The Mongol conquest of the Jin dynasty, also known as the Mongol–Jin War, was fought between the Mongol Empire and the Jurchen-led Jin dynasty in Manchuria and North China. The war, which started in 1211, lasted over 23 years and ended with the complete conquest of the Jin dynasty by the Mongols in 1234. Background Main article: Jin–Song Wars The Jurchen rulers of the Jin dynasty collected tribute from some of the nomadic tribes living on the Mongol steppes and encouraged rivalries among them. When the Mongols were unified under Khabul in the 12th century, the Jurchens encouraged the Tatars to destroy them, but the Mongols were able to drive Jin forces out of their territory. The Tatars eventually captured Khabul's successor, Ambaghai, and handed him over to the Jin imperial court. Emperor Xizong of the Jin dynasty had ordered Ambaghai executed by crucifixion (nailed to a wooden mule). The Jin dynasty also conducted regular punitive expeditions against the Mongol nomads, either enslaving or killing them. When the Tatars were in their original countries, during the Jin caitiff's Dading period [1161-1189] there was a rumor spoken in Yanjing and the Kitan areas saying: 'The Tatars come, the Tatars go, they'll chase His Lordship 'till he has nowhere to go!' The Chieftain of Ge, Yong, happened to hear of it and said in astonishment: 'Surely this means the Tatar people will bring disaster to my country!' and handed down a proclamation to the farthest frontiers and wastes to mobilize troops to destroy them. Every three years he would dispatch troops to the north to destroy and kill, and called it 'decreasing the number of fighting men.' Up to now, the people of the Central Plain are all able to remember this, saying: 'Twenty years ago in Shandong and Hebei, what house did not buy a Tatar to be a young slave?' All of these were those captured by soldiers. Today, among the great ministers of the Tatars, many were among those captured at that time and have lived within the state of Jin. Moreover, every year when their country came to present tribute [to the Jin] they would receive their rituals and offerings outside of the passes and then would drive them away, not allowing them to enter the border. The Tatars fled and concealed themselves in the sandy deserts and the hatred entered into the marrow of their bones... Temujin was infuriated about their bullying and insults and as a consequence of this attacked the frontier.[4] — Zhao Gong In 1210, a delegation arrived at the court of Genghis Khan (r. 1206–27) to proclaim the ascension of Wanyan Yongji to the Jin throne and demanded the submission of the Mongols as a vassal state. Because the Jurchens defeated the powerful steppe nomads and allied with the Keraites and the Tatars, they claimed sovereignty over all the tribes of the steppe. High court officials in the Jin government defected to the Mongols and urged Genghis Khan to attack the Jin dynasty. But fearful of a trap or some other nefarious scheme, Genghis Khan refused. Upon receiving the order to demonstrate submission, Genghis Khan reportedly turned to the south and spat on the ground; then he mounted his horse, and rode toward the north, leaving the stunned envoy choking in his dust. He gave the Jin emperor a very insulting message which the envoy dared not repeat upon his return to the Jin court. His defiance of the Jin envoys was tantamount to a declaration of war between the Mongols and Jurchens.[5] Mongol cavalry battle Jurchen warriors After Genghis Khan returned to the Kherlen River, in early 1211, he summoned a kurultai. By organising a long discussion, everyone in the community was included in the process. The Khan prayed privately on a nearby mountain. He removed his hat and belt, bowed down before the Eternal Sky, and recounted the generations of grievances his people held against the Jurchens and detailed the torture and murder of his ancestors. He explained that he had not sought this war against the Jurchens. At the dawn on the fourth day, Genghis Khan emerged with the verdict: "The Eternal Blue Sky has promised us victory and vengeance".[6] Wanyan Yongji, angry on hearing how Genghis Khan behaved, sent the message to the Khan that "Our Empire is like the sea; yours is but a handful of sand ... How can we fear you?"[7] Mongol conquest under Genghis Khan When the conquest of the Tangut-led Western Xia empire started, there were multiple raids between 1207 and 1209.[8] When the Mongols invaded Jin territory in 1211, Ala 'Qush, the chief of the Ongut, supported Genghis Khan and showed him a safe road to the Jin dynasty's heartland. The first important battle between the Mongol Empire and the Jin dynasty was the Battle of Yehuling at a mountain pass in Zhangjiakou which took place in 1211. There, Wanyan Jiujin, the Jin field commander, made a tactical mistake in not attacking the Mongols at the first opportunity. Instead, he sent a messenger to the Mongol side, Shimo Ming'an, who promptly defected and told the Mongols that the Jin army was waiting on the other side of the pass. At this engagement, fought at Yehuling, the Mongols massacred thousands of Jin troops. While Genghis Khan headed southward, his general Jebe travelled even further east into Manchuria and captured Mukden (present-day Shenyang). The Khitan leader Liu-ke had declared his allegiance to Genghis in 1212 and conquered Manchuria from the Jin. When the Mongol army besieged the Jin central capital, Zhongdu (present-day Beijing), in 1213, Li Ying, Li Xiong and a few other Jin generals assembled a militia of more than 10,000 men who inflicted several defeats on the Mongols. The Mongols smashed the Jin armies, each numbering in the hundreds of thousands, and broke through Juyong Pass and Zijing Gap by November 1213.[9] From 1213 until early 1214, the Mongols pillaged the entire North China plain. In 1214, Genghis Khan surrounded the court of the Golden Khan in Zhongdu.[10] The Jin general Hushahu had murdered the emperor Wanyan Yongji and enthroned Wanyan Yongji's nephew, Emperor Xuanzong. When the Mongols besieged Zhongdu, the Jin government temporarily agreed to become a tributary state of the Mongol Empire, presenting a Jurchen princess to Genghis Khan. But when the Mongols withdrew in 1214, believing the war was over after being given a large tribute by the Jurchens, Li Ying wanted to ambush them on the way with his forces (which had grown to several tens of thousands). However, the Jin ruler, Emperor Xuanzong, was afraid of offending the Mongols again so he stopped Li Ying. Emperor Xuanzong and the general Zhuhu Gaoqi then decided to shift the capital south to Kaifeng, above the objections of many courtiers including Li Ying. From then on, the Jin were strictly on the defensive and Zhongdu fell to the Mongols in 1215. The Jurchen Jin emperor Wanyan Yongji's daughter, Jurchen Princess Qiguo was married to Mongol leader Genghis Khan in exchange for relieving the Mongol siege upon Zhongdu (Beijing) in the Mongol conquest of the Jin dynasty.[11] After the shift of the Jin capital to Kaifeng, the Jin chancellor Wanyan Chenghui and general Moran Jinzhong were left to guard Zhongdu. At this point, one of the Jin armies defected to the Mongols and launched an attack on Zhongdu from the south, taking Lugou Bridge. Genghis Khan then dispatched his troops to attack Zhongdu again, led by the surrendered Khitan generals Shimo Ming'an, Yelü Ahai and Yelü Tuhua. Moran Jinzhong's second-in-command, Pucha Qijin, surrendered to the Mongols with all the troops under him, throwing Zhongdu into crisis. Emperor Xuanzong then sent reinforcements north: Yongxi leading the troops from Zhending and Zhongshan (numbers not given), and Wugulun Qingshou leading 18,000 imperial guards, 11,000 infantry and cavalry from the southwestern route, and 10,000 soldiers from Hebei Province, with Li Ying in charge of the supply train. Zhongdu fell to the Mongols on June 1, 1215. Then they systematically rooted out all resistance in Shanxi, Hebei and Shandong provinces from 1217 to 1223. Genghis Khan did however need to turn his attention to the east in 1219, due to another event in Central Asia and Persia. The Mongol Empire in 1227 at Genghis Khan's death Muqali's advance In 1223, the Mongol general Muqali had struck into Shaanxi Province, attacking Chang'an when Genghis Khan was attacking Khwarezmia. The garrison in Chang'an, 200,000 under Wanyan Heda, was too strong and Muqali had to turn to besieging Feng County with 100,000 men. The siege dragged on for months and the Mongols were harassed by local militia, while Jin reinforcements were about to arrive. Muqali then died of illness, and the Mongols retreated. This was the siege in which the Western Xia troops supporting the Mongols gave up and went home, incurring the wrath of Genghis Khan. In the wars against the Mongols, therefore, the Jin relied heavily on subjects or allies like the Uighurs, Tanguts and Khitans to supply cavalry. Mongol conquest under Ögedei Khan Mongol Empire's Ayimaq [ja] in North China When Ögedei Khan succeeded his father, he rebuffed Jin offers of peace talks but the Jin officers murdered Mongol envoys.