crossed borders to ensure their safety in an increasingly lawless and communal environment. With British authority gone, the newly formed governments were completely unequipped to deal with migrations of such staggering magnitude, and massive violence and slaughter occurred on both sides of the border along communal lines. Estimates of the number of deaths range around roughly 500,000, with low estimates at 200,000 and high estimates at one million.

Modern India

Large-scale religious violence and riots have periodically occurred in India since its independence from British colonial rule. The aftermath of the Partition of India in 1947 to create a separate Islamic state of Pakistan for Muslims, saw large scale sectarian strife and bloodshed throughout the nation. Since then, India has witnessed sporadic large-scale violence sparked by underlying tensions between sections of the Hindu and Muslim communities. These conflicts also stem from the ideologies of hardline right-wing groups versus Islamic Fundamentalists and prevalent in certain sections of the population. Since independence, India has always maintained a constitutional commitment to secularism. The major incidences include the 1969 Gujarat riots, 1984 anti-Sikh riots, the 1989 Bhagalpur riots, 1989 Kashmir violence, Godhra train burning, 2002 Gujarat riots, 2013 Muzaffarnagar riots and 2020 Delhi riots.

Gujarat communal riots (1969)

Religious violence broke out between Hindus and Muslims during September–October 1969, in Gujarat. It was the most deadly Hindu-Muslim violence since the 1947 partition of India.

The violence included attacks on Muslim chawls by their Dalit neighbours. The violence continued over a week, then the rioting restarted a month later. Some 660 people were killed (430 Muslims, 230 Hindus), 1074 people were injured and over 48,000 lost their property.

Anti-Sikh riots (1984)

In the 1970s, Sikhs in Punjab had sought autonomy and complained about domination by the Hindu. Indira Gandhi government arrested thousands of Sikhs for their opposition and demands particularly during Indian Emergency. In Indira Gandhi's attempt to "save democracy" through the Emergency, India's constitution was suspended, 140,000 people were arrested without due process, of which 40,000 were Sikhs.

After the Emergency was lifted, during elections, she supported Jarnail Singh Bhindranwale, a Sikh leader, in an effort to undermine the Akali Dal, the largest Sikh political party. However, Bhindranwale began to oppose the central government and moved his political base to the Darbar Sahib (Golden temple) in Amritsar, demanding creation on Punjab as a new country. In June 1984, under orders from Indira Gandhi, the Indian army attacked the Golden temple with tanks and armoured vehicles, due to the presence of Sikh Khalistanis armed with weapons inside. Thousands of Sikhs died during the attack. In retaliation for the storming of the Golden temple, Indira Gandhi was assassinated on 31 October 1984 by two Sikh bodyguards.

The assassination provoked mass rioting against Sikh. During the 1984 anti-Sikh pogroms in Delhi, government and police officials aided Indian National Congress party worker gangs in "methodically and systematically" targeting Sikhs and Sikh homes. As a result of the pogroms 10,000–17,000 were burned alive or otherwise killed, Sikh people suffered massive property damage, and at least 50,000 Sikhs were displaced.

The 1984 riots fueled the Sikh insurgency movement. In the peak years of the insurgency, religious violence by separatists, government-sponsored groups, and the paramilitary arms of the government was endemic on all sides. Human Rights Watch reports that separatists were responsible for "massacre of civilians, attacks upon Hindu minorities in the state, indiscriminate bomb attacks in crowded places, and the assassination of a number of political leaders". Human Rights Watch also stated that the Indian Government's response "led to the arbitrary detention, torture, extrajudicial execution, and enforced disappearance of thousands of Sikhs". The insurgency paralyzed Punjab's economy until peace initiatives and elections were held in the 1990s. Allegations of coverup and shielding of political leaders of Indian National Congress over their role in 1984 riot crimes, have been widespread.

Exodus of Kashmiri Hindus

In the Kashmir region, approximately 300 Kashmiri Pandits were killed between September 1989 to 1990 in various incidents. In early 1990, local Urdu newspapers Aftab and Al Safa called upon Kashmiris to wage jihad against India and ordered the expulsion of all Hindus choosing to remain in Kashmir. In the following days masked men ran in the streets with AK-47 shooting to kill Hindus who would not leave. Notices were placed on the houses of all Hindus, telling them to leave within 24 hours or die.

Since March 1990, estimates of between 300,000 and 500,000 pandits have migrated outside Kashmir due to persecution by Islamic fundamentalists in the largest case of ethnic cleansing since the partition of India.

Many Kashmiri Pandits have been killed by Islamist militants in incidents such as the Wandhama massacre and the 2000 Amarnath pilgrimage massacre. The incidents of massacring and forced eviction have been termed ethnic cleansing by some observers.

Religious involvement in North-East India militancy

Religion has begun to play an increasing role in reinforcing ethnic divides among the decades-old militant separatist movements in north-east India.

The Christian separatist group National Liberation Front of Tripura (NLFT) has proclaimed bans on Hindu worship and has attacked animist Reangs and Hindu Jamatia tribesmen in the state of Tripura. Some resisting tribal leaders have been killed and some tribal women raped.

