"To read about the evolution of the DSM is to know this: It is an entirely political document. What it includes, what it does not include, are the result of intensive campaigning, lengthy negotiating, infighting, and power plays."

- Louise Armstrong, And They Call It Help: The Psychiatric Policing of America's Children

DSM-IV: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

Introduction

This is the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV. The utility and credibility of DSM-IV require that it focus on its clinical, research, and educational purposes and be supported by an extensive empirical foundation. Our highest priority has been to provide a helpful guide to clinical practice. We hoped to make DSM-IV practical and useful for clinicians by striving for brevity of criteria sets, clarity of language, and explicit statements of the constructs embodied in the diagnostic criteria. An additional goal was to facilitate research and improve communication among clinicians and researchers. We were also mindful of the use of DSM-IV for improving the collection of clinical information and as an educational tool for teaching psychopathology.

An official nomenclature must be applicable in a wide diversity of contexts. DSM-IV is used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). It is used by psychiatrists, other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, counselors, and other health and mental health professionals. DSM-IV must be usable across settings - inpatient, outpatient, partial hospital, consultation - liaison, clinic, private practice, and primary care, and with community populations. It is also a necessary tool for collecting and communicating accurate public health statistics. Fortunately, all these many uses are compatible with one another.

In this way psychiatry puts forth the the "bible" of "mental illness". This book is used by every field mentioned above as the guideline for understanding and categorizing "mental disorders". It also has the effect of setting the stage for accepted terminology, constructs, and basic viewpoints on the subject. A nomenclature, by it's very nature, sets the pattern for how any subject is perceived and understood. But also, it is not always so much what is said in the DSM, as what is implied and not said. The entire system of thought "makes sense" within it's own framework. But being "logically consistent" implies nothing about truth, relation to actual existing things, workability or quality of results. To read more about how a subject can be "logical" and "make sense", yet have absolutely nothing with observable reality see the essay Reality, Belief and the Mind. There are obviously many possible ways for a person, their mind, and their dealings with the world around them to be less than perfect (I choose to describe it this way instead of as "mental illness" or "disorders"). Observing and categorizing some of them, as the DSM has done, in no way implies understanding of causes or cures. Obviously, if the cause of something isn't understood, it is unlikely that any cure derived from the same "method" can be useful or effective. Those responsible for putting the DSM together admit this themselves. Psychiatry would like there to be medical and biochemical solutions (i.e drugs) to all the many listed "mental disorders", but that is extreme wishful thinking and impossible, because so many "mental disorders" have absolutely no observable cause in biology or chemistry. They say the causes are physiological and biological, but they have never observed this fact anywhere, except in their own fantasies and "professional" biases. Underlying the entire approach to the DSM-IV are the ideas that the mind and human behavior is completely understood and explained by biochemistry and physiology (and environmental factors). It isn't understood at all on this level and the psychiatric field's posturing along these lines is pure theatrics. There are no proven genes causing any mental condition, and no detectable chemical imbalance in any brain leading to a mental disorder. These are both only theories with absolutely no basis in verifiable fact. They may be very popular theories, but this implies nothing else. Popularity has NEVER implied truth or validity of that which is popular. This is extremely true in this case. The "mind" is mentioned often in the context of various "mental disorders". Phrases such as "lowered attention", "impaired memory", and "cognitive reduction" are used solely as symptoms to excuse the diagnosis of some purported "mental illness". One gets the idea while reading the DSM-IV that "they obviously know about the mind because they talk about it so much". Make the effort to observe what they say and how they say it. There is NO analysis of the mind as a thing in itself, no attempt to understand a mind and it's functioning, and no attempt to positively influence and help a mind directly through therapy or other techniques. The mind is USED and appealed to only as one of the categories of things wrong with a person to justify some psychiatric label for an "illness" or "disorder". "Weakened attention span" might be one of the criteria used to justify a label of depression or anxiety disorder. But the faculty of attention in a person, as a quality of a mind, as a function of any mind with tendencies, characteristics and potentials, is never examined or understood with an intention to develop means to improve or control attention. To the psychiatrists, you simply "have " attention, and if it's not "good" or "acceptable" it must be due to some "mental disease". They do the same things with students and learning. To them "learning" just exists. If you are a good student and can learn, lucky you. But if you are a slow or troubled student, you must have a "learning disability" or some "mental disorder". No one ever thinks to ask, "well, did anyone ever teach little Billy how to study?" This should seem glaringly unusual, but the supposed "sciences" of modern education (which is now all run by behavioral engineering and psychiatry) have never investigated, much less come up with a workable method of study for children, able to be taught so as to improve any student's ability to study and learn. To them, you either can study, or you have a "mental disease". These people are the most pretentious, dull and poor excuse for a "professional" I have ever encountered! This is equally true for every other aspect of mind mentioned in the book. Simply, psychiatry, as elucidated in this DSM-IV, the "bible" of modern psychiatry, has absolutely no understanding of the human mind, no way to address it, and no way to help and improve it. They pretend to this understanding and ability, but this is 100% pretense. An even larger joke is that the DSM is presented as a comprehensive guide for diagnosing "mental illness". What does it matter what the diagnosis is? The only solution modern psychiatry ever offers is DRUGS, DRUGS and MORE DRUGS. Or worse, electric shock and brain butchery. These barbaric and ineffective "treatments" derive directly from the medical orthodoxy that the mind & personality = chemical reactions in the brain. This is completely wrong, and so are the solutions offered to the problems outlined in the DSM. It's not that the various problems with minds and people don't exist. They do. And it's not that they don't exist in many ways as described in the DSM. They do. What doesn't exist, but is assumed and believed to exist, is the absurd notion that man is solely a biological entity, able to be understood in all his facets by chemistry, biology and physiology alone. The "mind" has been ignored and neglected, and Man along with it. This has had disastrous results to Man and society wherever psychiatry has reared it's ugly head.