[12] Jin armies under Emperor Aizong successfully stopped several Mongol offensives, with major victories in the process, such as at the Battle of Dachangyuan in 1229, Battle of Weizhou (1230), Battle of Daohuigu (1231). The Kheshig commander Doqolqu was dispatched to attempt a frontal attack on Tong Pass, but Wanyan Heda defeated him and forced Subutai to withdraw in 1230. In 1231, the Mongols attacked again and finally took Fengxiang. The Jin garrison in Chang'an panicked and abandoned the city, pulling back to Henan Province with all the city's population. One month later, the Mongols decided to use a three-pronged attack to converge on Kaifeng from north, east and west. The western force under Tolui would start from Fengxiang, enter Tong Pass, and then pass through Song territory at the Han River (near Xiangyang) to reemerge south of Kaifeng to catch the Jurchens by surprise. Wanyan Heda learned of this plan and led 200,000 men to intercept Tolui. At Dengzhou, he set an ambush in a valley with several tens of thousands of cavalry hidden behind the crest of either mountain, but Tolui's spies alerted him and he kept his main force with the supply train, sending only a smaller force of light cavalry to skirt around the valley and attack the Jin troops from behind. Wanyan Heda saw that his plan had been foiled and prepared his troops for a Mongol assault. At Mount Yu, southwest of Dengzhou, the two armies met in a pitched battle. The Jin army had an advantage in numbers, and fought fiercely. The Mongols then withdrew from Mount Yu by about 30 li, and Tolui changed his strategy. Leaving a part of his force to keep Wanyan Heda occupied, he sent most of his men to strike northwards at Kaifeng in several dispersed contingents to avoid alerting Heda. On the way from Dengzhou to Kaifeng, the Mongols easily took county after county, and burnt all the supplies they captured so as to cut off Wanyan Heda's supply lines. Wanyan Heda was forced to withdraw, and ran into the Mongols at Three-peaked Hill in Junzhou. At this point, the Jin troops on the Yellow River were also diverted southwards to meet Tolui's attack, and the Mongol northern force under Ögedei Khan seized this opportunity to cross the frozen river and join up with Tolui – even at this point, their combined strength was only about 50,000. By 1232, the Jurchen ruler, Emperor Aizong, was besieged in Kaifeng. They together smashed the Jin forces. Ögedei Khan soon departed, leaving the final conquest to his generals. Mongol–Song alliance In 1233, Emperor Aizong dispatched diplomats to implore the Song for supplies. Jin envoys reported to the Song that the Mongols would invade the Song after they were done with the Jin – a forecast that would later be proven true – but the Song ignored the warning and rebuffed the request. They instead formed an alliance with the Mongols against the Jin. The Song provided supplies to the Mongols in return for parts of Henan. The fall of the Jin dynasty Main article: Mongol siege of Kaifeng Mongol invasion of the Jin dynasty (1211–1215) Mongol conquest of the Jin dynasty (1230–1234) Conquest of Jurchen Jin by Mongols and Song Dynasty Mongol conquest of China Wanyan Heda's army still had more than 100,000 men after the battle at Mount Yu, and the Mongols adopted a strategy of exhausting the enemy. The Jin troops had little rest all the way from Dengzhou, and had not eaten for three days because of the severing of their supply lines. Their morale was plummeting and their commanders were losing confidence. When they reached Sanfengshan (Three-peaked Hill), a snowstorm suddenly broke out, and it was so cold that the faces of the Jin troops went as white as corpses, and they could hardly march. Rather than attack them when they were desperate with their backs to the wall, the Mongols left them an escape route and then ambushed them when they let down their guard during the retreat. The Jin army collapsed without a fight, and the Mongols pursued the fleeing Jin troops relentlessly. Wanyan Heda was killed, and most of his commanders also lost their lives. After the Battle of Sanfengshan, Mongol troops took the city of Yuzhou. Kaifeng was doomed and Emperor Aizong soon abandoned the city and entered Hebei Province in a vain attempt to reestablish himself there. Thousands of people offered a stubborn resistance to the Mongols, who entrusted the conduct of the attack to Subutai, the most daring of all their commanders. Emperor Aizong was driven south again, and by this time Kaifeng had been taken by the Mongols so he established his new capital at Caizhou (present-day Runan County, Henan Province). Subutai wished to massacre the whole of the population. But Yelü Chucai was more humane, and under his advice Ögedei Khan rejected the cruel proposal. The Jurchens used fire arrows against the Mongols during the defence of Kaifeng in 1232. The Mongols adopted this weapon in later conquests.[13] In 1233, after Emperor Aizong had abandoned Kaifeng and failed to raise a new army for himself in Hebei, he returned to Henan and established his base in Guide (present-day Anyang). Scattered Jin armies began to gather at Guide from the surrounding region and Hebei, and the supplies in the city could no longer feed all these soldiers. Thus Emperor Aizong was left with only 450 Han Chinese troops under the command of Pucha Guannu and 280 men under Ma Yong to guard the city, and dispersed the rest of the troops to forage in Su (in Anhui Province), Xu (present-day Xuzhou, Jiangsu Province), and Chen (present-day Huaiyang, Henan Province). Pucha Guannu then launched a coup with his troops, killing Ma Yong and more than 300 other courtiers, as well as about 3,000 officers, palace guards and civilians who refused to cooperate with him. He made Emperor Aizong a puppet ruler and became the real master of the Jin imperial court. At this point the Mongols had arrived outside Guide and were preparing to besiege the city. The Mongol general Sajisibuhua had set up camp north of the city, on the bank of a river. Guannu then led his 450 troops out on boats from the southern gate at night, armed with fire-lances. They rowed along the river by the eastern side of the city, reaching the Mongol camp early in the morning. Emperor Aizong watched the battle from the northern gate of the city, with his imperial boat prepared for him to flee to Xuzhou if the Jin troops were defeated. The Jin troops assaulted the Mongol camp from two directions, using their fire-lances to throw the Mongols into a panic. More than 3,500 Mongols drowned in the river while trying to flee, and the Mongol stockades were all burned to the ground. Sajisibuhua was also killed in the battle. Pucha Guannu had achieved a remarkable victory and was promoted by Emperor Aizong. But Guide was not defensible in the long term, and the other courtiers urged Emperor Aizong to move to Caizhou, which had stronger walls and more provisions and troops. Pucha Guannu opposed the move, afraid that his power base would be weakened and arguing that Caizhou's advantages had been overstated. The Han Chinese general Shi Tianze led troops to pursue Emperor Aizong as he retreated, and destroyed an 80,000-strong Jin army led by Wanyan Chengyi (完顏承裔) at Pucheng (蒲城). Three months later, Emperor Aizong used a plot to assassinate Guannu, and then quickly began preparations to move to Caizhou. By the time new reports reached him that Caizhou was still too weak in defences, troops and supplies, he was already on the way there. The fate of the Jin dynasty was then sealed for good, despite the earlier victory against great odds at Guide. The Southern Song dynasty, wishing to give the Jin dynasty the coup de grâce, declared war upon the Jurchens, and placed a large army in the field. The remainder of the Jin army took shelter in Caizhou, where they were closely besieged by the Mongols on one side and the Song army on the other. Driven thus into a corner, the Jurchens fought with the courage of despair and long held out against the combined efforts of their enemies. At last, Emperor Aizong saw that the struggle could not be prolonged, and he prepared himself to end his life. When the enemy breached the city walls, Emperor Aizong committed suicide after passing the throne to his general Wanyan Chenglin. Wanyan Chenglin, historically known as Emperor Mo, ruled for less than a day before he was finally killed in battle. Thus the Jin dynasty came to an end on February 9, 1234. There are great men of the vanquished Jin who have gotten mixed up in odd jobs falling as low as butchering and peddling, or leaving to become Yellow Caps. All of them are still referred to by their old government [titles]. The family of Pacification Commissioner Wang has a number of men who push carts and are called 'Transport Commissioner' or 'Attendant Courtier.' In Changchun Palace, 'Palace of Long Spring,' there are many gentlemen of the vanquished Jin court, who by being there avoid baijiao, escape taxes and corvée labor, and receive clothing and food. It is to a great extent the cause for the people's sorrow and distress.[14] — Zhao Gong Mongol policies James Waterson cautioned against attributing the population drop in northern China to Mongol slaughter since much of the population may have moved to southern China under the Southern Song or died of disease and famine as agricultural and urban city infrastructure were destroyed.[15] The Mongols spared cities from massacre and sacking if they surrendered, such as Kaifeng, which was surrendered to Subetai by Xu Li,[16] Yangzhou, which was surrendered to Bayan by Li Tingzhi's second in command after Li Tingzhi was executed by the Southern Song,[17] and Hangzhou, which was spared from sacking when it surrendered to Kublai Khan.[18] Han Chinese and Khitan soldiers defected en masse to Genghis Khan against the Jurchen Jin dynasty.[19] Towns which surrendered were spared from sacking and massacre by Kublai Khan.[20] The Khitan reluctantly left their homeland in Manchuria as the Jin moved their primary capital from Beijing south to Kaifeng and defected to the Mongols.[21] Many Han Chinese and Khitans defected to the Mongols to fight against the Jin dynasty. Two Han Chinese leaders, Shi Tianze and Liu Heima (劉黑馬),[22] and the Khitan Xiao Zhala (蕭札剌) defected and commanded the three tumens in the Mongol army.[23] Liu Heima and Shi Tianze served Genghis Khan's successor, Ögedei Khan.[24] Liu Heima and Shi Tianxiang led armies against Western Xia for the Mongols.[25] There were four Han tumens and three Khitan tumens, with each tumen consisting of 10,000 troops. The three Khitan generals Shimo Beidi'er (石抹孛迭兒), Tabuyir (塔不已兒), and Xiao Zhongxi (蕭重喜; Xiao Zhala's son) commanded the three Khitan tumens and the four Han generals Zhang Rou (張柔), Yan Shi (嚴實), Shi Tianze and Liu Heima commanded the four Han tumens under Ögedei Khan.[26][27][28][29] Shi Tianze, Zhang Rou, Yan Shi and other Han Chinese who served in the Jin dynasty and defected to the Mongols helped build the structure for the administration of the new Mongol state.[30] The Mongols valued physicians, craftsmen and religious clerics and ordered them to be spared from death and brought to them when cities were taken in northern China.[31] The Han Chinese nobles Duke Yansheng and Celestial Masters continued possessing their titles in the Mongol empire and Yuan dynasty since the previous dynasties. See also History of Beijing Jin–Song Wars Timeline of the Jin–Song Wars Manchuria under Yuan rule

