Comparison of DSM-III, DSM-III-R & DSM-IV

Comparison of the DSM-III, DSM-III-R and DSM-IV Manuals

The issue of psychiatric diagnosis, strictly avoided during the golden years of psychoanalysis in the 1940's and 1950's, rose to prominence in the early 1960's in conjunction with the "neoKraepelinian" school of thought. The neo-Kraepelinians sought to revive interest in the objective-descriptive approach to psychiatry; this approach involved classifying the signs, symptoms, course, and prognosis of mental illnesses through observation of phenomenological events rather than through etiological theories (Denton, 1989; Robins & Helzer, 1986). The American Psychiatric Association published their first Diagnostic and Statistical Manual (DSM-I) in 1952, followed in 1968 by the DSM-II. However, neither document was as heavily influenced by the neo-Kraepelians and other proponents of descriptive psychiatry as the DSM-III (Robins & Helzer, 1986).

The format and content of the DSM-III was considered a radical change in psychiatry's approach to diagnosis. It was also the subject of a great deal of controversy even before publication of the final document. At a conceptual level, one of the most controversial issues concerned a proposed definition of mental disorders that was included in a draft discussion of the DSM-III: The definition, prepared by two members of the DSM-III Task Force, Robert Spitzer and Jean Endicott, contained the statement that "'mental disorders [are] a subset of medical disorders ... with primarily

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ply, Williams and Spitzer (1983) criticized Kaplan for making faulty assumptions about the possible misuse of clinical diagnosis and not providing specific examples of sex-bias. Schacht (1985) presents a thorough review of the political concerns that are posed by the DSM-III, but often ignored by mental health professionals who tend to dichotomize science and politics. Some of the main points made by Schacht include the following: 1) the special communication mode of the DSM-III confers upon professionals the power of linguistic dominance, 2) the assignment of people to a diagnostic category has important impact upon their status, benefits, opportunities, self-image and reputation, 3) DSM-III can be viewed as a mechanism of social control, since it is used to determine insurance reimbursement and disability eligibility, 4) the DSM-III substantiates professionals' roles as "experts" and validates boundaries of professional control. Schacht uses the controversy over mental versus medical disorders and the debate about homosexuality and "dyshoriophilia" disorders to illustrate his contention that science and politics cannot be dichotomized, even in the fields of psychiatry or psychology. Some of these same social control issues

Category: Psychology - C