DSM-III and the transformation of American psychiatry: a history

Abstract

The author traces the history of the development of DSM-III within the larger context--intellectual, economic, scientific, and ideological--of the development of American psychiatry since World War II. Data were obtained through a literature review, investigation of archival material from the DSM-III task force and APA, and interviews with key participants. This research indicates that from the end of World War II until the mid-1970s, a broadly conceived biopsychosocial model, informed by psychoanalysis, sociological thinking, and biological knowledge, was the organizing model for American psychiatry. However, the biopsychosocial model did not clearly demarcate the mentally well from the mentally ill, and this failure led to a crisis in the legitimacy of psychiatry by the 1970s. The publication of DSM-III in 1980 represented an answer to this crisis, as the essential focus of psychiatric knowledge shifted from the clinically-based biopsychosocial model to a research-based medical model. The author concludes that while DSM-III, and the return to descriptive psychiatry which it inaugurated, has had positive consequences for the profession, at the same time it represents a significant narrowing of psychiatry's clinical gaze.

Psychopathology research in the RDoC era: Unanswered questions and the importance of the psychophysiological unit of analysis

“…We would also add that in psychopathology research, a paradigm shift away from DSM would require a great deal of investment in time and money from influential institutions. Indeed, the last paradigm shift in psychopathology was the development and publication of the DSM-III in 1980, an event that could not have occurred without ‘institutional buy-in’ from the American Psychiatric Association (APA; Mayes and Horwitz, 2005; Wilson, 1993). It is therefore interesting that with the RDoC initiative, the NIMH may be breaking the hegemony held by the DSM (and by association the American Psychiatric Association [APA]).…”

What kind of science for psychiatry?

“…While earlier versions of U.S. psychiatric nosology were underwritten by psychoanalysis, DSM-III ushered in an era of operationalizing diagnostic categories through specific symptom criteria (Wilson, 1993). DSM-III was driven by a medical model that saw psychiatric disorders as closely analogous to physical diseases.…”

Magic Bullets for Mental Disorders: The Emergence of the Concept of an “Antipsychotic” Drug

“…Szasz published Myth of Mental Illness in 1960, and psychiatry came under attack from various sources through the 1960s and 1970s as the antipsychiatry movement progressed. Budgetary constraints and the introduction of managed care in the United States also increased competition from nonmedical therapists (Wilson, 1993). The profession reacted by attempting to strengthen its medical and scientific credentials, and the idea of the specificity of drug treatment became a central part of that endeavor (Moncrieff, 2008b).…”