 The Mongol conquest of the Jin dynasty, also known as the Mongol–Jin War, was fought between the Mongol Empire and the Jurchen-led Jin dynasty in Manchuria and North China. The war, which started in 1211, lasted over 23 years and ended with the complete conquest of the Jin dynasty by the Mongols in 1234.


Background

Main article: Jin–Song Wars

The Jurchen rulers of the Jin dynasty collected tribute from some of the nomadic tribes living on the Mongol steppes and encouraged rivalries among them. When the Mongols were unified under Khabul in the 12th century, the Jurchens encouraged the Tatars to destroy them, but the Mongols were able to drive Jin forces out of their territory. The Tatars eventually captured Khabul's successor, Ambaghai, and handed him over to the Jin imperial court. Emperor Xizong of the Jin dynasty had ordered Ambaghai executed by crucifixion (nailed to a wooden mule). The Jin dynasty also conducted regular punitive expeditions against the Mongol nomads, either enslaving or killing them.


When the Tatars were in their original countries, during the Jin caitiff's Dading period [1161-1189] there was a rumor spoken in Yanjing and the Kitan areas saying: 'The Tatars come, the Tatars go, they'll chase His Lordship 'till he has nowhere to go!' The Chieftain of Ge, Yong, happened to hear of it and said in astonishment: 'Surely this means the Tatar people will bring disaster to my country!' and handed down a proclamation to the farthest frontiers and wastes to mobilize troops to destroy them. Every three years he would dispatch troops to the north to destroy and kill, and called it 'decreasing the number of fighting men.' Up to now, the people of the Central Plain are all able to remember this, saying: 'Twenty years ago in Shandong and Hebei, what house did not buy a Tatar to be a young slave?' All of these were those captured by soldiers. Today, among the great ministers of the Tatars, many were among those captured at that time and have lived within the state of Jin. Moreover, every year when their country came to present tribute [to the Jin] they would receive their rituals and offerings outside of the passes and then would drive them away, not allowing them to enter the border. The Tatars fled and concealed themselves in the sandy deserts and the hatred entered into the marrow of their bones... Temujin was infuriated about their bullying and insults and as a consequence of this attacked the frontier.[4]


— Zhao Gong

In 1210, a delegation arrived at the court of Genghis Khan (r. 1206–27) to proclaim the ascension of Wanyan Yongji to the Jin throne and demanded the submission of the Mongols as a vassal state. Because the Jurchens defeated the powerful steppe nomads and allied with the Keraites and the Tatars, they claimed sovereignty over all the tribes of the steppe. High court officials in the Jin government defected to the Mongols and urged Genghis Khan to attack the Jin dynasty. But fearful of a trap or some other nefarious scheme, Genghis Khan refused. Upon receiving the order to demonstrate submission, Genghis Khan reportedly turned to the south and spat on the ground; then he mounted his horse, and rode toward the north, leaving the stunned envoy choking in his dust. He gave the Jin emperor a very insulting message which the envoy dared not repeat upon his return to the Jin court. His defiance of the Jin envoys was tantamount to a declaration of war between the Mongols and Jurchens.[5]



Mongol cavalry battle Jurchen warriors

After Genghis Khan returned to the Kherlen River, in early 1211, he summoned a kurultai. By organising a long discussion, everyone in the community was included in the process. The Khan prayed privately on a nearby mountain. He removed his hat and belt, bowed down before the Eternal Sky, and recounted the generations of grievances his people held against the Jurchens and detailed the torture and murder of his ancestors. He explained that he had not sought this war against the Jurchens. At the dawn on the fourth day, Genghis Khan emerged with the verdict: "The Eternal Blue Sky has promised us victory and vengeance".[6]


Wanyan Yongji, angry on hearing how Genghis Khan behaved, sent the message to the Khan that "Our Empire is like the sea; yours is but a handful of sand ... How can we fear you?"[7]


Mongol conquest under Genghis Khan

When the conquest of the Tangut-led Western Xia empire started, there were multiple raids between 1207 and 1209.[8] When the Mongols invaded Jin territory in 1211, Ala 'Qush, the chief of the Ongut, supported Genghis Khan and showed him a safe road to the Jin dynasty's heartland. The first important battle between the Mongol Empire and the Jin dynasty was the Battle of Yehuling at a mountain pass in Zhangjiakou which took place in 1211. There, Wanyan Jiujin, the Jin field commander, made a tactical mistake in not attacking the Mongols at the first opportunity. Instead, he sent a messenger to the Mongol side, Shimo Ming'an, who promptly defected and told the Mongols that the Jin army was waiting on the other side of the pass. At this engagement, fought at Yehuling, the Mongols massacred thousands of Jin troops. While Genghis Khan headed southward, his general Jebe travelled even further east into Manchuria and captured Mukden (present-day Shenyang). The Khitan leader Liu-ke had declared his allegiance to Genghis in 1212 and conquered Manchuria from the Jin.


When the Mongol army besieged the Jin central capital, Zhongdu (present-day Beijing), in 1213, Li Ying, Li Xiong and a few other Jin generals assembled a militia of more than 10,000 men who inflicted several defeats on the Mongols. The Mongols smashed the Jin armies, each numbering in the hundreds of thousands, and broke through Juyong Pass and Zijing Gap by November 1213.[9] From 1213 until early 1214, the Mongols pillaged the entire North China plain. In 1214, Genghis Khan surrounded the court of the Golden Khan in Zhongdu.[10] The Jin general Hushahu had murdered the emperor Wanyan Yongji and enthroned Wanyan Yongji's nephew, Emperor Xuanzong. When the Mongols besieged Zhongdu, the Jin government temporarily agreed to become a tributary state of the Mongol Empire, presenting a Jurchen princess to Genghis Khan. But when the Mongols withdrew in 1214, believing the war was over after being given a large tribute by the Jurchens, Li Ying wanted to ambush them on the way with his forces (which had grown to several tens of thousands). However, the Jin ruler, Emperor Xuanzong, was afraid of offending the Mongols again so he stopped Li Ying. Emperor Xuanzong and the general Zhuhu Gaoqi then decided to shift the capital south to Kaifeng, above the objections of many courtiers including Li Ying. From then on, the Jin were strictly on the defensive and Zhongdu fell to the Mongols in 1215.


The Jurchen Jin emperor Wanyan Yongji's daughter, Jurchen Princess Qiguo was married to Mongol leader Genghis Khan in exchange for relieving the Mongol siege upon Zhongdu (Beijing) in the Mongol conquest of the Jin dynasty.[11]


After the shift of the Jin capital to Kaifeng, the Jin chancellor Wanyan Chenghui and general Moran Jinzhong were left to guard Zhongdu. At this point, one of the Jin armies defected to the Mongols and launched an attack on Zhongdu from the south, taking Lugou Bridge. Genghis Khan then dispatched his troops to attack Zhongdu again, led by the surrendered Khitan generals Shimo Ming'an, Yelü Ahai and Yelü Tuhua. Moran Jinzhong's second-in-command, Pucha Qijin, surrendered to the Mongols with all the troops under him, throwing Zhongdu into crisis. Emperor Xuanzong then sent reinforcements north: Yongxi leading the troops from Zhending and Zhongshan (numbers not given), and Wugulun Qingshou leading 18,000 imperial guards, 11,000 infantry and cavalry from the southwestern route, and 10,000 soldiers from Hebei Province, with Li Ying in charge of the supply train. Zhongdu fell to the Mongols on June 1, 1215. Then they systematically rooted out all resistance in Shanxi, Hebei and Shandong provinces from 1217 to 1223. Genghis Khan did however need to turn his attention to the east in 1219, due to another event in Central Asia and Persia.



