Diagnostic Psychiatry

Abstract

Psychiatry faced a major predicament as it entered the 1970s: it lacked the disease conditions that would provide the field with medical legitimacy. The publication of the DSM-III by the American Psychiatric Association in 1980 marked a thoroughgoing change in thinking about mental illness. In one stroke, psychiatry discarded one intellectual paradigm that had little concern with diagnosis and adopted an entirely new system of classification that imported a model from medicine where diagnosis is “the keystone of medical practice and clinical research.” The promulgators of the DSM-III overthrew the broad, vague, and often etiologically oriented concepts that were embodied in the DSM-I and DSM-II, reclaiming the diagnostic tradition that dominated 19th-century psychiatry. The fundamental principle of the new manual was to define distinct mental disorders through using observable clusters of symptoms without reference to their causes. The DSM-III created a powerful standardized system of diagnoses that reigned virtually unchallenged for the following three decades. It allowed psychiatry to reorganize itself from a discipline where diagnosis played a marginal role to one where it was the basis of the specialty. The DSM-III revolutionized conceptions of mental disorder through transforming conditions that had been thought to be distinctively psychosocial into ones that were disease-like states.