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alexandra_k said:
What is controversial, however, is how much we should lament the fact that more people don't ask for help (take drugs seek therapy) when we have decided that they have a mental illness.

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Okay, Alex, you're losing me. WHO is "we" and how have we decided they have a mental illness if they haven't come to us to ask for help or have hurt themselves or others without "realizing" it. And you have to define "ask for" in a better way too; people sky diving are not deemed (by society) to be seeking help but people trying to kill themselves by jumping from high places without "nets"/parachutes or talking about doing same are "seeking attention" and crying for help.

We don't pass laws that people have to get better in any particular way (therapy or meds) either, anymore than we pass laws insisting that people have to buy health insurance. They have to buy car insurance because their uninsurance could impact me in a car but if they don't "like" doctors or don't want to spend their little bit of money on doctors (preferring to eat, perhaps, instead) then that is their perrogative.

Your rape problem,

"Would it be adaptive to not have a negative emotional response to rape? Would the DSM consider rape to be a negative ENVIRONMENTAL event such that my negative emotional response would be excusable (so not a mark of mental non optimality)?"

People DO have a negative emotional response to rape! It is the suppression of that negative emotion that is non-optimal; animals when they're dying don't have "emotions" like we have so don't get tangled in them. But rape is not environmental as much as it is idiosyncratic. The "environment" doesn't "choose"; if you have a wife and 4 kids and a "mean" drunk husband/father; everyone loses in that environment. If you have just a husband/wife and they argue and are going through an ugly divorce (or not - Richard Burton/Elizabeth Taylor) they both lose in that environment. But if you are out on a date and get date-raped, the "environment" doesn't have anything to do about it. It will probably be a bit more "private" than other environments but "private" can be selective too. I had a good friend in college, she had to work her way through, attending a semester then working a couple semesters to pay for the next semester. She was raped and murdered late one night waiting for transportion from her job at the train yard. The "environment" didn't cause or suffer; we, her friends, weren't anywhere near that kind of environment and it didn't happen to us. But I ended up at Georgetown University Hospital the next evening after work with stomach pains. They worked me up well (this was early 1970s when doctors/hospitals were still "good") and after 2-3 hours I suddenly remembered (and related) the news I'd gotten the night before and how "coincidental" it was that I now had these extreme pains in my "belly"?

I think it is not as cut and dried as any "tool" to help diagnose is going to appear. But the tool is not the diagnosis. Trying to quickly find a "level" of need like this tool appears to do does not mean anything is set is cement. No one is going to say, "Ah, level 4, she's Borderline for sure!" (or if they do, you go to a different facility where they have better doctors!).