The Mongol Empire in 1227 at Genghis Khan's death

Muqali's advance

In 1223, the Mongol general Muqali had struck into Shaanxi Province, attacking Chang'an when Genghis Khan was attacking Khwarezmia. The garrison in Chang'an, 200,000 under Wanyan Heda, was too strong and Muqali had to turn to besieging Feng County with 100,000 men. The siege dragged on for months and the Mongols were harassed by local militia, while Jin reinforcements were about to arrive. Muqali then died of illness, and the Mongols retreated. This was the siege in which the Western Xia troops supporting the Mongols gave up and went home, incurring the wrath of Genghis Khan. In the wars against the Mongols, therefore, the Jin relied heavily on subjects or allies like the Uighurs, Tanguts and Khitans to supply cavalry.


Mongol conquest under Ögedei Khan


Mongol Empire's Ayimaq [ja] in North China

When Ögedei Khan succeeded his father, he rebuffed Jin offers of peace talks but the Jin officers murdered Mongol envoys.[12]


Jin armies under Emperor Aizong successfully stopped several Mongol offensives, with major victories in the process, such as at the Battle of Dachangyuan in 1229, Battle of Weizhou (1230), Battle of Daohuigu (1231).


The Kheshig commander Doqolqu was dispatched to attempt a frontal attack on Tong Pass, but Wanyan Heda defeated him and forced Subutai to withdraw in 1230. In 1231, the Mongols attacked again and finally took Fengxiang. The Jin garrison in Chang'an panicked and abandoned the city, pulling back to Henan Province with all the city's population. One month later, the Mongols decided to use a three-pronged attack to converge on Kaifeng from north, east and west. The western force under Tolui would start from Fengxiang, enter Tong Pass, and then pass through Song territory at the Han River (near Xiangyang) to reemerge south of Kaifeng to catch the Jurchens by surprise.


Wanyan Heda learned of this plan and led 200,000 men to intercept Tolui. At Dengzhou, he set an ambush in a valley with several tens of thousands of cavalry hidden behind the crest of either mountain, but Tolui's spies alerted him and he kept his main force with the supply train, sending only a smaller force of light cavalry to skirt around the valley and attack the Jin troops from behind. Wanyan Heda saw that his plan had been foiled and prepared his troops for a Mongol assault. At Mount Yu, southwest of Dengzhou, the two armies met in a pitched battle. The Jin army had an advantage in numbers, and fought fiercely. The Mongols then withdrew from Mount Yu by about 30 li, and Tolui changed his strategy. Leaving a part of his force to keep Wanyan Heda occupied, he sent most of his men to strike northwards at Kaifeng in several dispersed contingents to avoid alerting Heda.


On the way from Dengzhou to Kaifeng, the Mongols easily took county after county, and burnt all the supplies they captured so as to cut off Wanyan Heda's supply lines. Wanyan Heda was forced to withdraw, and ran into the Mongols at Three-peaked Hill in Junzhou. At this point, the Jin troops on the Yellow River were also diverted southwards to meet Tolui's attack, and the Mongol northern force under Ögedei Khan seized this opportunity to cross the frozen river and join up with Tolui – even at this point, their combined strength was only about 50,000. By 1232, the Jurchen ruler, Emperor Aizong, was besieged in Kaifeng. They together smashed the Jin forces. Ögedei Khan soon departed, leaving the final conquest to his generals.


Mongol–Song alliance

In 1233, Emperor Aizong dispatched diplomats to implore the Song for supplies. Jin envoys reported to the Song that the Mongols would invade the Song after they were done with the Jin – a forecast that would later be proven true – but the Song ignored the warning and rebuffed the request. They instead formed an alliance with the Mongols against the Jin. The Song provided supplies to the Mongols in return for parts of Henan.


The fall of the Jin dynasty

Main article: Mongol siege of Kaifeng


Mongol invasion of the Jin dynasty (1211–1215)


Mongol conquest of the Jin dynasty (1230–1234)


Conquest of Jurchen Jin by Mongols and Song Dynasty


Mongol conquest of China

Wanyan Heda's army still had more than 100,000 men after the battle at Mount Yu, and the Mongols adopted a strategy of exhausting the enemy. The Jin troops had little rest all the way from Dengzhou, and had not eaten for three days because of the severing of their supply lines. Their morale was plummeting and their commanders were losing confidence. When they reached Sanfengshan (Three-peaked Hill), a snowstorm suddenly broke out, and it was so cold that the faces of the Jin troops went as white as corpses, and they could hardly march. Rather than attack them when they were desperate with their backs to the wall, the Mongols left them an escape route and then ambushed them when they let down their guard during the retreat. The Jin army collapsed without a fight, and the Mongols pursued the fleeing Jin troops relentlessly. Wanyan Heda was killed, and most of his commanders also lost their lives. After the Battle of Sanfengshan, Mongol troops took the city of Yuzhou. Kaifeng was doomed and Emperor Aizong soon abandoned the city and entered Hebei Province in a vain attempt to reestablish himself there. Thousands of people offered a stubborn resistance to the Mongols, who entrusted the conduct of the attack to Subutai, the most daring of all their commanders. Emperor Aizong was driven south again, and by this time Kaifeng had been taken by the Mongols so he established his new capital at Caizhou (present-day Runan County, Henan Province). Subutai wished to massacre the whole of the population. But Yelü Chucai was more humane, and under his advice Ögedei Khan rejected the cruel proposal.


The Jurchens used fire arrows against the Mongols during the defence of Kaifeng in 1232. The Mongols adopted this weapon in later conquests.[13]


In 1233, after Emperor Aizong had abandoned Kaifeng and failed to raise a new army for himself in Hebei, he returned to Henan and established his base in Guide (present-day Anyang). Scattered Jin armies began to gather at Guide from the surrounding region and Hebei, and the supplies in the city could no longer feed all these soldiers. Thus Emperor Aizong was left with only 450 Han Chinese troops under the command of Pucha Guannu and 280 men under Ma Yong to guard the city, and dispersed the rest of the troops to forage in Su (in Anhui Province), Xu (present-day Xuzhou, Jiangsu Province), and Chen (present-day Huaiyang, Henan Province).


Pucha Guannu then launched a coup with his troops, killing Ma Yong and more than 300 other courtiers, as well as about 3,000 officers, palace guards and civilians who refused to cooperate with him. He made Emperor Aizong a puppet ruler and became the real master of the Jin imperial court. At this point the Mongols had arrived outside Guide and were preparing to besiege the city. The Mongol general Sajisibuhua had set up camp north of the city, on the bank of a river. Guannu then led his 450 troops out on boats from the southern gate at night, armed with fire-lances. They rowed along the river by the eastern side of the city, reaching the Mongol camp early in the morning. Emperor Aizong watched the battle from the northern gate of the city, with his imperial boat prepared for him to flee to Xuzhou if the Jin troops were defeated.


The Jin troops assaulted the Mongol camp from two directions, using their fire-lances to throw the Mongols into a panic. More than 3,500 Mongols drowned in the river while trying to flee, and the Mongol stockades were all burned to the ground. Sajisibuhua was also killed in the battle. Pucha Guannu had achieved a remarkable victory and was promoted by Emperor Aizong. But Guide was not defensible in the long term, and the other courtiers urged Emperor Aizong to move to Caizhou, which had stronger walls and more provisions and troops. Pucha Guannu opposed the move, afraid that his power base would be weakened and arguing that Caizhou's advantages had been overstated.


The Han Chinese general Shi Tianze led troops to pursue Emperor Aizong as he retreated, and destroyed an 80,000-strong Jin army led by Wanyan Chengyi (完顏承裔) at Pucheng (蒲城).


Three months later, Emperor Aizong used a plot to assassinate Guannu, and then quickly began preparations to move to Caizhou. By the time new reports reached him that Caizhou was still too weak in defences, troops and supplies, he was already on the way there. The fate of the Jin dynasty was then sealed for good, despite the earlier victory against great odds at Guide.


The Southern Song dynasty, wishing to give the Jin dynasty the coup de grâce, declared war upon the Jurchens, and placed a large army in the field. The remainder of the Jin army took shelter in Caizhou, where they were closely besieged by the Mongols on one side and the Song army on the other. Driven thus into a corner, the Jurchens fought with the courage of despair and long held out against the combined efforts of their enemies. At last, Emperor Aizong saw that the struggle could not be prolonged, and he prepared himself to end his life. When the enemy breached the city walls, Emperor Aizong committed suicide after passing the throne to his general Wanyan Chenglin. Wanyan Chenglin, historically known as Emperor Mo, ruled for less than a day before he was finally killed in battle. Thus the Jin dynasty came to an end on February 9, 1234.


