"DSM-III represents a bold series of choices based on guess, taste, prejudice, and hope ... few are based on fact or truth." - George Valiant, "A Debate on DSM-III"

"Only in psychiatry is the existence of physical disease determined by APA presidential proclamations, by committee decisions, and even, by a vote of the members of APA, not to mention the courts". - Peter Breggin, Toxic Psychiatry

DSM-IV: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

Historical Background

The need for a classification of mental disorders has been clear throughout the history of medicine, but there has been little agreement on which disorders should be included and the optimal method for their organization. The many nomenclatures that have been developed during the past two millennia have differed in their relative emphasis on phenomenology, etiology, and course as defining features. Some systems have included only a handful of diagnostic categories; others have included thousands. Moreover, the various systems for categorizing mental disorders have differed with respect to whether their principle objective was for use in clinical, research, or statistical settings. Because the history of classification is too extensive to be summarized here, we focus briefly only on those aspects that have led directly to the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and to the "Mental Disorders" sections in the various editions of the International Classification of Diseases (ICD).

In a classification of physical phenomena, it is often quite obvious what to describe and label. If any group of people look at trees, they will find themselves describing "leaves", "stems", "branches", "roots" and "bark". It's quite obvious by the nature of the thing observed how to classify its parts and describe their structure. There is little room for opinion. In psychology and psychiatry exactly the opposite is true. According to the above, "some systems have included only a handful of diagnostic categories; others have included thousands". The thing being observed, the "human mind" (actually psychiatry ignores the mind and deals largely and almost exclusively with human behavior) is not obvious to any group of people, there is little general agreement, and what ultimately appears as consensus is just that. It's a "consensus" and not truth, facts, what actually is, or even "scientific". What becomes consensus is largely based on opinions grounded in faulty basic assumptions on the nature of man, his mind, and their relationship. The abundance of codes, terms and complex nomenclature gives the illusion of "science" and deep "understanding", but this is only an illusion. The basic nomenclature and temrinology of the field of psychiatry assumes, quite incorrectly, that "mental disorders" are "diseases" like any other "physical disease". They just go right ahead and classify "mental disorders" in the various editions of the International Classification of Diseases (ICD), as if things like "depression", "anxiety disorder", "schizophrenia" and hundreds of other conditions existed in any way even closely resembling a physical disease or condtion such as arhtritis, pereonditis, or cancer. There is, and never has been the slightest indication that psychological phenomena and unwanted mental or emotional conditions are based on physiological causes or "diseases of the brain". Calling these things "diseases" is a very incorrect approach, and has put a slant on the entire field which prevents most people from taking a clear look at what is actually occurring regarding "mental illness". It has caused the field itself to tread down a path which can only lead to dead-ends of true knowledge and oppression of human beings. Since the "diseases" they endlessly discuss don't actually exist, all treatments such as drugs and electric shock treatments fail completely to address and cure any real ailment or situation. In fact, their use only makes matters worse.

In the United States, the initial impetus for developing a classification of mental disorders was the need to collect statistical information. What might be considered the first official attempt to gather information about mental illness in the United States was the recording of the frequency of one category - "idiocy/insanity" in the 1840 census. By the 1880 census, seven categories of mental illness were distinguished - mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy. In 1917, the Committee on Statistics of the American Psychiatric Association (at that time called the American Medico-Psychological Association (the name was changed in 1921), together with the National Commission on Mental Hygiene, formulated a plan that was adopted by the Bureau of the Census for gathering uniform statistics across mental hospitals. Although this system devoted more attention to clinical utility than did previous systems, it was still primarily a statistical classification. The American Psychiatric Association subsequently collaborated with the New York Academy of Medicine to develop a nationally acceptable psychiatric nomenclature that would be incorporated within the first edition of the American Medical Association's Standard Classified Nomenclature of Disease. This nomenclature was designed primarily for diagnosing inpatients with severe psychiatric and neurological disorders.

A much broader nomenclature was later developed by the U.S. Army (and modified by the Veterans Administration) in order to better incorporate the outpatient presentations of World War II servicemen and veterans (e.g., psychophysiological, personality, and acute disorders). Contemporaneously, the World Health Organization (WHO) published the sixth edition of ICD, which, for the first time, included a section for mental disorders. ICD-6 was heavily influenced by the Veterans Administration nomenclature and included 10 categories for psychoses, 9 for psychoneuroses, and 7 for disorders of character, behavior, and intelligence.

The American Psychiatric Association Committee on Nomenclature and Statistics developed a variant of the ICD-6 that was published in 1952 as the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I). DSM-I contained a glossary of descriptions of the diagnostic categories and was the first official manual of mental disorders to focus on clinical utility. The use of the term reaction throughout DSM-I reflected the influence of Adolf Meyer's psychobiological view that mental disorders represented reactions of the personality to psychological, social, and biological factors.

In part because of the lack of widespread acceptance of the mental disorder taxonomy contained in ICD-6 and ICD-7, WHO sponsored a comprehensive review of diagnostic issues that was conducted by the British psychiatrist Stengel. His report can be credited with having inspired many of the recent advances in diagnostic methodology - most especially the need for explicit definitions as a means of promoting reliable clinical diagnoses. However, the next round of diagnostic revision, which led to DSM-II and ICD-8, did not follow Stengel's recommendations to any great degree. DSM-II was similar to DSM-I but eliminated the term reaction.

