DSM-III and the revolution in the classification of mental illness

University of Richmond, Department of Political Science, USA.
Journal of the History of the Behavioral Sciences (Impact Factor: 0.79). 02/2005; 41(3):249-67. DOI: 10.1002/jhbs.20103
Source: PubMed

ABSTRACT A revolution occurred within the psychiatric profession in the early 1980s that rapidly transformed the theory and practice of mental health in the United States. In a very short period of time, mental illnesses were transformed from broad, etiologically defined entities that were continuous with normality to symptom-based, categorical diseases. The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was responsible for this change. The paradigm shift in mental health diagnosis in the DSM-III was neither a product of growing scientific knowledge nor of increasing medicalization. Instead, its symptom-based diagnoses reflect a growing standardization of psychiatric diagnoses. This standardization was the product of many factors, including: (1) professional politics within the mental health community, (2) increased government involvement in mental health research and policymaking, (3) mounting pressure on psychiatrists from health insurers to demonstrate the effectiveness of their practices, and (4) the necessity of pharmaceutical companies to market their products to treat specific diseases. This article endeavors to explain the origins of DSM-III, the political struggles that generated it, and its long-term consequences for clinical diagnosis and treatment of mental disorders in the United States.

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    • "The growing size of the DSM itself provides material representation of medicalization. Whereas the DSM-I listed 106 diagnoses in its 130 pages, the DSM-IV lays out 297 diagnoses in 866 pages (Mayes and Horwitz 2005). In addition to new diagnoses , another source of medicalization is found when an existing DSM category expands to include cases far outside of the original diagnostic boundaries. "
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    ABSTRACT: A central mechanism by which medicalization occurs is through domain expansion, wherein an existing diagnostic definition widens to include cases beyond its original scope. This has been especially commonplace with respect to mental illness diagnoses. In contrast, there are few clear instances of domain contraction. The controversy surrounding the revisions to autism in advance of the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is thus of considerable importance. Many autism advocates feared the new definition of autism would exclude a significant number of individuals who are already diagnosed. We examine lay claims making to this perceived instance of domain contraction through a content analysis of online reader comments to a high-profile New York Times article reporting on the DSM-5 autism criteria. Our analysis points to an amorphous group of social stakeholders who express a variety of concerns about unabated medicalization. We also identify the stance of diagnostic domain defense, which is an oppositional response by laypeople with a personal connection to a diagnosis to a real or perceived challenge to the definitional boundaries of that diagnosis. Our analysis explicates the dimensions of diagnostic domain defense, which include its grounding in experiential certainty and anguish, and the accrual and deployment of diagnostic resources. We make a case for the utility of this concept for theorizing the relationship between lay claims making, diagnoses, and medicalization. We also make a case for the use of online reader comments as a way to unobtrusively study lay claims making related to pressing social problems in the Internet era. Un mecanismo central a través del cuál se produce la medicalización es la ampliación del dominio, es decir cuando la definición de un diagnóstico se amplía para incluir casos más allá de su alcance original. Esto ha sido especialmente común con respecto a los diagnósticos sobre enfermedades mentales. Sin embargo, existen pocos casos de contracción del dominio, por ello es de mucha importancia la controversia en torno a las revisiones de autismo ante la publicación del DSM-5. Muchos defensores del autismo temían que la nueva definición excluiría un número significativo de personas que tienen el diagnóstico de autismo. A través de un análisis de contenido de 642 comentarios de lectores en línea sobre un artículo de alto perfíl del periódico New York Times sobre los criterios de autismo DSM-5 pudimos examinar la percepción del público sobre la contracción del dominio de autismo. En nuestro análisis encontramos que los actores sociales que expresan una variedad de preocupaciones sobre esta nueva medicalización constituyen un grupo amorfo. También encontramos que los actores que tienen una conexión personal con un diagnóstico de autismo se oponen a los límites reales o percibidos de la nueva definición de ese diagnóstico. El concepto de contracción de dominio sirve para teorizar sobre la relación entre reclamos, diagnósticos y procesos de medicalización o desmedicalización. Igualmente, el uso de los comentarios de los lectores en línea es una forma discreta para los sociólogos de estudiar los reclamos relacionados con problemas sociales urgentes en la era de Internet.
    Social Problems 03/2015; 62(1):120-140. DOI:10.1093/socpro/spu001 · 1.23 Impact Factor
    • "The return of a descriptive approach against speculative psychodynamic etiologies is often considered to be a significant change introduced by the DSM-III (Compton and Guze 1995; Mayes and Horwitz 2005; First 2012a). However, the adoption of a European descriptive stance in the DSM-II was what led to the elimination of Meyer's reactions from the manual. "
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    ABSTRACT: Many current debates about validity in psychiatry and psychology are predicted on the unexpected failure to validate commonly used diagnostic categories. The recognition of this failure has resulted in what Thomas Kuhn calls a period of extraordinary science in which validation problems are being given increased weight, alternatives are proposed, methodologies are debated, and philosophical and historical analyses are seen as more relevant than usual. The authors who contributed chapters to this book, a mix of senior scholars who are among the most respected names in their disciplines as well as younger up-and coming thinkers, include psychiatrists, psychologists, neurologists, and philosophers from Western and Eastern Europe, Latin America, and the United States. A diverse group of practicing clinicians and academics, they articulate a variety of perspectives on how to make progress on the problem of validity in psychiatric classification. They focus on classification issues in the DSM and the ICD, as well and the NIMH RDoC Project, the role of neuroimaging and psychometrics in psychiatry, the concept of natural kinds, and the debate over categorical versus dimensional models of personality disorder and psychopathology. Key words: Validity, DSM, ICD, RDoC, dimensional models, neuroimaging, psychometrics, natural kind, personality disorder
    11/2014; Oxford University Press.
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    • "Introduced with the publication of the DSM-III, the symptom-based approach characterizing both the DSM-5 and the ICD-10 classifications systems constitutes the outcome of the legitimacy crisis of psychiatry within the third quarter of the XX th century. The third revision of the DSM aimed at responding to the strong criticisms and suspicions addressed to the post-world-war-II American psychiatry by endorsing a strictly atheoretical, purely descriptive and as objective as possible approach to mental illness (Mayes & Horwitz, 2005). Committing psychiatry to the scientific and deontological standards of evidence-based western medicine, it reaffirmed the status of psychiatry as a sub-discipline of medicine, giving rise to the medical model of psychiatry (Murphy, 2005). "
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    ABSTRACT: Mental disorders are currently defined in the official classification systems (DSM-5 and ICD-10) as syndromes consisting in clusters of symptoms combined with various exclusions conditions. However, these systems also assume that the symptoms occurs because of some underlying causes, which explain as why we regularly encounter in the population some specific clusters of symptoms rather than random distribution of symptoms. This paper aims at investigating the ontological status of mental disorders, reviewing the ontological commitments of various theoretical accounts defining mental disorders. It argues that, especially given the current state of the art in empirical research, mental disorders should be conceived as theoretical entities.
    XXIII. Kongress der Deutschen Gesellschaft für Philosophie 2014 Münster, Geschichte – Gesellschaft – Geltung, Münster; 10/2014
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