There are great men of the vanquished Jin who have gotten mixed up in odd jobs falling as low as butchering and peddling, or leaving to become Yellow Caps. All of them are still referred to by their old government [titles]. The family of Pacification Commissioner Wang has a number of men who push carts and are called 'Transport Commissioner' or 'Attendant Courtier.' In Changchun Palace, 'Palace of Long Spring,' there are many gentlemen of the vanquished Jin court, who by being there avoid baijiao, escape taxes and corvée labor, and receive clothing and food. It is to a great extent the cause for the people's sorrow and distress.[14]


— Zhao Gong

Mongol policies

James Waterson cautioned against attributing the population drop in northern China to Mongol slaughter since much of the population may have moved to southern China under the Southern Song or died of disease and famine as agricultural and urban city infrastructure were destroyed.[15] The Mongols spared cities from massacre and sacking if they surrendered, such as Kaifeng, which was surrendered to Subetai by Xu Li,[16] Yangzhou, which was surrendered to Bayan by Li Tingzhi's second in command after Li Tingzhi was executed by the Southern Song,[17] and Hangzhou, which was spared from sacking when it surrendered to Kublai Khan.[18] Han Chinese and Khitan soldiers defected en masse to Genghis Khan against the Jurchen Jin dynasty.[19] Towns which surrendered were spared from sacking and massacre by Kublai Khan.[20] The Khitan reluctantly left their homeland in Manchuria as the Jin moved their primary capital from Beijing south to Kaifeng and defected to the Mongols.[21]


Many Han Chinese and Khitans defected to the Mongols to fight against the Jin dynasty. Two Han Chinese leaders, Shi Tianze and Liu Heima (劉黑馬),[22] and the Khitan Xiao Zhala (蕭札剌) defected and commanded the three tumens in the Mongol army.[23] Liu Heima and Shi Tianze served Genghis Khan's successor, Ögedei Khan.[24] Liu Heima and Shi Tianxiang led armies against Western Xia for the Mongols.[25] There were four Han tumens and three Khitan tumens, with each tumen consisting of 10,000 troops. The three Khitan generals Shimo Beidi'er (石抹孛迭兒), Tabuyir (塔不已兒), and Xiao Zhongxi (蕭重喜; Xiao Zhala's son) commanded the three Khitan tumens and the four Han generals Zhang Rou (張柔), Yan Shi (嚴實), Shi Tianze and Liu Heima commanded the four Han tumens under Ögedei Khan.[26][27][28][29] Shi Tianze, Zhang Rou, Yan Shi and other Han Chinese who served in the Jin dynasty and defected to the Mongols helped build the structure for the administration of the new Mongol state.[30]


The Mongols valued physicians, craftsmen and religious clerics and ordered them to be spared from death and brought to them when cities were taken in northern China.[31]


The Han Chinese nobles Duke Yansheng and Celestial Masters continued possessing their titles in the Mongol empire and Yuan dynasty since the previous dynasties.


See also

History of Beijing

Jin–Song Wars

Timeline of the Jin–Song Wars

Manchuria under Yuan rule











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을지문덕(乙支文德, ?~?)630128-1067814朴鐘權的大億劫的削的磨的滅的處理的서울特別市 永登浦區奉天洞345番地서울特別市 永登浦區奉天洞347番地입자 물리학의 입자기본 입자페르미온쿼크위(u)아래(d)맵시(c)기묘(s)꼭대기(t)바닥(b)렙톤전자(e−)/양전자(e+)뮤온(μ−/μ+)타우 입자(τ−/τ+)중성미자 전자 중성미자/전자 반중성미자뮤온 중성미자/뮤온 반중성미자타우 중성미자/타우 반중성미자보손게이지 보손 (광자W · Z보손글루온)스칼라 보손(힉스 보손)미관측 입자대통일 이론 등액시온(A0)마요론(J)X · Y보손W' · Z' 보손비활성 중성미자자기 홀극테크니컬러 관련 입자초대칭짝게이지노글루이노중력미자 (골드스티노)뉴트랄리노 (포티노힉시노지노)차지노 (위노힉시노)색시온액시노스페르미온스쿼크 (스칼라 위 쿼크, 스칼라 아래 쿼크, 스칼라 맵시 쿼크, 스칼라 기묘 쿼크, 스칼라 꼭대기 쿼크, 스칼라 바닥 쿼크)슬렙톤 (스엘렉트론, 스뮤온, 스타우온, 스뉴트리노, 스뮤온 스뉴트리노, 스타우 스뉴트리노)양자 중력 및 끈 이론중력자딜라톤라디온(중력스칼라)중력광자기타유령 입자골드스톤 보손타키온순간자합성 입자강입자중입자핵자(N) (양성자(p)중성자(n))Δ(델타)Λ(람다)Σ(시그마)Ξ(크시)Ω(오메가)맛깔없는 가벼운 중간자π(파이온)ρ(로)η(에타)·η′(에타 프라임)φ(피)ω(오메가)a(에이)b(비)f(에프)·f′(에프 프라임)h(에이치)·h′(에이치 프라임)맛깔없는 무거운 중간자J/ψ(제이/프시)ϒ(입실론)θ(세타)χ(키)ηc/b/t(에타 쿼코늄)hc/b/t맛깔있는 중간자K(케이온)DBT기타원자핵원자분자별난 원자 오늄포지트로늄뮤오늄 등펜타쿼크미관측 입자테트라쿼크글루볼중간자 분자준입자솔리톤엑시톤마그논포논플라스몬폴라리톤폴라론로톤목록기타 가설 입자무의식초자아트라우마방어기제정신분석게슈탈트 붕괴고전적 조건형성조작적 조건형성인지부조화바넘 효과심리 검사성격 검사초두효과설단 현상칵테일 파티 효과전경-배경 이론깨진 유리창 이론정보처리이론루시퍼 이펙트스탠퍼드 감옥 실험편안한 