History and Controversies of Psychiatry’s “DSM-V”

A Pen Writing a Diagnosis

This post will begin a several article attempt to explain the last few years’ controversy about the publication this last year, of the long awaited, DSM-V manual of the American Psychiatric Association. This book unknown to persons outside the “mental health professions” in the Western and many other parts of the world, is a mystery. Yet in the media in many countries for the last 2-3 years especially, there has been almost the hoopla associated with the anticipation of the early adopters of some tech company’s latest gadget, computer, or smartphone.

The title is not easy to understand either. “DSM” stands for “Diagnostic and Statistic Manual.” Years ago as a psychiatrist, when I was first introduced to this mandatory tool of my trade, I thought to myself that the title certainly discouraged opening and reading the book. Talk about boring and authors/publisher going out of their way to not “hook” the readers’ interest! It certainly did not live up to the interest kindling title in the 1960’s of his Yippie leader, Abbie Hoffman, Steal This Book that set the new standard for unforgettable book titles in those wacky times.

In the early days of modern psychiatry, beginning after World War II, the mental health field was peppered with several different systems for naming and classifying (diagnosing) mental illness conditions. Medical groups tended to use the Standard Classified Nomenclature of Disease, while the Veterans’ Administration Hospital system, then growing at a phenomenal rate in size and importance because of the hundreds of thousands of WWII veterans needing treatment medically and psychiatrically, used another. Within a few  years after WWII, the American Psychiatric Association saw the need for a unitary, standard, universal common system of naming and describing mental illnesses so that everyone would speak the same language. This developed against the long standing historical backdrop that in Europe and the United States, since the late 1800’s psychiatrists in asylums, had spent decades developing many schools of description and diagnosing from the psychoanalysts trained by Freud’s circle, to the “alienists” as psychiatrists working in public “state hospitals,” seeing mostly the chronically psychotic patients, were called in those days. For instance, Eugen Bleuler of Switzerland and Emil Kraeplin of Germany had two different systems of classifying the two major psychotic illnesses, schizophrenia and manic-depressive psychosis.

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