DSM-IV was the product of 13 Work Groups (see Appendix J), each of which had primary responsibility for a section of the manual. This organization was designed to increase participation by experts in each of the respective fields. We took a number of precautions to ensure that the Work Group recommendations would reflect the breadth of available evidence and opinion and not just the views of the specific members. After extensive consultations with experts and clinicians in each field, we selected Work Group members who represented a wide range of perspectives and experiences. Work Group members were instructed that they were to participate as consensus scholars and not as advocates of previously held views. Furthermore, we established a formal evidence based process for the Work Groups to follow.

The Work Groups reported to the Task Force on DSM-IV (see p. ix), which consisted of 27 members, many of whom also chaired a Work Group. Each of the 13 Work Groups was composed of 5 (or more) members whose reviews were critiqued by between 50 and 100 advisers, who were also chosen to represent diverse clinical and research expertise, disciplines, backgrounds, and settings. The involvement of many international experts ensured that DSM-IV had available the widest pool of information and would be applicable across cultures. Conferences and workshops were held to provide conceptual and methodological guidance for the DSM-IV effort. These included a number of consultations between the developers of DSM-IV and the developers of ICD-10 conducted for the purpose of increasing compatibility between the two systems. Also held were methods conferences that focused on cultural factors in the diagnosis of mental disorder, on geriatric diagnosis, and on psychiatric diagnosis in primary care settings.

To maintain open and extensive lines of communication, the Task Force on DSM-IV established a liaison with many other components within the American Psychiatric Association and with more than 60 organizations and associations interested in the development of DSM-IV (e.g., American Health Information Management Association, American Nurses' Association, American Occupational Therapy Association, American Psychoanalytic Association, American Psychological Association, American Psychological Society, Coalition for the Family, Group for the Advancement of Psychiatry, National Association of Social Workers, National Center for Health Statistics, World Health Organization). We attempted to air issues and empirical evidence early in the process in order to identify potential problems and differences in interpretation. Exchanges of information were also made possible through the distribution of a semiannual newsletter (the DSM-IV Update), the publication of a regular column on DSM-IV in Hospital and Community Psychiatry, frequent presentations at national and international conferences, and numerous journal articles.

Two years before the publication of DSM-IV, the Task Force published and widely distributed the DSM-IV Options Book. This volume presented a comprehensive summary of the alternative proposals that were being considered for inclusion in DSM-IV in order to solicit opinion and additional data for our deliberations. We received extensive correspondence from interested individuals who shared with us additional data and recommendations on the potential impact of the possible changes in DSM-IV on their clinical practice, teaching, research, and administrative work. This breadth of discussion helped us to anticipate problems and to attempt to find the best solution among the various options. One year before the publication of DSM-IV, a near-final draft of the proposed criteria sets was distributed to allow for one last critique.

In arriving at final DSM-IV decisions, the Work Groups and the Task Force reviewed all of the extensive empirical evidence and correspondence that had been gathered. It is our belief that the major innovation of DSM-IV lies not in any of its specific content changes but rather in the systematic and explicit process by which it was constructed and documented. More than any other nomenclature of mental disorders, DSM-IV is grounded in empirical evidence.

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 has an addictive aspect. But no, drug addiction via smoking is not a mental illness! It's simply drug addiction - the reaction physically and mentally to drug taking. "Withdrawal" is a physiological reaction a person experiences when they stop taking a drug. It is also not a mental illness! Of course, the more "mental illnesses" the psychiatric field can "fabricate" and place in the DSM, the more coverage insurance companies will provide to psychiatrists and drug companies as insurance companies use the DSM as their main source for ascertaining the "legitimacy" of a "mental illness".

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