According to The Government of Tripura, the Baptist Church of Tripura is involved in supporting the NLFT and arrested two church officials in 2000, one of them for possessing explosives. In late 2004, the National Liberation Front of Tripura banned all Hindu celebrations of Durga Puja and Saraswati Puja. The Naga insurgency, militants have largely depended on their Christian ideological base for their cause.

Anti-Hindu violence

Maddur Mosque inscription declaring that Muslims have agreed not to object to non-Muslim religious processions.

There have been a number of attacks on Hindu temples and Hindus by Muslim militants and Christian evangelists. Prominent among them are the 1998 Chamba massacre, the 2002 fidayeen attacks on Raghunath temple, the 2002 Akshardham Temple attack by Islamic terrorist outfit Lashkar-e-Toiba and the 2006 Varanasi bombings (also by Lashkar-e-Toiba), resulting in many deaths and injuries. Recent attacks on Hindus by Muslim mobs include Marad massacre and the Godhra train burning.

In August 2000, Swami Shanti Kali, a popular Hindu priest, was shot to death inside his ashram in the Indian state of Tripura. Police reports regarding the incident identified ten members of the Christian terrorist organisation, NLFT, as being responsible for the murder. On 4 Dec 2000, nearly three months after his death, an ashram set up by Shanti Kali at Chachu Bazar near the Sidhai police station was raided by Christian militants belonging to the NLFT. Eleven of the priest's ashrams, schools, and orphanages around the state were burned down by the NLFT.

In September 2008, Swami Laxmanananda, a popular regional Hindu Guru was murdered along with four of his disciples by unknown assailants (though a Maoist organisation later claimed responsibility for that). Later the police arrested three Christians in connection with the murder. Congress MP Radhakant Nayak has also been named as a suspected person in the murder, with some Hindu leaders calling for his arrest.

Lesser incidents of religious violence happen in many towns and villages in India. In October 2005, five people were killed in Mau in Uttar Pradesh during Muslim rioting, which was triggered by the proposed celebration of a Hindu festival.

On 3 and 4 January 2002, eight Hindus were killed in Marad, near Kozhikode due to scuffles between two groups that began after a dispute over drinking water. On 2 May 2003, eight Hindus were killed by a Muslim mob, in what is believed to be a sequel to the earlier incident. One of the attackers, Mohammed Ashker was killed during the chaos. The National Development Front (NDF), a right-wing militant Islamist organisation, was suspected as the perpetrator of the Marad massacre.

In the 2010 Deganga riots after hundreds of Hindu business establishments and residences were looted, destroyed and burnt, dozens of Hindus were killed or severely injured and several Hindu temples desecrated and vandalised by the Islamist mobs allegedly led by Trinamul Congress MP Haji Nurul Islam. Three years later, during the 2013 Canning riots, several hundred Hindu businesses were targeted and destroyed by Islamist mobs in the Indian state of West Bengal.

Religious violence has led to the death, injuries and damage to numerous Hindus. For example, 254 Hindus were killed in 2002 Gujarat riots out of which half were killed in police firing and rest by rioters. During 1992 Bombay riots, 275 Hindus died.

In October, 2018, a Christian personal security officer of an additional sessions judge assassinated his 38-year-old wife and his 18-year-old son for not converting to Christianity.

In October 2020, a 20-year old Nikita Tomar was shot by Tausif, a Muslim, for not converting to Islam and marrying to him. Tausif was imprisoned for life.

Some cases of murder because of blasphemy have also taken place. Kamlesh Tiwari was murdered for his allegedly blasphemous comments on Muhammad in October 2019. A similar case took place in Gujrat in January 2022 where Kishan Bharvad was murdered for making a allegedly blasphemous social media post on Muhammad on the directive of a Muslim cleric. A Hindu man named Nagaraju was murdered by a Muslim man for marrying a Muslim woman.

Violence against Muslims

The history of modern India has many incidents of communal violence. During the 1947 partition there was religious violence between Muslim-Hindu, Muslim-Sikhs and Muslim-Jains on a gigantic scale. Hundreds of religious riots have been recorded since then, in every decade of independent India. In these riots, the victims have included many Muslims, Hindus, Sikhs, Jains, Christians and Buddhists.

On 6 December 1992, members of the Vishva Hindu Parishad and the Bajrang Dal destroyed the 430-year-old Babri Mosque in Ayodhya—it was claimed by the Hindus that the mosque was built over the birthplace of the ancient deity Rama (and a 2010 Allahabad court ruled that the site was indeed a Hindu monument before the mosque was built there, based on evidence submitted by the Archaeological Survey of India). The resulting religious riots caused at least 1200 deaths. Since then the Government of India has blocked off or heavily increased security at these disputed sites while encouraging attempts to resolve these disputes through court cases and negotiations.

In the aftermath of the destruction of the Babri Mosque in Ayodhya by Hindu nationalists on 6 December 1992, riots took place between Hindus and Muslims in the city of Mumbai. Four people died in a fire in the Asalpha timber mart at Ghatkopar, five were killed in the burning of Bainganwadi; shacks along the harbour line track between Sewri and Cotton Green stations were gutted; and a couple was pulled out of a rickshaw in Asalpha village and burnt to death. The riots changed the demographics of Mumbai greatly, as Hindus moved to Hindu-majority areas and Muslims moved to Muslim-majority areas.

