James Davies

So the DSM was developed to try to identify and standardise the symptoms characteristic of any given mental illness – anxiety disorder, phobia, mood disorder and so on.’ Every psychiatrist was then expected to learn this list so that different psychiatrists in different places would all be working from the same page.

Once the first DSM arrived in the 1950s, psychiatrists were expected to use the dictionary in the same standardised way still in operation today

course, sometimes your symptoms will not fall neatly into any single category, but rather span two or three. In this case your problem will be considered ‘comorbid’ – namely, that you are suffering from a disorder that is occurring simultaneously with another (perhaps you suffer from major depression as well as panic disorder).

How does your psychiatrist know if he or she has assigned the correct diagnosis? Is there a safe and reliable way that he or she can test, objectively speaking, whether the diagnosis given is the right one?

Pardes: ‘Well, one way to test whether the diagnosis is correct is to apply a scientific or biological test [such as a blood, urine or saliva test] or some other form of physical examination to assess, firstly, whether a patient has a mental disorder, and, if so, precisely what disorder they suffer from. But the crucial problem for psychiatry is that we still have no such objective biological tests.’

because psychiatry has yet to identify any clear biological causes for most of the disorders in the DSM

the only method available to psychiatrists is what we could call the ‘matching method’: match the symptoms the patient reports to the relevant diagnosis in the book.

These facts, although at first glance appearing innocuous, are crucial for understanding why psychiatry, in the 1970s, fell into serious crisis. They help us explain why psychiatrists were not only guilty of branding sane people as insane (as the Rosenhan experiment revealed), but also guilty of regularly failing to agree on what diagnosis to assign a given patient (as the ‘diagnostic reliability’ experiments showed). Psychiatry was making these errors because it possessed no objective way of testing whether a person was mentally disordered, and if so, precisely what disorder they were suffering from.

And so without any objective way of testing the validity of a diagnosis, psychiatry was in peril of falling far behind the diagnostic achievements of other branches of medicine.
A solution was needed, and fast.

The bold idea was to write an entirely new manual that would solve all the problems beleaguering DSM-II. This new manual would be called DSM-III, and its central aim would be to improve the reliability of psychiatric diagnosis and thereby answer the mounting criticisms that were threatening to shatter the profession’s legitimacy.