Major Revision of the Diagnostic and Statistical Manual of Mental Disorders
(DSM)
− Background of the Change and Conceptualization of Mental Disorders −
Abstruct
I. Purpose of Study
Autism is currently defined as "a developmental disorder
caused by brain damage". However, until the 1960s, it was generally viewed as "a psychological disorder resulting in closed mind" or "infantile type of
schizophrenia". How did this radical change occur? Not only the understanding of autism but the entire focus of mental disorders
studies had shifted from psychogenic theory to organic theory of biological
mental science and other psychiatry between the latter half of the 1960s
and the 1980s. I realized 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 the change. In short, the manual switched from earlier psychology-based
psychoanalysis to an approach emphasizing scientific proof. This realization naturally led me to the question, "why did DSM undergo such a radical change?"
There is a major
difference of approach towards mental disorders between the first and second
versions of DSM and the third version (DSM-III). The first two versions prescribe diagnostic
standards based on psychogenic theory that, in turn, have roots in
psychodynamics. The diagnostic standards
prescribed in the third version are, in 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 Making of DSM−III and Its Background
１ Comparison between DSM−I・II and DSM−III
|
|
DSM-I・II |
DSM-III |
|
No. of disorders |
130（II） |
265 |
|
Diagnosis |
Psychodynamic etiology based on patient's psychology |
Descriptive, mechanical practical, symptomatological approach. multiaxis diagnosis |
|
Key concept |
Psychodynamics (Psychoanalysis) |
Scientific, medical, objective concepts |
Table
1 Comparison between DSM−I・II and DSM−III
２ Reasons for the Change to
DSM−III
（１）Emergence of behavior therapy
Since the 1950s, behavior therapy, which emphasizes objective
observation and experiments focusing on learning and environment, gained
popularity in the Untied States.As a
result, psychoanalysis, which emphasizes consciousness, internal observation and
instinct, lost its stance.
（２）Emergence of biological mental
science
Use of psychotropic drugs became common in the 1960s, causing
radical change in mental treatment.Biological research was stirred up by the emergence of psychotropic
drugs.
（３）Inconsistencies in diagnoses
Practitioners and a number of studies pointed out inconsistencies of
diagnoses based on previous diagnostic standards (DSM−I and II, etc),
resulting in calls for their revisions.
（４）Social movement
Accepted diagnostic standards of
mental disorders had changed due to pressures from insurance companies,
pharmaceutical companies and political lobby groups.(E.g., homosexuality, PTSD)
（５）Social
integration of American Jews
It had become meaningless for the Jews to promote psychoanalysis because
of the following reasons: a) Jewish culture had become diluted through
intermarriage; b) the American society had become more tolerant towards
other races.
３ From
Psychoanalysis to Scientific Indications ―How to Describe
Mental Disordersー
Psychiatry regained the
status of a branch of medicine as it moved away from psychoanalysis-based
psychogenetic theory to scientific indications. Unlike other illnesses, however, the diagnosis of mental disorders, which
requires social contextualization, cannot ignore social relationships. Mental health is dependant on the relationships between an individual and
society as well as on individuals themselves, 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
The study found the following facts:
Regarding the change of
approach to mental disorders from DSM−I・II to DSM−III;
１ Emergence of new treatments including behavior therapy and the revolution
of treatments by psychotropic drugs resulted in the decline of psychodynamic,
psychoanalytical paradigm (DSM−I and II) and facilitated the rise of biological
psychiatry. The social integration of Jews to the American society influenced the
process in the background.
２ The advancement
of biological research technology (e.g. for researches of brain and genes) 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.
３ 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", 1968
American Psychiatric Association, "DSM-III, 1980
American Psychiatric Association, "DSM−IV", 1994
Edward Shorter: "History of Psychiatry: From the Era of the Asylum to the Age of
Prozac" 1997
Herb Kutchins & Stuart A.Kirk: "MAKING US CRAZY" DSM-The
Psychiatric Bible and the Creation of Mental Disorders" 1997
Emile Kraepelin: "Psychiatrie: Ein Lehrbuch für Studierende und
Ärzte" Unveränderter Abdruck der Achte Auflage. 1909
Kurt Schneider: "Klinische Psychopathologie" 12 unveränderte
Auflage. Georg Thieme Verlag Stuttgart・New York. 1980
etc.
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