Many of Ahmedabad's buildings were set on fire during 2002 Gujarat violence.

The Godhra train burning incident in which Hindus were burned alive allegedly by Muslims by closing door of train, led to the 2002 Gujarat riots in which mostly Muslims were killed. According to the death toll given to the parliament on 11 May 2005 by the United Progressive Alliance government, 790 Muslims and 254 Hindus were killed, and another 2,548 injured. 223 people are missing. The report placed the number of riot widows at 919 and 606 children were declared orphaned. According to hone advocacy group, the death tolls were up to 2000. According to the Congressional Research Service, up to 2000 people were killed in the violence.

Tens of thousands were displaced from their homes because of the violence. According to New York Times reporter Celia Williams Dugger, witnesses were dismayed by the lack of intervention from local police, who often watched the events taking place and took no action against the attacks on Muslims and their property. Sangh leaders as well as the Gujarat government maintain that the violence was rioting or inter-communal clashes—spontaneous and uncontrollable reaction to the Godhra train burning.

The Government of India has implemented almost all the recommendations of the Sachar Committee to help Muslims.

The February 2020 North East Delhi riots, which left more than 40 dead and hundreds injured, were triggered by protests against a citizenship law seen by many critics as anti-Muslim and part of Prime Minister Narendra Modi's Hindu nationalist agenda.

Anti-Christian violence

A 1999 Human Rights Watch report states increasing levels of religious violence on Christians in India, perpetrated by Hindu organizations. In 2000, acts of religious violence against Christians included forcible reconversion of converted Christians to Hinduism, distribution of threatening literature and destruction of Christian cemeteries. According to a 2008 report by Hudson Institute, "extremist Hindus have increased their attacks on Christians, until there are now several hundred per year. But this did not make news in the U.S. until a foreigner was attacked." In Orissa, starting December 2007, Christians have been attacked in Kandhamal and other districts, resulting in the deaths of two Hindus and one Christian, and the destruction of houses and churches. Hindus claim that Christians killed a Hindu saint Laxmananand, and the attacks on Christians were in retaliation. However, there was no conclusive proof to support this claim. Twenty people were arrested following the attacks on churches. Similarly, starting 14 September 2008, there were numerous incidents of violence against the Christian community in Karnataka.

In 2007, foreign Christian missionaries became targets of attacks.

Graham Stuart Staines (1941 – 23 January 1999) an Australian Christian missionary who, along with his two sons Philip (aged 10) and Timothy (aged 6), was burnt to death by a gang of Hindu Bajrang Dal fundamentalists while sleeping in his station wagon at Manoharpur village in Kendujhar district in Odisha, India on 23 January 1999. In 2003, a Bajrang Dal activist, Dara Singh, was convicted of leading the gang that murdered Graham Staines and his sons, and was sentenced to life in prison.

In its annual human rights reports for 1999, the United States Department of State criticised India for "increasing societal violence against Christians." The report listed over 90 incidents of anti-Christian violence, ranging from damage of religious property to violence against Christian pilgrims.

In Madhya Pradesh, unidentified persons set two statues inside St Peter and Paul Church in Jabalpur on fire. In Karnataka, religious violence was targeted against Christians in 2008.

Anti-atheist violence

Statistics

Riots incidence rates per 100,000 people in India during 2012. Kerala reported the highest riot incidence rate in 2012, while Punjab and Meghalaya reported zero riot incidence rates.
 
Communal violence in India
Year Incidents Deaths Injured
2005 779 124 2066
2006 698 133 2170
2007 761 99 2227
2008 943 167 2354
2009 849 125 2461
2010 701 116 2138
2011 580 91 1899
2012 668 94 2117
2013 823 133 2269
2014 644 95 1921
2015 751 97 2264
2016 703 86 2321
2017 822 111 2384

From 2005 to 2009, an average of 130 people died every year from communal riots, and 2,200 were injured. In pre-partitioned India, over the 1920–1940 period, numerous communal violence incidents were recorded, an average of 381 people died per year during religious violence, and thousands were injured.

According to PRS India, 24 out of 35 states and union territories of India reported instances of religious riots over the five years from 2005 to 2009. However, most religious riots resulted in property damage but no injuries or fatalities. The highest incidences of communal violence in the five-year period were reported from Maharashtra (700). The other three states with high counts of communal violence over the same five-year period were Madhya Pradesh, Uttar Pradesh and Orissa. Together, these four states accounted for 64% of all deaths from communal violence. Adjusted for widely different population per state, the highest rate of communal violence fatalities were reported by Madhya Pradesh, at 0.14 death per 100,000 people over five years, or 0.03 deaths per 100,000 people per year. There was a wide regional variation in rate of death caused by communal violence per 100,000 people. The India-wide average communal violence fatality rate per year was 0.01 person per 100,000 people per year. The world's average annual death rate from intentional violence, in recent years, has been 7.9 per 100,000 people.

