Bulletin of the Menninger Clinic. XXII, 1958: The Unitary Concept of Mental Illness. Karl Menninger with Henri Ellenberger, Paul Pruyser, and Martin Mayman. Pp. 4-12.

During the past two centuries in Europe there has been an alternation between the trend toward multiplication of psychiatric disease entities and the trend toward nosological simplifications. In America these two trends developed side by side. They were represented by Kraepelin's specific entity concept and the unitary concept of Adolf Meyer. The former trend prevailed. However, the present tendency is toward development of 'simpler, more holistic, and process-oriented concepts'. There is growing realization of the danger inherent in use of concepts of specific entities. Terms become reified and develop harmful connotations: 'The word schizophrenia becomes a damning designation'. The authors propose a unitary concept of mental diseases in which quantitative rather than qualitative differences are assumed to exist between the mental states of individuals. The mental health (or mental illness) of an individual may be taken as indicative of the effectiveness of his ego's efforts to cope with and to reconcile various conflicting pressures, internal and environmental. In mental illness the ego succeeds in these efforts 'at the cost of emergency-coping devices which may be painful. Psychiatrists are apt to look upon mental illness as an indication of ego failure. But now this "failure" acquires a different meaning. Beset by a variety of stresses, the ego tries to insure survival and optimal adaptation at the least cost, and in this it has succeeded.'