DSM: A History of Psychiatry's Bible

by Allan V. Horwitz

The first comprehensive history of "psychiatry's bible"―the Diagnostic and Statistical Manual of Mental Disorders . Over the past seventy years, the Diagnostic and Statistical Manual of Mental Disorders , or DSM , has evolved from a virtually unknown and little-used pamphlet to an imposing and comprehensive compendium of mental disorder. Its nearly 300 conditions have become the touchstones for the diagnoses that patients receive, students are taught, researchers study, insurers reimburse, and drug companies promote. Although the manual is portrayed as an authoritative corpus of psychiatric knowledge, it is a product of intense political conflicts, dissension, and factionalism. The manual results from struggles among psychiatric researchers and clinicians, different mental health professions, and a variety of patient, familial, feminist, gay, and veterans' interest groups. The DSM is fundamentally a social document that both reflects and shapes the professional, economic, and cultural forces associated with its use. In DSM , Allan V. Horwitz examines how the manual, known colloquially as "psychiatry's bible," has been at the center of thinking about mental health in the United States since its original publication in 1952. The first book to examine its entire history, this volume draws on both archival sources and the literature on modern psychiatry to show how the history of the DSM is more a story of the growing social importance of psychiatric diagnoses than of increasing knowledge about the nature of mental disorder. Despite attempts to replace it, Horwitz argues that the DSM persists because its diagnostic entities are closely intertwined with too many interests that benefit from them. This comprehensive treatment should appeal to not only specialists but also anyone who is interested in how diagnoses of mental illness have evolved over the past seven decades―from unwanted and often imposed labels to resources that lead to valued mental health treatments and social services.

Genres: Psychology, Nonfiction, History, Psychiatry, Mental Illness, Audiobook, Psychoanalysis

232 pages, Hardcover

Published August 17, 2021

Reviews

[Audrey Farley · Rating 3 out of 5]

Useful history here, but disappointing that the author made no attempt to think about how racism has shaped the DSM. I was expecting some discussion of, say, the recoding of schizophrenia as a black disease during civil rights movement (see Jonathan Metzl's The Protest Psychosis). I also thought there would be more on how religious interests contributed to the addition of Multiple Personality Disorder (MPD), widely understood as involving spiritual possession. (MPD is discussed, but in the context of feminism and abuse.) Lastly, there's surprisingly little in-chapter discussion of how all these changes played out in the lives of mentally ill. All in all, I'm glad I read the book, but I wasn't blown away.

[Vannessa Anderson · Rating 5 out of 5]

A History of Psychiatry’s Bible was an eye-opener!

According to author Horwitz the DSM is fundamentally a social document that both reflects and shapes the professional economic and cultural forces associated with it. The DSM also determines who receives government benefits, what diagnosis and prescriptions are prescribed and much more.

Statements that rang true to me

…what is called “madness” is more a consequence of civilization than antithesis. Fn 20

…regard psychiatry’s claims about the scientific basis of the DSM as inflated at best and self-serving and hypocritical at worse … mental disorders cannot be describe in the same ways as physical diseases. …

…psychiatry is more likely to use DSM diagnoses for social control than for scientific purposes. …

… the DSM increasingly applies medical labels to normal emotions, exposing more people to the negative consequences that often follow from psychiatric diagnoses, such as stigma and the harmful side effects of drug regiments…

… Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and behavior addictions’ will soon be mislabeled as psychiatrically sick and given inappropriate treatment. Fn 21

A History of Psychiatry’s Bible is an easy to read exploration into how the DSM started, how it works, how it harms and everything in between and beyond!

A History of Psychiatry’s Bible is well written and author Horwitz appeared not afraid to approach the subject from various viewpoints.

To me, the DSM should not be used to come to a conclusion but to be use as a starting point to trigger the mind to explore as many options as possible before making a firm diagnoses.

Author Horwitz did a great job in writing a book most can easily understand.

Author Horwitz stayed away from useless jargon that would trick or bore or confuse or misdirect readers.

Would I recommend A History of Psychiatry’s Bible? Absolutely! Whether you as the reader agree or not agree with the information contained therein you will, most certainly, learn about the good, the bad, and the ugly concerning the DSM.

[David · Rating 3 out of 5]

Concise overview of the history of the various DSM editions. I've been working in mental health field since shortly after DSM-III was published, so pretty familiar with III/III-R/IV/5 issues. For the most part it's fairly neutral and descriptive (like DSM-III!!!) -- e.g., makes the point that the first big external push on American Psychiatric Assn. re a particular diagnosis was to get the diagnosis OUT (homosexuality; early/mid-1970s), whereas most subsequent (late luteal phase dysphoric disorder is an exception) activism has been around adding or maintaining diagnoses (PTSD, autism spectrum disorder, gender identity disorder) or making their criteria more inclusive.

But then in a few cases he has a definite stance and pushes it hard, maybe a bit repetitively. For example, he clearly thinks melancholic depression (with dexamethasone suppression test as marker) is a valid entity that should not have been collapsed into major depressive disorder, which he sees as an overinclusive hodge-podge.

