Do You Know The Shaky History Of The DSM?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is one of the most complicated, scientifically-unsupported caricatures in the field of psychology and psychiatry. A lot of parents, families, and caregivers are unaware of the complex history of the DSM and its multiple revisions. Many parents, families, and caregivers disagree with diagnoses and treatment options, but fear speaking up or disagreeing with the manual and it’s supporters. Let’s take a look into the history of the DSM so that you can understand why it is one of the biggest problems in modern day society.
Back in the early 1950s and 1960s, the field of psychology and psychiatry were largely unsophisticated and lacked the scientific rigor that the field of medicine, science, and research had. Leading professionals in the two fields (i.e., Sigmund Freud, an Australian Neurologist and leading psychoanalyst and Emile Krapelin, a German Psychiatrist) were bent on trying to prove their “expertise” and “scientific foundation” to society and other leading professionals. This led to multiple theories in the field and many more years of trying to understand psychiatry and mental illness.
Emile Krapeline, the “father” of psychiatric classification came up with 3 categories (known as the Krapelinian dichotomy):
- Dementia Praecox (now called Schizophrenia, which was re-formulated in 1908 by Eugene Bleuler, a Swiss Psychiatrist)
- Manic-depressive psychosis (now bipolar disorder)
- Paranoid Psychosis
Although Krapelin rejected many of Freud’s theories (which focused on early sexual experiences), Krapelin added very little to no greater value and understanding of science or biology and may have helped to promote a flawed system of categorization. Today, the DSM and its proponents categorize labels that have been agreed upon by a pre-chosen group of individuals in the fields of psychology and psychiatry. The labels (neuro-cognitive disorder, disruptive mood dysregulation disorder, etc., found in the DSM-5) have been discussed in meetings known as Work Groups that comprise a group of men and women who engage in multiple “debates” on whether to vote in a particular label or not. The process of developing the DSM is literally a black and white, yes or no process. If you think researchers, psychiatrist, and professors get together to look at “the research” on mental health, think again! Some simply discuss the different labels and work to agree or disagree on the labels.
History of Revisions
Multiple historical accounts show that Krapelin greatly influenced and inspired psychiatrists to revise the first editions of the Diagnostic and Statistical Manual. In fact, the DSM has been revised multiple times beginning in the 1950s and ending in 2013. You can bet your money that the DSM-5 will be revised in the next 4-years or so. The timeline for revisions are as follows:
1952: DSM-I was developed and only included about 106-108 categories
1960s: DSM-II was developed and included a total of 168 categories
1973: political and cultural pressure led to the removal of homosexuality from DSM-II
1974-1975: work began on the DSM-III which led to it being implemented in 1980.
1984: DSM-III was developed and included a total of 265 disorders
1987: DSM-III-R: Revision of the DSM-III manual, 292 disorders
1994: DSM-IV included broadened criteria of some of the categories, namely ADHD and Autism. 886 pages/297 disorders
2000: DSM-IV-TR (TR: Text Revision) included revisions to DSM-IV
2013: DSM-V includes updated categories, new additions, and different theories
None of these revisions were based solely upon science, but rather politics, culture, and preference. Most of our theories of mental illness are culturally-based, which is why many other countries disagree with some of our theories. For more information on the manual and the ICD (International Classification of Disorders) click here.
None of the above mentioned, however, reduce the reality that mental illness, developmental problems, or behavioral problems exist and affect daily life. None of this information erases the fact that our DSM is useful in helping us identify, categorize, and name the expression of behavioral or mental problems we observe in people.
The unstructured foundation upon which the DSM has been built frustrates many families today. The DSM minimizes human suffering to a label and drug. This does not characterize every case, but it does characterize many. The goal of this article is to jump-start your critical thinking, not to change it. It’s okay if we challenge the foundation of our theories, many have.
The DSM is simply a manual designed by humans who have biases, prejudices, political beliefs, and cultural agendas. It is not a bible; to state that it is a bible is to overestimate its ability. The DSM provides voted upon labels that professionals can use to label a suffering individual. It is mainly used to provide business/insurance reimbursement or care to individuals seeking help. The system helps to classify individuals so that insurance reimbursement can be received, medication prescribed, and treatment maintained. But every diagnoses can be questionable and many families have questioned it. Without labels, the field of psychiatry and psychology would not exist or at least, suffer in its existence.
What does all of this say about the future?
The field has taken many short-cuts and the DSM is one of them. The field has yet to engage in real research involving certain diagnoses. The field has portrayed itself over the years as a concrete science that is just as accurate as the medical field. This is not necessarily true and some scientists agree. Many truth-seeking and caring professionals in the field continue to refer to the DSM as a “house of cards” because it lacks the ability to stand against those who question it with wisdom. This often involves many parents, families, and caregivers.
I urge all parents, families, and caregivers to be watchful, question a diagnosis, research that diagnosis, get a second opinion, and research your medications. You can research your medication at www.drugs.com. Self-knowledge is power.
To watch a documentary on the truth of the DSM, visit my site: AnchoredInKnowledge
Hill, T. (2014). Do You Know The Shaky History Of The DSM?. Psych Central. Retrieved on April 28, 2015, from http://blogs.psychcentral.com/caregivers/2014/02/do-you-know-the-history-of-the-dsm/