The Selling of DSM: The Rhetoric of Science in Psychiatry

by Stuart A. Kirk

When it was first published in 1980, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition ―univer-sally known as DSM-III ―embodied a radical new method for identifying psychiatric illness. Kirk and Kutchins challenge the general understanding about the research data and the pro-cess that led to the peer acceptance of DSM-III. Their original and controversial reconstruction of that moment concen-trates on how a small group of researchers interpreted their findings about a specific problem―psychiatric reliability―to promote their beliefs about mental illness and to challenge the then-dominant Freudian paradigm.

Genres: Psychology, Psychiatry, History, Science

280 pages, Paperback

First published December 31, 1992

Reviews

[Adam Guthmiller · Rating 4 out of 5]

“In fact, the expansion of the psychiatric domain is limited by nothing except the political judgement of the APA (237).” A fascinating account of the formation of the DSM, and Psychiatry’s own fundamental presuppositions since.

[Michael Burnam-Fink · Rating 4 out of 5]

Kirk and Kutchins chronicle the scientific rhetoric used to justify the replacement of the DSM-II with the DSM-III, the process of convincing the mental health community to use the new DSM, and the failure of the newfound manual to live up to its own standards of reliability and validity. This is a comprehensive and sophisticated history, drawing mostly from the public statements of the American Psychiatric Association and the driving force behind the new manual, Dr. Robert Spitzer. This book traces the development of kappa, a statistical measure of reliability, and how colored descriptive terms were used to make the same numerical values denigrated as 'no better than fair' transform into 'good' via slight of rhetoric. Having created a a problem of reliability, the low chance of two psychiatrists arriving at the same diagnosis for the same patient, and proposed the solution of significantly altering the whole system of diagnosis according to a minority view, the APA created a weighty tome backed up more by politics than science, one that enshrines the dominant view of psychiatrists in mental health.

Losers don't usually get to write history, and as social work professors, Kirk and Kutchins were definitely losers here. The story of the DSM is written here as a fall rather than a triumph. But while Kirk and Kutchins draw links to some big names in STS (Kuhn, Merton, Latour, etc), they don't quite have the answer to why the DSM-III became the standard. Why, in the tide of anti-psychiatry scholarship in the 1960s and 1970s, was it a medicalized, neo-Kraepelian who rewrote the book on mental illness and closed down dissent with a much more nominative and non-causative style of diagnosis?

There are perhaps no answers for that questions, but The Selling of the DSM succeeds in other areas, exploring the creation of a new scientific instrument, the micro-decisions and discretions characteristic of using the DSM, and the ways in which the many users of the DSM have learned to manipulate it to their own ends, making a mockery of its supposed 'objectivity'. The legitimacy of psychiatry, more than most other sciences, rests on political processes. This book brings those processes to light

[Jeffrey Acorn · Rating 4 out of 5]

I read this during graduate school which was quite a while ago. It provided a good background on the history of the DSM and nosological aspects of certain disorders. It was definitely influential in my approach to working with my clients.

[Alo · Rating 5 out of 5]

Anyone who hopes to go into the field(s) of psychology/ psychiatry should read this book. This is some incredibly important history and science, and clearly has a huge effect on our modern psych bureaucracy. Peoples' lives are at stake. Peoples' lives! But really.

[Kevin Bass · Rating 4 out of 5]

Only book of its kind, as far as I am aware. Covers the internal history of the creation of DSM-III. Perspective both biased and insightful.