복제인간 증후군원인론목적론해석 수준 이론심리치료인문학재난심리학(disaster psychology)군사심리학(영어판)군중심리학자살 예방환경심리학깨진 유리창 이론범죄예방 환경설계심리역사학(영어판)로이드 드마우스(영어판)의상심리학(clothing psychology)의사소통(휴먼 커뮤니케이션)대인간 커뮤니케이션(영어판)잔소리 (심리)(영어판)편집성 인격 장애폭력 / 가정폭력아동학대 / 동물학대힐가드와 애트킨슨의 심리학 원론(Atkinson & Hilgard's Introduction to Psychology)볼더 모델찰스 다윈심리학역사심리학자연구 분야감정생물심리학임상심리학인지심리학인지 신경과학비교심리학비판심리학문화심리학발달심리학진화심리학실험심리학개인심리학해방심리학수리심리학매체심리학약물심리학신경심리학수행심리학성격심리학생리심리학정치심리학긍정심리학심리언어학정신병리학정신물리학심리생리학정성적 심리 연구정량적 심리 연구사회심리학이론심리학교육심리학군중심리학스포츠심리학프시응용 분야심리 실험임상심리학상담심리학교육심리학법정심리학건강심리학산업 및 조직 심리학법심리학산업 건강심리학관계심리학학교심리학스포츠심리학음향심리학체제심리학심리철학시각심리학접근 방법분석심리학행동주의인지주의인지 행동 치료기술심리학실존주의 상담가족 치료인지 정서 행동 치료여성주의 상담게슈탈트 치료인본주의심리학초심리학이야기 치료정신분석학정신 역동 치료초개인심리학주요 심리학자버러스 프레더릭 스키너장 피아제지그문트 프로이트오토 랑크멜라니 클라인앨버트 반두라레온 페스팅거로이 샤퍼칼 로저스스탠리 샤흐터닐 엘가 밀러에드워드 손다이크에이브러햄 매슬로고던 올포트에릭 에릭슨한스 아이젠크윌프레드 비용윌리엄 제임스데이비드 맥클랜드앨버트 엘리스아론 벡레이몬드 캐텔존 B. 왓슨쿠르트 르빈도널드 올딩 헤브조지 밀러클라크 헐제롬 케이건카를 융이반 파블로프앙드레 그린알프레트 아들러사회과학주류경제학 거시경제학미시경제학계량경제학수리경제학법학 공법학사법학법계학법제사학판례학사학 경제사학군사사학문화사학사회사학세계사학정치사학역사보조학사회학 농촌사회학도시사회학범죄학인구통계학인터넷사회학언어학 기호학인류학 고고학문화인류학사회인류학체질인류학정치학 국제관계학비교정치학정치철학공공정책학지리학 기술지리학인문지리학자연지리학환경지리학응용개발학경영학군 경영학행정학계획학군 토지이용계획연구지역계획연구도시계획연구공중보건학과학기술학과학철학군 경제철학사회과학철학심리철학역사철학교육학기술사학과학학군 과학사학양자과학학사회복지학상업학언론정보학역사사회학인간동물학인지과학인류생태학정보과학정치경제학정치사회학정치생태학젠더학지역과학지역학환경학군 환경사회과학환경연구문화연구미디어연구세계화연구식품연구지역연구채식연구해부학뼈대뼈몸통뼈대 머리뼈척추가슴우리팔다리뼈대 팔뼈대다리뼈대골수연골유리연골섬유연골탄력연골관절섬유관절연골관절윤활관절근육계골격근민무늬근심장근내분비계뇌하수체시상하부솔방울샘갑상샘부갑상샘가슴샘부신이자정소난소순환계심혈관계심장혈관 동맥정맥모세혈관대동맥대정맥폐동맥폐정맥혈액 혈장적혈구백혈구혈소판림프계림프관림프절비장가슴샘편도파이어판점막관련림프조직비뇨계콩팥요관방광요도생식계남성고환부고환정관정삭요도정낭전립샘망울요도샘음낭음경귀두포피여성난소자궁관자궁질질입구주름음문대음순소음순젖샘소화계소화관입인두식도위작은창자 샘창자공장회장큰창자 맹장결장곧은창자항문소화샘침샘이자쓸개간신경계중추신경계 뇌척수말초신경계 몸신경계자율신경계 교감신경계부교감신경계눈귀코혀피부계피부모낭땀샘피지샘손발톱유방호흡계비강인두후두기관기관지허파외분비계땀샘망울요도샘스킨샘젖샘전립샘전미골부샘점액정낭침샘코딱지큰질어귀샘생물학의 주요 분야생물학의 분야계생명학고생물학고유전학균학기생충학동물학면역학미생물학발생생물학 (발생학)병리학보전생물학분류학분자생물학분자세포유전학생리학생물리학생물정보학생물통계학생태학생화학세포생물학세포유전학수리생물학시간생물학식물학신경과학약리학역학우주생물학유전체학유전학위생학인간생물학조직학진화생물학해부학해양생물학생물학의 가설들자연발생설Personality disorder classificationGeneral classificationsDimensionalCategoricalMulti-axialPrototypalRelationalStructuralICD classifications (ICD-10)SchizotypalSchizotypalSpecificAnankastic personality disorderAnxious (avoidant)DependentDissocialEmotionallyunstableHistrionicParanoidSchizoidOtherEccentricHaltloseImmatureNarcissisticPassive–aggressivePsychoneuroticOrganicOrganicUnspecifiedUnspecifiedDSM classificationsDSM-III-R onlySadisticSelf-defeating (masochistic)DSM-IV onlyPersonality disorder not otherwise specifiedAppendix B (proposed)DepressiveNegativistic (passive–aggressive)DSM-5Cluster A (odd)ParanoidSchizoidSchizotypalCluster B (dramatic)AntisocialBorderlineHistrionicNarcissisticCluster C (anxious)AvoidantDependentObsessive-compulsiveOtherOther specifiedUnspecifiedAlternative DSM-5 Modelfor Personality DisordersSpecificAntisocialAvoidantBorderlineNarcissisticObsessive-compulsiveSchizotypalGeneralTrait SpecifiedvteMental disorders (Classification)Adult personality and behaviorChildhood and learningMood (affective)Neurological and symptomaticNeurotic, stress-related and somatoformPhysiological and physical behaviorPsychoactive substances, substance abuse and substance-relatedSchizophrenia, schizotypal and delusionalSymptoms and uncategorized시시비비 是是非非right and[or] wrong불문곡직without inquiring into the right or wrong敗輪敗tolose(agame)tobedefeatedtofailsuccessorfailuretodefeattotarnishtoruintodestroytosquanderafamilyfortunetohaveone'sreputationdestroyedtocorruptpublicmoralstowitherandfallwitheredbranchesandleavesThechrysanthemumshavewithereddilapidatedworn-outofclothingtatteredworncottonwooltorotrottentoremovetogetridof輪wheelgeartricyclecargoshipedgerimtotaketurnstoworkinshiftsIt'syourturnI'vewaitedforovertenminutesnowandit'sstillnotmyturnthisisridiculoustowaitforone'sturntoqueueforpublichousingClassifierforthesunortheroundmoonabrightmoonaredsunClassifierforroundssecondroundoftalksacycleofChinesezodiactwelveyearstogang-rape飼敎飼tofeedtoraise敎toteachtoinstructtocausetomakeetc較贖較tocomparetocompetecomparativelyrelativelyratherbetterthanintroducestheobjectofcomparisonMy salaryismorethanmyparentsobviousclearmoreevenmorenomatterhow贖toredeemtoransomwashingawayyoursinclearingyourdebtbyofferingmoneywealthoreffort