For 2012, there were 93 deaths in India from many incidences of communal violence (or 0.007 fatalities per 100,000 people). Of these, 48 were Muslims, 44 Hindus and one police official. The riots also injured 2,067 people, of which 1,010 were Hindus, 787 Muslims, 222 police officials and 48 others. Over 2013, 107 people were killed during religious riots (or 0.008 total fatalities per 100,000 people), of which 66 were Muslims, 41 were Hindus. The various riots in 2013 also injured 1,647 people including 794 Hindus, 703 Muslims and 200 policemen.

International human rights reports

  • The 2007 United States Department of State International Religious Freedom Report noted The Constitution provides for freedom of religion, and the National Government generally respected this right in practice. However, some state and local governments limited this freedom in practice.
  • The 2008 Human Rights Watch report notes: India claims an abiding commitment to human rights, but its record is marred by continuing violations by security forces in counterinsurgency operations and by government failure to rigorously implement laws and policies to protect marginalised communities. A vibrant media and civil society continue to press for improvements, but without tangible signs of success in 2007.
  • The 2007 Amnesty International report listed several issues concern in India and noted Justice and rehabilitation continued to evade most victims of the 2002 Gujarat communal violence.
  • The 2007 United States Department of State Human Rights Report noted that the government generally respected the rights of its citizens; however, numerous serious problems remained. The report which has received a lot of controversy internationally, as it does not include human rights violations of United States and its allies, has generally been rejected by political parties in India as interference in internal affairs, including in the Lower House of Parliament.
  • In a 2018 report, United Nations Human Rights office expressed concerns over attacks directed at minorities and Dalits in India. The statement came in an annual report to the United Nations Human Rights Council's March 2018 session where Zeid Ra’ad al-Hussein said,

"In India, I am increasingly disturbed by discrimination and violence directed at minorities, including Dalits and other scheduled castes, and religious minorities such as Muslims. In some cases this injustice appears actively endorsed by local or religious officials. I am concerned that criticism of government policies is frequently met by claims that it constitutes sedition or a threat to national security. I am deeply concerned by efforts to limit critical voices through the cancellation or suspension of registration of thousands of NGOs, including groups advocating for human rights and even public health groups."

In film and literature

Religious violence in India have been a topic of various films and novels.

Classification of mental disorders

From Wikipedia, the free encyclopedia

The classification of mental disorders is also known as psychiatric nosology or psychiatric taxonomy. It represents a key aspect of psychiatry and other mental health professions and is an important issue for people who may be diagnosed. There are currently two widely established systems for classifying mental disorders:

Both list categories of disorders thought to be distinct types, and have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be in use more locally, for example the Chinese Classification of Mental Disorders. Other manuals have some limited use by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual.

The widely used DSM and ICD classifications employ operational definitions.

Definitions

In the scientific and academic literature on the definition or categorization of mental disorders, one extreme argues that it is entirely a matter of value judgments (including of what is normal) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms); other views argue that the concept refers to a "fuzzy prototype" that can never be precisely defined, or that the definition will always involve a mixture of scientific facts (e.g. that a natural or evolved function isn't working properly) and value judgments (e.g. that it is harmful or undesired). Lay concepts of mental disorder vary considerably across different cultures and countries, and may refer to different sorts of individual and social problems.

The WHO and national surveys report that there is no single consensus on the definition of mental disorder, and that the phrasing used depends on the social, cultural, economic and legal context in different contexts and in different societies. The WHO reports that there is intense debate about which conditions should be included under the concept of mental disorder; a broad definition can cover mental illness, intellectual disability, personality disorder and substance dependence, but inclusion varies by country and is reported to be a complex and debated issue. There may be a criterion that a condition should not be expected to occur as part of a person's usual culture or religion. However, despite the term "mental", there is not necessarily a clear distinction drawn between mental (dys)functioning and brain (dys)functioning, or indeed between the brain and the rest of the body.

Most international clinical documents avoid the term "mental illness", preferring the term "mental disorder". However, some use "mental illness" as the main overarching term to encompass mental disorders. Some consumer/survivor movement organizations oppose use of the term "mental illness" on the grounds that it supports the dominance of a medical model. The term "serious mental impairment" (SMI) is sometimes used to refer to more severe and long-lasting disorders while "mental health problems" may be used as a broader term, or to refer only to milder or more transient issues. Confusion often surrounds the ways and contexts in which these terms are used.

Mental disorders are generally classified separately to neurological disorders, learning disabilities or mental retardation.

ICD-10

The International Classification of Diseases (ICD) is an international standard diagnostic classification for a wide variety of health conditions. The ICD-10 states that mental disorder is "not an exact term", although is generally used "...to imply the existence of a clinically recognisable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions." Chapter V focuses on "mental and behavioural disorders" and consists of 10 main groups:

  • F0: Organic, including symptomatic, mental disorders
  • F1: Mental and behavioural disorders due to use of psychoactive substances
  • F2: Schizophrenia, schizotypal and delusional disorders
  • F3: Mood [affective] disorders
  • F4: Neurotic, stress-related and somatoform disorders
  • F5: Behavioural syndromes associated with physiological disturbances and physical factors
  • F6: Disorders of personality and behaviour in adult persons
  • F7: Mental retardation
  • F8: Disorders of psychological development
  • F9: Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
  • In addition, a group of "unspecified mental disorders".

