Mental Maladies and the History of the DSM

The Diagnostic & Statistical Manual of Mental Disorders

Why is there a need for a diagnosis, anyway?

There isn’t.  Unless you want doctors and researchers to be able to talk to each other and study the illness.  As I see it, there are only two reasons to use diagnoses.  The first is to enable different medical professionals to speak the same language so they can collaborate with you to coordinate your care more systematically and effectively.  The second is for researchers to understand the same definitions in categorizing body-mind disease process for the purpose of studying it, as they work to develop more and more effective treatment protocols.

Just as with medical illnesses, people can feel great relief knowing that there is a name for their psychic suffering.  It’s a terrible experience to be told that “it’s just your imagination.”  Knowing the name of a problem gives you a huge head start in solving it.

DSMA Brief History of the DSM

Between 1840 and 1880, the U.S. Census Bureau identified seven “mental illnesses” for the purpose of collecting population statistics. The illnesses were defined in the vernacular of that time:  mania, melancholia, monomania, paresis (muscular weakness, usually the result of advanced syphilis), dementia, dipsomania (alcoholism), and epilepsy.  The data on these illnesses were presumably used as one input to develop a public health system (which originally evolved out of the “Poor Laws” adopted from Elizabethan England).  Before the 20th century, the mentally ill were treated worse than criminals, but that’s another story—a very long and sordid one—for a different page.

In 1917, several professional medical associations got into the act to develop a “nationally acceptable psychiatric nomenclature” that could be published by the American Medical Association. The purpose of this nomenclature was not as focused on population statistics, but instead more focused on the clinical necessities of doctors and their patients.

Over the years since then, the DSM has been revised and refined based on the increasing shared knowledge of clinicians and researchers.  What started as a list of  seven illnesses is now a heavy tome of almost a thousand pages, detailing over 300 different kinds and categories of mental disorders.  It contains detailed information to help professionals differentiate one problem from another, understand what kinds of interventions might be useful, and what effects one might expect in response.

The DSM is only a tool. May it be used with care, expertise, and for the good.

The DSM is not a bible.  It is merely a reference guide, which can be used when helpful and desired.  It reflects a much-debated agreement of the current knowledge in the field of psychiatry/psychology.  Yet, just as with any other tool, the DSM can be used constructively or destructively.  It can be used to help people, or it can be used by some people to objectify and stigmatize others.  You should be the final judge of its constructive use for you.

This article is based on my opinions, and information provided in the DSM itself (historical background, cautionary statements, uses, and limitations).

Copyright © 2011 by Marilee Snyder