Realize this all seems to make sense unless you keep firmly in mind that the majority of the "mental illnesses" and "disorders" are NOT illnesses in any sense analogous to physical illness. This idea or notion has "crept" into the understanding of the subject, and this is obvious from reading the above. At some point the "personality" was referred to as "responding" to other factors in explaining "disorders" (or undesirable conditions of the mind), but has since been erased as a concept completely. You, the personality, the mind, or wahtever you choose to call this aspect of Man has been dismissed from any degree of importance. Psychiatry and the drug companies spend millions of dollars a year to find that one "gene" that causes a "mental illness". They haven't found it and they never will - it doesn't exist. They spend huge amounts of money to convince the public that various "disorders" are due to "chemical imbalance in the brain". Of course, there is NO known test to locate or measure the elusive chemical imbalance, but they go on talking about it as if it exists and is something real. It is a theory, and a very ignorant theory, not based an any honest empirical evidence, which has never come close to being proven! Labeling general problems with one's mind, emotions, and living as "mental illness" is truly absurd. There is no doubt that these problems can at times be quite severe to the personand those arounf them. But forcing a connection of these concepts of "mental illnesses" with biochemistry, neurology, and electrophysiology is more absurd, intellectually unwarranted, and "scientifically" invalid. People do have problems with their mind, emotions, thinking, observation, dealing with others, working, playing, and on and on. If there is something a person can do, well, they can probably have a problem with it. That is the nature of life, and NOT the nature of "mental illness". These problems are NOT "mental illnesses" and have only come to be thought of in this way because a very heavily financed group of posturing, authoritative pseudo-intellectuals have chosen to explain them in this way. Delineating these problems with complex terminology and into various categories creates an illusion of understanding. The only thing really understood is that people have all these problems. There is no other understanding here, so please don't fall for the charade. Psychiatry details many various problems and then ASSUMING all these things to be "medical" and "biophysiological" in nature, does what it does best - drug, shock, and dissect living brains as the purported "cures" for the "diseases" they so graphically describe, investigate, and "discover". Words like "empirical", "etiology", "diagnostic' and "clinical" are tossed around freely. This gives an impression of "science", "professionalism", and "erudition". This subject in it's simplest and truest form is a very glib and faulty understanding of Man which shrouds itself in a complex pseudo-scientific nomenclature in an attempt to secure believers. Sadly, there are many believers. And they are BELIEVERS. The believers think of themselves as rigidly pragmatic, honest and intelligent members of modern society. They believe this subject as presented is "the truth". Realize none of this is true, and they are BELIEVERS - someone who completely agrees with a system or structure of thought about some subject regardless of the inherent validity of the system or structure. They are no different from an Inquisition priest who applied the thumbscrews to the local heretic. The priest also BELIEVED in his mythology and complex demonic nomenclature, and also believed himself to be intelligent and honest. Both are shams. The excesses of the Spanish Inquisition disappeared with time but sadly, psychiatry is still with us. Psychiatry is a false and arbitrary ideology and orthodoxy, enjoying many modern believers.

As had been the case for DSM-I and DSM-II, the development of DSM-III was coordinated with the development of the next (ninth) version of TCD, which was published in 1975 and implemented in 1978. Work began on DSM-III in 1974, with publication in 1980. DSM-III introduced a number of important methodological innovations, including explicit diagnostic criteria, a multiaxial system, and a descriptive approach that attempted to be neutral with respect to theories of etiology. This effort was facilitated by the extensive empirical work then under way on the construction and validation of explicit diagnostic criteria and the development of semistructured interviews. ICD-9 did not include diagnostic criteria or a multiaxial system largely because the primary function of this international system was to delineate categories to facilitate the collection of basic health statistics. In contrast, DSM-III was developed with the additional goal of providing a medical nomenclature for clinicians and researchers. Because of dissatisfaction across all of medicine with the lack of specificity in ICD-9, a decision was made to modify it for use in the United States, resulting in ICD-9-CM (for Clinical Modification).

Experience with DSM-III revealed a number of inconsistencies in the system and a number of instances in which the criteria were not entirely clear. Therefore, the American Psychiatric Association appointed a Work Group to Revise DSM-III, which developed the revisions and corrections that led to the publication of DSM-III-R in 1987.

Read first hand for yourself and discover the true nature of psychiatry as a very complicated modern mythology masquerading as "true science". Where else would one find "coffee drinking" (292.9 Caffeine-Related Disorder) turned into a mental illness! Smoking is now classified as a mental illness also! You'll find it under category 305.10 Nicotine Dependence, and 292.0 Nicotine Withdrawal. Yes, smoking does has an addictive aspect. But, no, drug addiction is not a mental illness! It's drug addiction - the physical and mental reaction to drug taking. "Withdrawal" is a physiological reaction to stopping the taking of a drug. It is not a mental illness! The same is true for the other invented and named "disorders" and "mental illnesses".

Say NO To Psychiatry!

Book Links

DSM-IV published by the American Psychiatric Association

They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal by Paula J. Caplan, Ph.D.

Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders by Herb Kutchins, Stuart A. Kirk

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct by Thomas S. Szasz, M.D., Professor

Law, Liberty, and Psychiatry : An Inquiry into the Social Uses of Mental Health Practices by Thomas S. Szasz, M.D., Professor

DSM-IV Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders by Robert L. Spitzer, Miriam Gibbon, Andrew E. Skodol, Michael B. First

DSM-IV Made Easy: The Clinician's Guide to Diagnosis by James Morrison

Diagnostic Criteria from DSM-IV (4th Ed) by John S. McIntyre

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©Gene Zimmer 1999 ALL RIGHTS RESERVED