A mirror of the times
Something was wrong with the water in London. Or if not the water, then the architecture. Or if not the architecture, then the traffic patterns. Or maybe the problem was the diagnostic tools.
What happened: In 1972, a team of British and American researchers published a study called “Psychiatric Diagnosis in New York and London” that compared diagnoses from hospitals on each side of the Atlantic.
The study’s results were confusing: 62 percent of New York’s patients were diagnosed as schizophrenics, compared with only 34 percent of London’s test subjects. London doctors, on the other hand, declared 24 percent of their subjects to be suffering from depressive psychosis — a diagnoses given to only 5 percent of New York’s study participants.
The study illustrated a problem with diagnosis at the time: It wasn’t consistent, and it wasn’t repeatable. Psychiatrists were ostensibly using the same definitions but were arriving at different conclusions.
The second revision of the DSM had been more of an update than an overhaul, but in the mid-1970s, the DSM task force decided that the third edition would be a rigorous and ambitious reimagining of what a psychiatric manual could do. Columbia psychiatrist Robert Spitzer was tapped to act as chair, and he set about changing the DSM from a more descriptive document to a rule-bound field guide for classification.
Gone were the Freudian “neuroses” that had populated earlier editions. Introduced were guidelines to help clinicians from different facilities arrive at the same conclusions, writes Bob Whitaker in “Anatomy of an Epidemic,” a history of mental health in the United States. A practitioner could not, for example, declare someone to be experiencing a “major depressive episode” unless five of nine listed criteria were met.
Moreover, the DSM-III was a rhetorical revolution, expanding the number of potential diagnoses — and the terms people had available to describe their suffering — to 265. It neatly organized people and behaviors into tidy compartments, laying the groundwork for manuals to come, and for the future of psychiatry as a whole. One psychiatrist at the time, writes Whitaker, heralded the new DSM as the victory of scientific psychiatry: “The old psychiatry derives from theory, the new psychiatry from fact.”