Within each group there are more specific subcategories. The WHO has revised ICD-10 to produce the latest version of the ICD, ICD-11 adopted by the 72nd World Health Assembly in 2019 and came into effect on 1 January 2022.

DSM-IV

The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. It was produced by the American Psychiatric Association and it characterizes mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual,...is associated with present distress...or disability...or with a significantly increased risk of suffering" but that "...no definition adequately specifies precise boundaries for the concept of 'mental disorder'...different situations call for different definitions" (APA, 1994 and 2000). The DSM also states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or no mental disorders."

The DSM-IV-TR (Text Revision, 2000) consisted of five axes (domains) on which disorder could be assessed. The five axes were:

Axis I: Clinical Disorders (all mental disorders except Personality Disorders and Mental Retardation)
Axis II: Personality Disorders and Mental Retardation
Axis III: General Medical Conditions (must be connected to a Mental Disorder)
Axis IV: Psychosocial and Environmental Problems (for example limited social support network)
Axis V: Global Assessment of Functioning (Psychological, social and job-related functions are evaluated on a continuum between mental health and extreme mental disorder)

The axis classification system was removed in the DSM-5 and is now mostly of historical significance. The main categories of disorder in the DSM are:

DSM Group Examples
Disorders usually first diagnosed in infancy, childhood or adolescence. *Disorders such as ADHD and epilepsy have also been referred to as developmental disorders and developmental disabilities. ADHD
Delirium, dementia, and amnesia and other cognitive disorders Alzheimer's disease
Mental disorders due to a general medical condition AIDS-related psychosis
Substance-related disorders Alcohol use disorder
Schizophrenia and other psychotic disorders Delusional disorder
Mood disorders Major depressive disorder, Bipolar disorder
Anxiety disorders Generalized anxiety disorder, Social anxiety disorder
Somatoform disorders Somatization disorder
Factitious disorders Münchausen syndrome
Dissociative disorders Dissociative identity disorder
Sexual and gender dysphoria Dyspareunia, Gender dysphoria
Eating disorders Anorexia nervosa, Bulimia nervosa
Sleep disorders Insomnia
Impulse control disorders not elsewhere classified Kleptomania
Adjustment disorders Adjustment disorder
Personality disorders Narcissistic personality disorder
Other conditions that may be a focus of clinical attention Tardive dyskinesia, Child abuse

Other schemes

Childhood diagnosis

Child and adolescent psychiatry sometimes uses specific manuals in addition to the DSM and ICD. The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3) was first published in 1994 by Zero to Three to classify mental health and developmental disorders in the first four years of life. It has been published in 9 languages. The Research Diagnostic criteria-Preschool Age (RDC-PA) was developed between 2000 and 2002 by a task force of independent investigators with the goal of developing clearly specified diagnostic criteria to facilitate research on psychopathology in this age group. The French Classification of Child and Adolescent Mental Disorders (CFTMEA), operational since 1983, is the classification of reference for French child psychiatrists.

Usage

The ICD and DSM classification schemes have achieved widespread acceptance in psychiatry. A survey of 205 psychiatrists, from 66 countries across all continents, found that ICD-10 was more frequently used and more valued in clinical practice and training, while the DSM-IV was more frequently used in clinical practice in the United States and Canada, and was more valued for research, with accessibility to either being limited, and usage by other mental health professionals, policy makers, patients and families less clear. . A primary care (e.g. general or family physician) version of the mental disorder section of ICD-10 has been developed (ICD-10-PHC) which has also been used quite extensively internationally. A survey of journal articles indexed in various biomedical databases between 1980 and 2005 indicated that 15,743 referred to the DSM and 3,106 to the ICD.

In Japan, most university hospitals use either the ICD or DSM. ICD appears to be the somewhat more used for research or academic purposes, while both were used equally for clinical purposes. Other traditional psychiatric schemes may also be used.

Types of classification schemes

Categorical schemes

The classification schemes in common usage are based on separate (but may be overlapping) categories of disorder schemes sometimes termed "neo-Kraepelinian" (after the psychiatrist Kraepelin) which is intended to be atheoretical with regard to etiology (causation). These classification schemes have achieved some widespread acceptance in psychiatry and other fields, and have generally been found to have improved inter-rater reliability, although routine clinical usage is less clear. Questions of validity and utility have been raised, both scientifically and in terms of social, economic and political factors—notably over the inclusion of certain controversial categories, the influence of the pharmaceutical industry, or the stigmatizing effect of being categorized or labelled.

Non-categorical schemes

Some approaches to classification do not use categories with single cut-offs separating the ill from the healthy or the abnormal from the normal (a practice sometimes termed "threshold psychiatry" or "dichotomous classification").

Classification may instead be based on broader underlying "spectra", where each spectrum links together a range of related categorical diagnoses and nonthreshold symptom patterns.

