I · Purpose of Study
Autism is currently defined as “a developmental disorder caused by brain damage.” Until the 1960s, however, it was generally viewed as “a psychological disorder resulting in a closed mind” or as “an infantile type of schizophrenia.” How did this radical change occur? Not only the understanding of autism, but the entire focus of the study of mental disorders, shifted from psychogenic theory to organic theory — that is, to biological psychiatry — between the latter half of the 1960s and the 1980s. We came to see that a major revision of the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, lies at the bottom of this change. In short, the manual switched from earlier psychology-based, psychoanalytic categories to an approach emphasising scientific demonstration. This recognition naturally led us to the question: why did the DSM undergo such a radical change?
There is a major difference of approach towards mental disorders between the first and second editions of the DSM and the third edition (DSM-III). The first two versions prescribe diagnostic standards based on psychogenic theory that, in turn, has roots in psychodynamics. The diagnostic standards prescribed in the third edition are, by contrast, based not on psychodynamics but on objective facts and scientific grounds. This paper aims at studying the background of the change and the evolution of approaches to mental disorders.
II · The Making of DSM-III and Its Background
1. Comparison between DSM-I/II and DSM-III
| DSM-I · II | DSM-III | |
|---|---|---|
| Number of disorders | 130 (II) | 265 |
| Diagnosis | Psychodynamic etiology based on the patient’s psychology | Descriptive, mechanical, practical, symptomatological approach · multiaxial diagnosis |
| Key concept | Psychodynamics (psychoanalysis) | Scientific, medical, objective concepts |
2. Reasons for the Change to DSM-III
(1) Emergence of behaviour therapy. Since the 1950s, behaviour therapy — which emphasises objective observation and experiments focused on learning and environment — gained popularity in the United States. As a result, psychoanalysis, which emphasises consciousness, internal observation, and instinct, lost ground.
(2) Emergence of biological psychiatry. The use of psychotropic drugs became common in the 1960s, causing radical change in mental treatment. Biological research was stimulated by the emergence of these drugs.
(3) Inconsistencies in diagnosis. Practitioners and a number of studies pointed out inconsistencies in diagnoses based on the previous diagnostic standards (DSM-I and DSM-II), resulting in calls for their revision.
(4) Social movements. Accepted diagnostic standards of mental disorders changed under pressure from insurance companies, pharmaceutical companies, and political lobby groups (e.g., homosexuality, PTSD).
(5) Social integration of American Jewry. It became less compelling, sociologically, to promote psychoanalysis for the following reasons: (a) Jewish culture had become diluted through intermarriage; (b) American society had become more tolerant towards other communities. Both processes weakened the cultural milieu in which psychoanalysis had taken root in mid-twentieth-century America.
3. From Psychoanalysis to Scientific Indications — How to Describe Mental Disorders
Psychiatry regained the status of a branch of medicine as it moved away from psychoanalysis-based psychogenic theory toward scientific indications. Unlike other illnesses, however, the diagnosis of mental disorders requires social contextualisation and cannot ignore social relationships. Mental health depends on the relationship between the individual and society as well as on the individual alone, and is not pertinent to a uniform definition. Consequently, mental disorders are not pertinent to a uniform definition either: it is very difficult to determine what is normal and what is abnormal.
III · Conclusion
Concerning the change of approach to mental disorders from DSM-I/II to DSM-III, the study found the following:
- The emergence of new treatments, including behaviour therapy and the revolution of treatment by psychotropic drugs, brought about the decline of the psychodynamic, psychoanalytic paradigm (DSM-I and II) and facilitated the rise of biological psychiatry. The social integration of American Jewry into mainstream American society influenced the process in the background.
- The advancement of biological research technology — for instance, in brain and gene research — gave rise to biological psychiatry. This caused psychiatry to regain the status of a branch of medicine and, in turn, encouraged the fundamental revision of diagnostic classifications.
- At the same time, social situations and political pressures forced the revision of diagnostic standards. The result is the current scientific diagnostic standards (DSM-III).
IV · Bibliography
American Psychiatric Association. DSM-II. Washington, D.C.: APA, 1968.
American Psychiatric Association. DSM-III. Washington, D.C.: APA, 1980.
American Psychiatric Association. DSM-IV. Washington, D.C.: APA, 1994.
Shorter, Edward. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: Wiley, 1997.
Kutchins, Herb, and Stuart A. Kirk. Making Us Crazy: DSM — The Psychiatric Bible and the Creation of Mental Disorders. New York: Free Press, 1997.
Kraepelin, Emil. Psychiatrie: Ein Lehrbuch für Studierende und Ärzte. Unveränderter Abdruck der achten Auflage. Leipzig: Barth, 1909.
Schneider, Kurt. Klinische Psychopathologie. 12. unveränderte Auflage. Stuttgart · New York: Georg Thieme Verlag, 1980.