A mental disorder, also referred to as a mental illness,[6] a mental health condition,[7] or a psychiatric disability,[2] is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.[8] A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context.[9][10] Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders.[10][11] A mental disorder is one aspect of mental health. The causes of mental disorders are often unclear. Theories incorporate findings from a range of fields. Disorders may be associated with particular regions or functions of the brain. Disorders are usually diagnosed or assessed by a mental health professional, such as a clinical psychologist, psychiatrist, psychiatric nurse, or clinical social worker, using various methods such as psychometric tests, but often relying on observation and questioning. Cultural and religious beliefs, as well as social norms, should be taken into account when making a diagnosis.[12] Services for mental disorders are usually based in psychiatric hospitals, outpatient clinics, or in the community (in the United Kingdom). Treatments are provided by mental health professionals. Common treatment options are psychotherapy or psychiatric medication, while lifestyle changes, social interventions, peer support, and self-help are also options. In a minority of cases, there may be involuntary detention or treatment. Prevention programs have been shown to reduce depression.[10][13] In 2019, common mental disorders around the globe include: major depression, which affects about 264 million people; dementia, which affects about 50 million; bipolar disorder, which affects about 45 million; and schizophrenia and other psychoses, which affect about 20 million people.[10] Neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (autism), and intellectual disability, of which onset occurs early in the developmental period.[14][10] Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements attempting to increase understanding and challenge social exclusion. Definition "Nervous breakdown" redirects here. For other uses, see Nervous breakdown (disambiguation). The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed. For a mental state to be classified as a disorder, it generally needs to cause dysfunction.[15] Most international clinical documents use the term mental "disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of the mind) is not necessarily meant to imply separateness from the brain or body. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published in 1994, a mental disorder is a psychological syndrome or pattern that is associated with distress (e.g., via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however, it excludes normal responses such as the grief from loss of a loved one and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual.[16] The DSM-IV definition states that, like many medical terms, mental disorder "lacks a consistent operational definition that covers all situations". It notes that different levels of abstraction can be used for medical definitions, including pathology, symptomology, deviance from a normal range, or etiology, and that the same is true for mental disorders, so that sometimes one type of definition is appropriate and sometimes another, depending on the situation.[17] In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning."[18] The final draft of ICD-11 contains a very similar definition.[19] The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder.[20] The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10 and are nearly absent from scientific literature regarding mental illness.[21][22] Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder involving symptoms such as anxiety or depression, usually precipitated by external stressors.[21] Many health experts today refer to a nervous breakdown as a mental health crisis.[23] Nervous illness This article contains too many or overly lengthy quotations. Please help summarize the quotations. Consider transferring direct quotations to Wikiquote or excerpts to Wikisource. (February 2026) (Learn how and when to remove this message) In addition to the concept of mental disorder, some people have argued for a return to the old-fashioned concept of nervous illness. In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, says: We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... The nervous patients of yesteryear are the depressives of today. That is the bad news.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point. — Edward Shorter, the University of Toronto[24] In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown. — David Healy, MD, FRCPsych, Professor of Psychiatry, University of Cardiff, Wales[25] Nerves stand at the core of common mental illness, no matter how much we try to forget them. — Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London[26] Classifications Main article: Classification of mental disorders There are currently two widely established systems that classify mental disorders: International Classification of Diseases produced by the WHO. The latest edition is the ICD-11, which is in effect since 1 January 2022.[27] The ICD is a broad medical classification system; mental disorders are contained in Chapter 06: Mental, behavioural or neurodevelopmental disorders (06). Diagnostic and Statistical Manual of Mental Disorders produced by the American Psychiatric Association since 1952. The latest edition is the Fifth Edition, Text Revision (DSM-5-TR), which was released in 2022.[28] Both of these list categories of disorder and provide standardized criteria for diagnosis. They 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 used in non-western cultures, for example, the Chinese Classification of Mental Disorders, and other manuals may be used by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual. In general, mental disorders are classified separately from neurological disorders, learning disabilities or intellectual disability. Unlike the DSM and ICD, some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal. There is significant scientific debate about the relative merits of categorical versus such non-categorical (or hybrid) schemes, also known as continuum or dimensional models. A spectrum approach may incorporate elements of both. In the scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is normal) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms).[29] Common hybrid views argue that the concept of mental disorder is objective even if only a "fuzzy prototype" that can never be precisely defined, or conversely that the concept always involves a mixture of scientific facts and subjective value judgments.[30] Although the diagnostic categories are referred to as 'disorders', they are presented as medical diseases, but are not validated in the same way as most medical diagnoses. Some neurologists argue that classification will only be reliable and valid when based on neurobiological features rather than clinical interview, while others suggest that the differing ideological and practical perspectives need to be better integrated.[31][32] The DSM and ICD approach remains under attack both because of the implied causality model[33] and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.[34] Dimensional models The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders have demonstrated two latent (unobserved) factors or dimensions in the structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance use symptoms.[35] A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports the internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia.[36] Biological evidence also supports the validity of the internalizing-externalizing structure of mental disorders, with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders.[37][38][39] A leading dimensional model is the Hierarchical Taxonomy of Psychopathology. Disorders See also: List of mental disorders There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.[40][41][42][43] Anxiety disorders Main article: Anxiety disorder An anxiety disorder is anxiety or fear that interferes with normal functioning.[41] Commonly recognized categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, and post-traumatic stress disorder. Obsessive–compulsive disorder was categorized as an anxiety disorder in DSM-III, which was published in 1980, but was later placed in its own section called "Obsessive-Compulsive and Related Disorder" in DSM-5.[44] Mood disorders Main article: Mood disorder Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as major depression (also known as unipolar or clinical depression). Milder, but still prolonged depression, can be diagnosed as dysthymia. Bipolar disorder (also known as manic depression) involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed moods. The extent to which unipolar and bipolar mood phenomena represent distinct categories of disorder, or mix and merge along a dimension or spectrum of mood, is subject to some scientific debate.[45][46] Psychotic disorders Main article: Psychotic disorder Patterns of belief, language use and perception of reality can become dysregulated (e.g., delusions, thought disorder, hallucinations). Psychotic disorders in this domain include schizophrenia, and delusional disorder. Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy is a category used for individuals showing some of the characteristics associated with schizophrenia, but without meeting cutoff criteria.[citation needed] Personality disorders Main article: Personality disorder Personality—the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive. Although treated separately by some[by whom?], the commonly used categorical schemes[which?] include them as mental disorders. Personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood. There is an emerging consensus that personality disorders, similar to personality traits in general, incorporate a mixture of acute dysfunctional behaviors that may resolve in short periods, and maladaptive temperamental traits that are more enduring.[47] Furthermore, there are also non-categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom-based cutoff from normal personality variation, for example through schemes based on dimensional models of personality disorders.[48][49][non-primary source needed] A number of different personality disorders are listed in the DSM-5-TR, including those sometimes classed as eccentric, such as paranoid, schizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocial, borderline, histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant, dependent, or obsessive–compulsive personality disorders.[citation needed] While the DSM-5-TR standard model diagnoses personality disorders as distinct categories, the ICD-11 classification of personality disorders contains a single, dimensional personality disorder which is diagnosed according to severity, with the possibility to additionally diagnose trait domains.[50] In the case of the Alternative DSM-5 Model for Personality disorders, the approach chosen is a dimensional–categorical model,[51] in which diagnosis can consist of either predefined categories based on specific combinations of traits and functioning levels,[52] or of a general diagnosis called personality disorder – trait specified.[52] The ICD-11 classifies schizotypal disorder among primary psychotic disorders rather than as a personality disorder as in the DSM-5.[53] Neurodevelopmental disorders Main article: Neurodevelopmental disorder Neurodevelopmental disorders are a group of mental disorders that affect the central nervous system, such as the brain and spinal cord.[54] These disorders can appear in early childhood.[55] They can even persist into adulthood.[56] A few of the common are attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (autism), intellectual disabilities, motor disorders, and communication disorders among others. Some causes can contribute to these disorders, such as genetic factors (genetics, family medical history),[57] environmental factors (excessive stress, exposure to neurotoxins, pollution, viral infections, bacterial infections),[58][59] physical factors (traumatic brain injury, illness),[60] and prenatal factors (birth defects, exposure to drugs during pregnancy, low birth weight).[61] Neurodevelopmental disorders can be managed with behavioral therapy, applied behavior analysis (ABA), educational interventions, specific medications, and other such treatments.[62] Approximately 8 in 10 people with autism suffer from a mental health problem in their lifetime, in comparison to 1 in 4 of the general population that suffers from a mental health problem in their lifetimes.[63][64][65] Eating disorders Main article: Eating disorder An eating disorder is a serious mental health condition that involves an unhealthy relationship with food and body image. They can cause severe physical and psychological problems.[66] Eating disorders involve disproportionate concern in matters of food and weight.[41] Categories eating disorders include anorexia nervosa, bulimia nervosa, exercise bulimia, or binge eating disorder.[67][68] Sleep disorders Main article: Sleep disorder Sleep disorders are associated with disruption to normal sleep patterns. A common sleep disorder is insomnia, which is described as difficulty falling and/or staying asleep. Other sleep disorders include narcolepsy, sleep apnea, REM sleep behavior disorder, chronic sleep deprivation, and restless leg syndrome. Narcolepsy is a condition of extreme tendencies to fall asleep whenever and wherever. People with narcolepsy feel refreshed after their random sleep, but eventually get sleepy again. Narcolepsy diagnosis requires an overnight stay at a sleep center for analysis, during which doctors ask for a detailed sleep history and sleep records. Doctors also use actigraphs and polysomnography.[69] Doctors will do a multiple sleep latency test, which measures how long it takes a person to fall asleep.[69] Sleep apnea, when breathing repeatedly stops and starts during sleep, can be a serious sleep disorder. Three types of sleep apnea include obstructive sleep apnea, central sleep apnea, and complex sleep apnea.[70] Sleep apnea can be diagnosed at home or with polysomnography at a sleep center. An ear, nose, and throat doctor may further help with the sleeping habits. Sexuality related Sexual disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others).[citation needed] Other Impulse control disorders: People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as a disorder.[citation needed] Substance use disorders: This disorder refers to the use of drugs (legal or illegal, including alcohol) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in the DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped.[citation needed] Dissociative disorders: People with severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders, including depersonalization-derealization disorder or dissociative identity disorder (which was previously referred to as multiple personality disorder or "split personality").[citation needed] Cognitive disorders: These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia).[citation needed] Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder. There are also disorders of how a person perceives their body, such as body dysmorphic disorder. Neurasthenia is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but no longer by the DSM-IV.[71][non-primary source needed] Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for.