Some approaches go further and propose continuously varying dimensions that are not grouped into spectra or categories; each individual simply has a profile of scores across different dimensions. DSM-5 planning committees are currently seeking to establish a research basis for a hybrid dimensional classification of personality disorders. However, the problem with entirely dimensional classifications is they are said to be of limited practical value in clinical practice where yes/no decisions often need to be made, for example whether a person requires treatment, and moreover the rest of medicine is firmly committed to categories, which are assumed to reflect discrete disease entities. While the Psychodynamic Diagnostic Manual has an emphasis on dimensionality and the context of mental problems, it has been structured largely as an adjunct to the categories of the DSM. Moreover, dimensionality approach was criticized for its reliance on independent dimensions whereas all systems of behavioral regulations show strong inter-dependence, feedback and contingent relationships. 

Descriptive vs Somatic

Descriptive classifications are based almost exclusively on either descriptions of behavior as reported by various observers, such as parents, teachers, and medical personnel; or symptoms as reported by individuals themselves. As such, they are quite subjective, not amenable to verification by third parties, and not readily transferable across chronologic and/or cultural barriers.

Somatic nosology, on the other hand, is based almost exclusively on the objective histologic and chemical abnormalities which are characteristic of various diseases and can be identified by appropriately trained pathologists. While not all pathologists will agree in all cases, the degree of uniformity allowed is orders of magnitude greater than that enabled by the constantly changing classification embraced by the DSM system. Some models, like Functional Ensemble of Temperament suggest to unify nosology of somatic, biologically based individual differences in healthy people (temperament) and their deviations in a form of mental disorders in one taxonomy.

Cultural differences

Classification schemes may not apply to all cultures. The DSM is based on predominantly American research studies and has been said to have a decidedly American outlook, meaning that differing disorders or concepts of illness from other cultures (including personalistic rather than naturalistic explanations) may be neglected or misrepresented, while Western cultural phenomena may be taken as universal. Culture-bound syndromes are those hypothesized to be specific to certain cultures (typically taken to mean non-Western or non-mainstream cultures); while some are listed in an appendix of the DSM-IV they are not detailed and there remain open questions about the relationship between Western and non-Western diagnostic categories and sociocultural factors, which are addressed from different directions by, for example, cross-cultural psychiatry or anthropology.

Historical development

Antiquity

In Ancient Greece, Hippocrates and his followers are generally credited with the first classification system for mental illnesses, including mania, melancholia, paranoia, phobias and Scythian disease (transvestism). They held that they were due to different kinds of imbalance in four humors.

Middle ages to Renaissance

The Persian physicians 'Ali ibn al-'Abbas al-Majusi and Najib ad-Din Samarqandi elaborated upon Hippocrates' system of classification. Avicenna (980−1037 CE) in the Canon of Medicine listed a number of mental disorders, including "passive male homosexuality".

Laws generally distinguished between "idiots" and "lunatics".

Thomas Sydenham (1624–1689), the "English Hippocrates", emphasized careful clinical observation and diagnosis and developed the concept of a syndrome, a group of associated symptoms having a common course, which would later influence psychiatric classification.

18th century

Evolution in the scientific concepts of psychopathology (literally referring to diseases of the mind) took hold in the late 18th and 19th centuries following the Renaissance and Enlightenment. Individual behaviors that had long been recognized came to be grouped into syndromes.

Boissier de Sauvages developed an extremely extensive psychiatric classification in the mid-18th century, influenced by the medical nosology of Thomas Sydenham and the biological taxonomy of Carl Linnaeus. It was only part of his classification of 2400 medical diseases. These were divided into 10 "classes", one of which comprised the bulk of the mental diseases, divided into four "orders" and 23 "genera". One genus, melancholia, was subdivided into 14 "species".

William Cullen advanced an influential medical nosology which included four classes of neuroses: coma, adynamias, spasms, and vesanias. The vesanias included amentia, melancholia, mania, and oneirodynia.

Towards the end of the 18th century and into the 19th, Pinel, influenced by Cullen's scheme, developed his own, again employing the terminology of genera and species. His simplified revision of this reduced all mental illnesses to four basic types. He argued that mental disorders are not separate entities but stem from a single disease that he called "mental alienation".

Attempts were made to merge the ancient concept of delirium with that of insanity, the latter sometimes described as delirium without fever.

On the other hand, Pinel had started a trend for diagnosing forms of insanity 'without delirium' (meaning hallucinations or delusions) – a concept of partial insanity. Attempts were made to distinguish this from total insanity by criteria such as intensity, content or generalization of delusions.

19th century

Pinel's successor, Esquirol, extended Pinel's categories to five. Both made a clear distinction between insanity (including mania and dementia) as opposed to mental retardation (including idiocy and imbecility). Esquirol developed a concept of monomania—a periodic delusional fixation or undesirable disposition on one theme—that became a broad and common diagnosis and a part of popular culture for much of the 19th century. The diagnosis of "moral insanity" coined by James Prichard also became popular; those with the condition did not seem delusional or intellectually impaired but seemed to have disordered emotions or behavior.

The botanical taxonomic approach was abandoned in the 19th century, in favor of an anatomical-clinical approach that became increasingly descriptive. There was a focus on identifying the particular psychological faculty involved in particular forms of insanity, including through phrenology, although some argued for a more central "unitary" cause. French and German psychiatric nosology was in the ascendency. The term "psychiatry" ("Psychiatrie") was coined by German physician Johann Christian Reil in 1808, from the Greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer or doctor"). The term "alienation" took on a psychiatric meaning in France, later adopted into medical English. The terms psychosis and neurosis came into use, the former viewed psychologically and the latter neurologically.

