The manual of madness

I’ve just found a wonderful article online that appeared a couple of years ago in The New Yorker retelling the curious and surprising story of how the DSM was written.

The DSM is the Diagnostic and Statistical Manual of Mental Disorders. Published by the American Psychiatric Association it gives the criteria that define different types of mental disorder.

In Europe we tend to use an alternative, the ICD (interestingly, the two manuals don’t always agree) but the DSM is often used by researchers for consistency.

The current version of the DSM is a revised version of the 4th edition. The 5th edition, the DSM V, is due out in 2011.

Politically, the DSM is very important as it describes what mental states and behaviours are considered pathological by mainstream medicine, as well as having massive implications for medical practice and healthcare provision.

As time has gone on, the definitions are more influenced by research and less influenced by political pressures and the whims of the authors.

However, there’s one particularly surprising bit of the New Yorker article that describes how two disorders got in an earlier version:

Spitzer read the paper and asked Peele and Luisada if he could come to Washington to meet them. During a forty-minute conversation, the three decided that “hysterical psychoses” should really be divided into two disorders. Short episodes of delusion and hallucination would be labelled “brief reactive psychosis,” and the tendency to show up in an emergency room without authentic cause would be called “factitious disorder.” “Then Bob asked for a typewriter,” Peele says. To Peele‚Äôs surprise, Spitzer drafted the definitions on the spot. “He banged out criteria sets for factitious disorder and for brief reactive psychosis, and it struck me that this was a productive fellow! He comes in to talk about an issue and walks away with diagnostic criteria for two different mental disorders!” Both factitious disorder and brief reactive psychosis were included in the DSM-III with only minor adjustments.

The article is a thoroughly fascinating look into the history and politics of the ‘bible’ of psychiatry, and is a great introduction to some of the vagaries of defining mental illness.

Link to New Yorker article ‘The Dictionary of Disorder’.

One thought on “The manual of madness”

  1. Hi, You might find this petition interesting. It’s not asking for autism to be removed from the DSM, but is asking that research be less deficit focused and more ability focused.
    Please sign the petition, even if you aren’t particularly interested in autism, if you agree with the petition’s aims, of course.
    More explanation here:
    Also, feel free to share the URL of the petition with anyone. The NIMH is asking for feedback from the public by the 16th of this month.

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