Diagnostic and Statistical Manual (DSM)
The Diagnostic and Statistical Manual of Mental Disorders (DSM), issued by the American Psychiatric Association (APA), is the United States’ official dictionary of mental illnesses. Its influence is global. The APA published a radical revision of the DSM in 1980 which reorganised and expanded the classification of mental illnesses. This new classification specified symptoms for each mental illness that had to be met to diagnose a patient with that illness. The new approach was inspired by a variety of intellectual and political developments, including controlled trials for psychiatric drugs, the antipsychiatry movement the decline of psychoanalysis within psychiatry, and the earlier work of Emil Kraepelin on psychiatric classification. The DSM has been revised twice since 1980 to include a growing number of disorders.
Each revision represents the opinion of many psychiatrists. They do not always agree. The 1980 revision was authored collectively and bureaucratically by committees, so in some cases controversies about what counts as a mental illness were settled by majority vote. The most famous was an APA vote that homosexuality, previously regarded as a mental illness, would be excluded from the 1980 revision.
The DSM is now often described as a ‘bible’ rather than a dictionary. It is a global standard by which researchers, government agencies and health insurance companies measure mental health care. It is difficult to find a psychiatry textbook or study not aligned to the latest DSM categories. Critics argue the DSM is insensitive to cultural differences in the way mental illness is perceived and experienced. Many psychiatrists worry it has promoted a cosy relationship between the psychiatrists who determine the diagnostic rules and the pharmaceutical companies that market psychiatric drugs.
S Kirk and H Kutchins, The Selling of DSM : The Rhetoric of Science in Psychiatry (New York: A. de Gruyter, 1992)
American Psychiatric Association, Diagnostic And Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (Washington, DC: APA, 1994)
S Walker, A Dose of Sanity: Mind, Medicine, and Misdiagnosis (United States: John Wiley & Sons, Inc, 1996)