In the second half of the century, Karl Kahlbaum and Ewald Hecker developed a descriptive categorizion of syndromes, employing terms such as dysthymia, cyclothymia, catatonia, paranoia and hebephrenia. Wilhelm Griesinger (1817–1869) advanced a unitary scheme based on a concept of brain pathology. French psychiatrists Jules Baillarger described "folie à double forme" and Jean-Pierre Falret described "la folie circulaire"—alternating mania and depression.

The concept of adolescent insanity or developmental insanity was advanced by Scottish Asylum Superintendent and Lecturer in Mental Diseases Thomas Clouston in 1873, describing a psychotic condition which generally impacts those aged 18–24 years, particularly males, and in 30% of cases proceeded to "a secondary dementia".

The concept of hysteria (wandering womb) had long been used, perhaps since ancient Egyptian times, and was later adopted by Freud. Descriptions of a specific syndrome now known as somatization disorder were first developed by the French physician, Paul Briquet in 1859.

An American physician, Beard, described "neurasthenia" in 1869. German neurologist Westphal, coined the term "obsessional neurosis" now termed obsessive-compulsive disorder, and agoraphobia. Alienists created a whole new series of diagnoses that highlighted single, impulsive behavior, such as kleptomania, dipsomania, pyromania, and nymphomania. The diagnosis of drapetomania was also developed in the Southern United States to explain the perceived irrationality of black slaves trying to escape what was thought to be a suitable role.

The scientific study of homosexuality began in the 19th century, informally viewed either as natural or as a disorder. Kraepelin included it as a disorder in his Compendium der Psychiatrie that he published in successive editions from 1883.

"Psychiatrists of Europe! Protect your sanctified diagnoses!" Cartoon by Emil Kraepelin, 1896.

In the late 19th century, Koch referred to "psychopathic inferiority" as a new term for moral insanity. In the 20th century the term became known as "psychopathy" or "sociopathy", related specifically to antisocial behavior. Related studies led to the DSM-III category of antisocial personality disorder.

20th century

Influenced by the approach of Kahlbaum and others, and developing his concepts in publications spanning the turn of the century, German psychiatrist Emil Kraepelin advanced a new system. He grouped together a number of existing diagnoses that appeared to all have a deteriorating course over time—such as catatonia, hebephrenia and dementia paranoides—under another existing term "dementia praecox" (meaning "early senility", later renamed schizophrenia). Another set of diagnoses that appeared to have a periodic course and better outcome were grouped together under the category of manic-depressive insanity (mood disorder). He also proposed a third category of psychosis, called paranoia, involving delusions but not the more general deficits and poor course attributed to dementia praecox. In all he proposed 15 categories, also including psychogenic neurosis, psychopathic personality, and syndromes of defective mental development (mental retardation). He eventually included homosexuality in the category of "mental conditions of constitutional origin".

The neuroses were later split into anxiety disorders and other disorders.

Freud wrote extensively on hysteria and also coined the term, "anxiety neurosis", which appeared in DSM-I and DSM-II. Checklist criteria for this led to studies that were to define panic disorder for DSM-III.

Early 20th century schemes in Europe and the United States reflected a brain disease (or degeneration) model that had emerged during the 19th century, as well as some ideas from Darwin's theory of evolution and/or Freud's psychoanalytic theories.

Psychoanalytic theory did not rest on classification of distinct disorders, but pursued analyses of unconscious conflicts and their manifestations within an individual's life. It dealt with neurosis, psychosis, and perversion. The concept of borderline personality disorder and other personality disorder diagnoses were later formalized from such psychoanalytic theories, though such ego psychology-based lines of development diverged substantially from the paths taken elsewhere within psychoanalysis.

The philosopher and psychiatrist Karl Jaspers made influential use of a "biographical method" and suggested ways to diagnose based on the form rather than content of beliefs or perceptions. In regard to classification in general he prophetically remarked that: "When we design a diagnostic schema, we can only do so if we forego something at the outset … and in the face of facts we have to draw the line where none exists... A classification therefore has only provisional value. It is a fiction which will discharge its function if it proves to be the most apt for the time".

Adolph Meyer advanced a mixed biosocial scheme that emphasized the reactions and adaptations of the whole organism to life experiences.

In 1945, William C. Menninger advanced a classification scheme for the US army, called Medical 203, synthesizing ideas of the time into five major groups. This system was adopted by the Veterans Administration in the United States and strongly influenced the DSM.

The term stress, having emerged from endocrinology work in the 1930s, was popularized with an increasingly broad biopsychosocial meaning, and was increasingly linked to mental disorders. The diagnosis of post-traumatic stress disorder was later created.

Mental disorders were first included in the sixth revision of the International Classification of Diseases (ICD-6) in 1949. Three years later, in 1952, the American Psychiatric Association created its own classification system, DSM-I.

The Feighner Criteria group described fourteen major psychiatric disorders for which careful research studies were available, including homosexuality. These developed as the Research Diagnostic Criteria, adopted and further developed by the DSM-III.

The DSM and ICD developed, partly in sync, in the context of mainstream psychiatric research and theory. Debates continued and developed about the definition of mental illness, the medical model, categorical vs dimensional approaches, and whether and how to include suffering and impairment criteria. There is some attempt to construct novel schemes, for example from an attachment perspective where patterns of symptoms are construed as evidence of specific patterns of disrupted attachment, coupled with specific types of subsequent trauma.

21st century

The ICD-11 and DSM-5 are being developed at the start of the 21st century. Any radical new developments in classification are said to be more likely to be introduced by the APA than by the WHO, mainly because the former only has to persuade its own board of trustees whereas the latter has to persuade the representatives of over 200 countries at a formal revision conference. In addition, while the DSM is a bestselling publication that makes huge profits for APA, the WHO incurs major expense in determining international consensus for revisions to the ICD. Although there is an ongoing attempt to reduce trivial or accidental differences between the DSM and ICD, it is thought that the APA and the WHO are likely to continue to produce new versions of their manuals and, in some respects, to compete with one another.

Criticism

There is some ongoing scientific doubt concerning the construct validity and reliability of psychiatric diagnostic categories and criteria even though they have been increasingly standardized to improve inter-rater agreement in controlled research. In the United States, there have been calls and endorsements for a congressional hearing to explore the nature and extent of harm potentially caused by this "minimally investigated enterprise".

Other specific criticisms of the current schemes include: attempts to demonstrate natural boundaries between related syndromes, or between a common syndrome and normality, have failed; inappropriateness of statistical (factor-analytic) arguments and lack of functionality considerations in the analysis of a structure of behavioral pathology; the disorders of current classification are probably surface phenomena that can have many different interacting causes, yet "the mere fact that a diagnostic concept is listed in an official nomenclature and provided with a precise operational definition tends to encourage us to assume that it is a "quasi-disease entity" that can be invoked to explain the patient's symptoms"; and that the diagnostic manuals have led to an unintended decline in careful evaluation of each individual person's experiences and social context.

Psychodynamic schemes have traditionally given the latter phenomenological aspect more consideration, but in psychoanalytic terms that have been long criticized on numerous grounds.

Some have argued that reliance on operational definition demands that intuitive concepts, such as depression, need to be operationally defined before they become amenable to scientific investigation. However, John Stuart Mill pointed out the dangers of believing that anything that could be given a name must refer to a thing and Stephen Jay Gould and others have criticized psychologists for doing just that. One critic states that "Instead of replacing 'metaphysical' terms such as 'desire' and 'purpose', they used it to legitimize them by giving them operational definitions. Thus in psychology, as in economics, the initial, quite radical operationalist ideas eventually came to serve as little more than a 'reassurance fetish' (Koch 1992, 275) for mainstream methodological practice." According to Tadafumi Kato, since the era of Kraepelin, psychiatrists have been trying to differentiate mental disorders by using clinical interviews. Kato argues there has been little progress over the last century and that only modest improvements are possible in this way; he suggests that only neurobiological studies using modern technology could form the basis for a new classification.

According to Heinz Katsching, expert committees have combined phenomenological criteria in variable ways into categories of mental disorders, repeatedly defined and redefined over the last half century. The diagnostic categories are termed "disorders" and yet, despite not being validated by biological criteria as most medical diseases are, are framed as medical diseases identified by medical diagnoses. He describes them as top-down classification systems similar to the botanic classifications of plants in the 17th and 18th centuries, when experts decided a priori which visible aspects of plants were relevant. Katsching notes that while psychopathological phenomena are certainly observed and experienced, the conceptual basis of psychiatric diagnostic categories is questioned from various ideological perspectives.

Psychiatrist Joel Paris argues that psychiatry is sometimes susceptible to diagnostic fads. Some have been based on theory (overdiagnosis of schizophrenia), some based on etiological (causation) concepts (overdiagnosis of post-traumatic stress disorder), and some based on the development of treatments. Paris points out that psychiatrists like to diagnose conditions they can treat, and gives examples of what he sees as prescribing patterns paralleling diagnostic trends, for example an increase in bipolar diagnosis once lithium came into use, and similar scenarios with the use of electroconvulsive therapy, neuroleptics, tricyclic antidepressants, and SSRIs. He notes that there was a time when every patient seemed to have "latent schizophrenia" and another time when everything in psychiatry seemed to be "masked depression", and he fears that the boundaries of the bipolar spectrum concept, including in application to children, are similarly expanding. Allen Frances has suggested fad diagnostic trends regarding autism and Attention deficit hyperactivity disorder.

Since the 1980s, psychologist Paula Caplan has had concerns about psychiatric diagnosis, and people being arbitrarily "slapped with a psychiatric label". Caplan says psychiatric diagnosis is unregulated, so doctors aren't required to spend much time understanding patients situations or to seek another doctor's opinion. The criteria for allocating psychiatric labels are contained in the Diagnostic and Statistical Manual of Mental Disorders, which can "lead a therapist to focus on narrow checklists of symptoms, with little consideration for what is causing the patient’s suffering". So, according to Caplan, getting a psychiatric diagnosis and label often hinders recovery.

The DSM and ICD approach remains under attack both because of the implied causality model and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.

Natural science

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