Could stand to go into more depth on such issues, which would raise the prior question of what validates a disorder, and then subsequently a criteria set, and separately a measure or measures for determining whether someone meets the criteria, but he mainly bypasses those concerns to go back to more documentation of the thesis that the alleged influences on DSM revisions (advances in research; improved ease of use in clinical practice; alignment with ICD) are almost completely nonoverlapping with the real influences (self-interest of well-connected psychiatry researchers; profit-seeking drug companies; disability accommodations desired by patients or their parents; insurance reimbursement qualification incentives for practitioners and patients).

If you already are aware of the extensive, overwhelming evidence consistent with this somewhat cynical take, then you won't find his account novel, but it is good to pull together the story in one place. There are other sources (e.g., Kutchins and Kirk book on the selling of DSM-III gave a more detailed takedown than this book does of the claims of triumphant improvement in interrater reliability starting with that edition) for learning about a specific edition or a specific issue.

Possibly the NIMH abandoning DSM in favor of RDoC will accelerate progress. As this author briefly acknowledges, it just doesn't seem possible to solve simultaneously for all the purposes to which DSM has been put. If you want standardized criteria for research that only change when some definitive new evidence emerges, then you're going to make different decisions than you will if you want to codify whose treatment should be covered by insurance, or raise awareness of a societal problem, or track changes in prevalence of disorders over time, or........

[Finn · Rating 3 out of 5]

DNF but because Audible snatched it back, not because I wanted to drop it.

Interesting history! Just not captivating enough to spend a credit on.

[Sebastian 14 1 9 18 · Rating 3 out of 5]

Definitely a history of the DSM from an anti-psychiatry perspective, but absolutely useful and a worthwhile project. There’s definitely a problematic Foucault style to his historical work - changes are explained in terms of interest groups (big pharma, feminists, patients trying to keep access to resources) and ideologies (medically oriented psychiatrists, empirically minded psychologists, ideological psychoanalysts, etc) rather than exploring any of the “on the ground” phenomena. The clinic and research practice are touched on but rarely explored.

He doesn’t really mention the progress made in each DSM, but he does a good job at deconstructing the many issues with each edition. He could do more to discuss the empirical issues of different diagnoses, and how research diagnoses differs from clinical.

He also basically completely brackets what “the biology” is when it comes up, it’s more used as a description of an ideological trend than of any evidence one way or the other. Feels very humanities coded in that it refuses to see research as anything other than a form of power generation for ideological groupings. It absolutely can, and often is, that, but it isn’t only that.

The discussion on DMDD, the way DSM-3/4 shaped prescription drug practices (SSRIs being used as antidepressants when research has consistently shown significantly higher efficacy as anxiolytics) and a few other moments were very good.

Overall I’d recommend only if you’re willing to read more to fill in the ideological gaps he leaves in the story.

[Mike Zickar · Rating 4 out of 5]

This was a concise review of the history of the DSM, a fascinating history that is of course much more about society's relationship with mental illness than just about the most important diagnostic tool.

The author covers lots of material though often not in as much depth as I would have expected. For example, he covers the removal of homosexuality from the DSM, a pivotal moment in LGBTQ history, but there was so much more rich detail about that event that he could have included.

He did cover a lot of ground in this book.

[Rae Simpson · Rating 3 out of 5]

Minuteman. Fairly scholarly. DSM thru DSM V, critical of the arbitrary processes and forces in pharmaceutical industry etc that shaped them. Would buy but too expensive. Scanned preface and first chapter.

[Julie · Rating 3 out of 5]

A good reference book.

[Rebecca Ubhi · Rating 3 out of 5]

3.5/5

"Most people have some degree of mental illness at some time, and many of them have a degree of mental illness most of the time.” - Karl Menninger

I am pretty familiar with the DSM because I studied psychology in university, so it was interesting to read about this take on the history and development of the manual rather than focussing on the specific criteria for the conditions.

[elle · Rating 4 out of 5]

This definitely eroded the confidence I had in Psychiatry... It was a bit dense, but I do think that it's worth a read nonetheless. Who knew that our whole system of mental health is basically built on speculation and profits!

[James Hansen · Rating 5 out of 5]

Excellent critical, historical account of the development of the various editions of the DSM.

[Andres · Rating 4 out of 5]

Good history

[Brian Hanson · Rating 3 out of 5]

Dry, limited, but informative.

[Hope · Rating 5 out of 5]

ah the beautiful hot mess of the dsm creation process...i love it

[Ricky Catto]

Interesting to see how Capitalism has screwed us in yet another field.

Sadly, not covered in this "history" is Racism and Misogyny.

[Leonie · Rating 3 out of 5]

I enjoyed this history, but would have enjoyed it more if the author would have been a bit more neutral in his writing. Last chapter was a nice overview.

[Ked Dixon · Rating 5 out of 5]

The last two chapters of this would be good for a DSM class