[citation needed] There are attempts to introduce a category of relational disorder, where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other.[citation needed] There are a number of uncommon psychiatric syndromes, which are often named after the person who first described them, such as Capgras syndrome, De Clerambault syndrome, Othello syndrome, Ganser syndrome, Cotard delusion, and Ekbom syndrome, and additional disorders such as the Couvade syndrome and Geschwind syndrome.[72] Signs and symptoms Course The onset of psychiatric disorders usually occurs from childhood to early adulthood.[73] Impulse-control disorders and a few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens.[74] Symptoms of schizophrenia typically manifest from late adolescence to early twenties.[75] The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders may last a brief period of time, while others may be long-term in nature. All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery is still plausible. The World Health Organization (WHO) concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century."[76][non-primary source needed][77] A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for the diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. Less than half go on to experience a new episode of mania or major depression within the next two years.[78][non-primary source needed] Disability Disorder Disability-adjusted life years[79] Major depressive disorder 65.5 million Alcohol-use disorder 23.7 million Schizophrenia 16.8 million Bipolar disorder 14.4 million Other drug-use disorders 8.4 million Panic disorder 7.0 million Obsessive-compulsive disorder 5.1 million Primary insomnia 3.6 million Post-traumatic stress disorder 3.5 million Some disorders may be very limited in their functional effects, while others may involve substantial disability and support needs. In this context, the terms psychiatric disability and psychological disability are sometimes used instead of mental disorder.[2][3] The degree of ability or disability may vary over time and across different life domains. Furthermore, psychiatric disability has been linked to institutionalization, discrimination and social exclusion as well as to the inherent effects of disorders. Alternatively, functioning may be affected by the stress of having to hide a condition in work or school, etc., by adverse effects of medications or other substances, or by mismatches between illness-related variations and demands for regularity.[80] It is also the case that, while often being characterized in purely negative terms, some mental traits or states labeled as psychiatric disabilities can also involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy.[81] In addition, the public perception of the level of disability associated with mental disorders can change.[82] Nevertheless, internationally, people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions, particularly in their social roles and personal relationships. The proportion with access to professional help for mental disorders is far lower, however, even among those assessed as having a severe psychiatric disability.[83] Disability in this context may or may not involve such things as: Basic activities of daily living. Including looking after the self (health care, grooming, dressing, shopping, cooking etc.) or looking after accommodation (chores, DIY tasks, etc.) Interpersonal relationships. Including communication skills, ability to form relationships and sustain them, ability to leave the home or mix in crowds or particular settings Occupational functioning. Ability to acquire an employment and hold it, cognitive and social skills required for the job, dealing with workplace culture, or studying as a student. In terms of total disability-adjusted life years (DALYs), which is an estimate of how many years of life are lost due to premature death or to being in a state of poor health and disability, psychiatric disabilities rank amongst the most disabling conditions. Unipolar depressive disorder (also known as major depressive disorder) is the third leading cause of disability worldwide, of any condition mental or physical, accounting for 65.5 million years lost. The first systematic description of global disability arising in youth, in 2011, found that among 10- to 24-year-olds nearly half of all disability (current and as estimated to continue) was due to psychiatric disabilities, including substance use disorders and conditions involving self-harm. Second to this were accidental injuries (mainly traffic collisions) accounting for 12 percent of disability, followed by communicable diseases at 10 percent. The psychiatric disabilities associated with most disabilities in high-income countries were unipolar major depression (20%) and alcohol use disorder (11%). In the eastern Mediterranean region, it was unipolar major depression (12%) and schizophrenia (7%), and in Africa it was unipolar major depression (7%) and bipolar disorder (5%).[84] Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35.[85][86] There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.[87] Risk factors Main article: Causes of mental disorders The predominant view as of 2018 is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders.[88] Different risk factors may be present at different ages, with risk occurring as early as during prenatal period.[89] Genetics Main article: Psychiatric genetics A number of psychiatric disorders are linked to a family history (including depression, narcissistic personality disorder[90][91] and anxiety).[92] Twin studies have also revealed a very high heritability for many mental disorders (especially autism and schizophrenia).[93] Although researchers have been looking for decades for clear linkages between genetics and mental disorders, that work has not yielded specific genetic biomarkers yet that might lead to better diagnosis and better treatments.[94] Statistical research looking at eleven disorders found widespread assortative mating between people with mental illness. That means that individuals with one of these disorders were two to three times more likely than the general population to have a partner with a mental disorder. Sometimes people seemed to have preferred partners with the same mental illness. Thus, people with schizophrenia or ADHD are seven times more likely to have affected partners with the same disorder. This is even more pronounced for people with autism who are 10 times more likely to have a spouse with the same disorder.[95] Environment Main article: Brain health and pollution The prevalence of mental illness is higher in more economically unequal countries. During the prenatal stage, factors like unwanted pregnancy, lack of adaptation to pregnancy or substance use during pregnancy increases the risk of developing a mental disorder.[89] Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness.[96] Infants neglected or not provided optimal nutrition have a higher risk of developing cognitive impairment.[89] Social influences have also been found to be important,[97] including abuse, neglect, bullying, social stress, traumatic events, and other negative or overwhelming life experiences. Aspects of the wider community have also been implicated,[98] including employment problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies and cultures. The specific risks and pathways to particular disorders are less clear, however. Nutrition also plays a role in mental disorders.[10][99] In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, recreational use of drugs,[100] and urbanicity.[98] In anxiety, risk factors may include parenting factors including parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behavior, and child abuse (emotional, physical and sexual).[101] Adults with imbalance work to life are at higher risk for developing anxiety.[89] For bipolar disorder, stress (such as childhood adversity) is not a specific cause, but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness.[102] Drug use Mental disorders are associated with drug use including: cannabis,[103] alcohol[104] and caffeine,[105] use of which appears to promote anxiety.[106] For psychosis and schizophrenia, usage of a number of drugs has been associated with development of the disorder, including cannabis, cocaine, and amphetamines.[107][103] There has been debate regarding the relationship between usage of cannabis and bipolar disorder.[108] Cannabis has also been associated with depression.[103] Adolescents are at increased risk for tobacco, alcohol and drug use; Peer pressure is the main reason why adolescents start using substances. At this age, the use of substances could be detrimental to the development of the brain and place them at higher risk of developing a mental disorder.[89] Chronic disease People living with chronic conditions like HIV and diabetes are at higher risk of developing a mental disorder. People living with diabetes experience significant stress from the biological impact of the disease, which places them at risk for developing anxiety and depression. Diabetic patients also have to deal with emotional stress trying to manage the disease. Conditions like heart disease, stroke, respiratory conditions, cancer, and arthritis increase the risk of developing a mental disorder when compared to the general population.[109] Personality traits Risk factors for mental illness include a propensity for high neuroticism[110][111] or "emotional instability". In anxiety, risk factors may include temperament and attitudes (e.g. pessimism).[92] Causal models Mental disorders can arise from multiple sources, and in many cases there is no single accepted or consistent cause currently established. An eclectic or pluralistic mix of models may be used to explain particular disorders.[111][112] The primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial model, which incorporates biological, psychological and social factors, although this may not always be applied in practice. Biological psychiatry follows a biomedical model where many mental disorders are conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience. A common assumption is that disorders may have resulted from genetic and developmental vulnerabilities, exposed by stress in life (for example in a diathesis–stress model), although there are various views on what causes differences between individuals. Some types of mental disorders may be viewed as primarily neurodevelopmental disorders.[citation needed] A distinction is sometimes made between a "medical model" or a "social model" of psychiatric disability.[113] Diagnosis Psychiatrists seek to provide a medical diagnosis of individuals by an assessment of symptoms, signs and impairment associated with particular types of mental disorder. Other mental health professionals, such as clinical psychologists, may or may not apply the same diagnostic categories to their clinical formulation of a client's difficulties and circumstances.[114] The majority of mental health problems are, at least initially, assessed and treated by family physicians (in the UK general practitioners) during consultations, who may refer a patient on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview known as a mental status examination, where evaluations are made of appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of other professionals, relatives, or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires, which may include algorithms based on ticking off standardized diagnostic criteria, and in rare specialist cases neuroimaging tests may be requested, but such methods are more commonly found in research studies than routine clinical practice.[115][116] Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.[117] It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.[118] In addition, comorbidity is very common in psychiatric diagnosis, where the same person meets the criteria for more than one disorder. On the other hand, a person may have several different difficulties only some of which meet the criteria for being diagnosed. There may be specific problems with accurate diagnosis in developing countries. More structured approaches are being increasingly used to measure levels of mental illness. HoNOS is the most widely used measure in English mental health services, being used by at least 61 trusts.[119] In HoNOS a score of 0–4 is given for each of 12 factors, based on functional living capacity.[120] Research has been supportive of HoNOS,[121] although some questions have been asked about whether it provides adequate coverage of the range and complexity of mental illness problems, and whether the fact that often only 3 of the 12 scales vary over time gives enough subtlety to accurately measure outcomes of treatment.[122] Criticism icon This section relies excessively on references to primary sources. Please improve this section by adding secondary or tertiary sources. Find sources: "criticism" psychiatric diagnosis – news · newspapers · books · scholar · JSTOR (July 2021) (Learn how and when to remove this message) Since the 1980s, Paula Caplan has been concerned about the subjectivity of psychiatric diagnosis, and people being arbitrarily "slapped with a psychiatric label." Caplan says because psychiatric diagnosis is unregulated, doctors are not required to spend much time interviewing patients or to seek a second opinion. The Diagnostic and Statistical Manual of Mental Disorders can lead a psychiatrist to focus on narrow checklists of symptoms, with little consideration of what is actually causing the person's problems. So, according to Caplan, getting a psychiatric diagnosis and label often stands in the way of recovery.[123] In 2013, psychiatrist Allen Frances wrote a paper entitled "The New Crisis of Confidence in Psychiatric Diagnosis", which said that "psychiatric diagnosis... still relies exclusively on fallible subjective judgments rather than objective biological tests." Frances was also concerned about "unpredictable overdiagnosis."[124] For many years, marginalized psychiatrists (such as Peter Breggin, Thomas Szasz) and outside critics (such as Stuart A. Kirk) have "been accusing psychiatry of engaging in the systematic medicalization of normality." More recently these concerns have come from insiders who have worked for and promoted the American Psychiatric Association (e.g., Robert Spitzer, Allen Frances).[125] A 2002 editorial in the British Medical Journal warned of inappropriate medicalization leading to disease mongering, where the boundaries of the definition of illnesses are expanded to include personal problems as medical problems or risks of diseases are emphasized to broaden the market for medications.[126] Gary Greenberg, a psychoanalyst, in his book "the Book of Woe", argues that mental illness is really about suffering and how the DSM creates diagnostic labels to categorize people's suffering.[127] Indeed, the psychiatrist Thomas Szasz, in his book "the Medicalization of Everyday Life", also argues that what is psychiatric illness, is not always biological in nature (i.e. social problems, poverty, etc.), and may even be a part of the human condition.[128] Potential routine use of MRI/fMRI in diagnosis in 2018 the American Psychological Association commissioned a review to reach a consensus on whether modern clinical MRI/fMRI will be able to be used in the diagnosis of mental health disorders. The criteria presented by the APA stated that the biomarkers used in diagnosis should: