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


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.

Download full-text


Available from: Rick Mayes, Mar 13, 2014
  • Source
    • "Epistemic in the sense that it was related to a specifically desired way to structure knowledge (i.e., scientifically). Political in the sense that by aligning psychiatry with other medical specialties that perform preventive interventions it would improve the medical status of psychiatric field, a position questioned from time to time in the history of the specialty[32]by those who consider it scientifically underdevel- oped[3]. Both researchers and Work Group members were committed to the value of scientific development. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although values have increasingly received attention in psychiatric literature over the last three decades, their role has been only partially acknowledged in psychiatric classification endeavors. The review process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) received harsh criticism, and was even considered secretive by some authors. Also, it lacked an official discussion of values at play. In this perspective paper we briefly discuss the interplay of some values in the scientific and non-scientific debate around one of the most debated DSM-5 category proposals, the Attenuated Psychosis Syndrome (APS). Then, we point out some ethical consequences of a facts-plus-values perspective in psychiatric classification. Different stakeholders participated in the APS-debate and for analytical purposes we divided them into four groups: (i) researchers in the field of high-risk mental states; (ii) the DSM-5 Psychotic Disorders Work Group; (iii) patient, carers and advocacy groups; and (iv) external stakeholders, not related to the previous groups, but which also publicly expressed their opinions about APS inclusion in DSM-5. We found that each group differently stressed the role of values we examined in the APS-debate. These values were ethical, but also epistemic, political, economic and ontological. The prominence given to some values, and the lack of discussion about others, generated divergent positions among stakeholders in the debate. As exemplified by the APS discussion, although medicine is primarily an ethical endeavor, values of different kinds that take part in it also shape to a large extent the profession. Thus, it may be strategic to openly discuss values at play in the elaboration of diagnostic tools and classificatory systems. This task, more than scientifically or politically significant, is ethically important.
    Full-text · Article · Jan 2016 · BMC Medical Ethics
  • Source
    • "Women, too, have long been denied equal opportunities based on their supposed physical and mental deficiencies (Reed 1978; Schur 1984). Likewise, homosexuality was classified as a mental disorder by the American Psychiatric Association until 1973, thus legitimizing any number of medical 'interventions' on homosexual patients (Mayes and Horwitz 2005). Medicalization has been a powerful tool of social control, and this control, we argue, extends into the social movement arena. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nonhuman Animal rights activists are sometimes dismissed as ‘crazy’ or irrational by countermovements seeking to protect status quo social structures. Social movements themselves often utilize disability narratives in their claims-making as well. In this article, we argue that Nonhuman Animal exploitation and Nonhuman Animal rights activism are sometimes medicalized in frame disputes. The contestation over mental ability ultimately exploits humans with disabilities. The medicalization of Nonhuman Animal rights activism diminishes activists’ social justice claims, but the movement’s medicalization of Nonhuman Animal use unfairly otherizes its target population and treats disability identity as a pejorative. Utilizing a content analysis of major newspapers and anti-speciesist activist blogs published between 2009 and 2013, it is argued that disability has been incorporated into the tactical repertoires of the Nonhuman Animal rights movement and countermovements, becoming a site of frame contestation. The findings could have implications for a number of other social movements that also negatively utilize disability narratives.
    Full-text · Article · Oct 2015 · Disability & Society
  • Source
    • "En su primera edición (de corte psicoanalítico) se incluían 106 trastornos, en la edición siguiente, de 1968, 137. En 1980, el DSM III inauguró el uso del diagnóstico categorial basado en los síntomas para definir los trastornos mentales (Mayes y Horwitz, 2005); el número de trastornos aumentó hasta 182. En el último DSM, el 5, publicado en 2013, el número es 216. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Presentación el monográfico que reivindica las posibilidades de las aproximaciones psicosociológicas cuando aceptan la pluralidad epistemológica, metodológica, etc., de las psicologías sociales. La visión hegemónica que sobre lo colectivo encontramos en la Psicología Social instituida está sobre-determinada por la visión hegemónica que de lo colectivo tiene y va extendiendo la Psicología y con ella el proceso cultural y social de psicologización de las formas de vidas actuales. Por ello iniciamos la andadura de este número interrogándonos sobre el sentido de la Psicología y sobre la labor que la Psicología Social puede (o debe, según se mire) desarrollar en el campo de las identidades colectivas.
    Full-text · Article · Sep 2015
Show more