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Classifications have power, but how does power make classification?
Decker has written a great book in the history of medicine; accessible, deeply researched, appropriately contextualized, and full of vital details. The DSM-III is the 'Bible of mental illnesses', a standardized descriptive approach that since its publication in 1980 has redefined how we understand and treat mental illnesses. Decker uses Kuhn's paradigm shift to explain psychiatry as a field in crisis in the 1960s and 1970s. Though psychodynamic and Freudian approaches had been dominant for decades, they were unable to answer the challenges of the antipsychiatry movement; that psychiatrists were unable to distinguish between insanity and sanity, unable to cure the insane, were not scientifically grounded, and were simply a reificiation of various forms of unjust power. In this charged atmosphere, Robert Spitzer, an energetic and iconoclastic psychiatric, lead a neo-Kraepelian revolution through the creation of a new DSM.
Roughly half the book describes the history and major players, the other half being a nearly day-by-day account of the campaign that Spitzer used to get his version of the DSM published. He was willing to compromise on many fronts (the specific language of disorders, particularly female specific problems like PMS and hysteria), even on the key issue of whether psychiatric disorders were a strict subset of medical disorders. However, on the core issue of including neurosis as an explanatory theory for mental illnesses, Spitzer was unable to reach an accord with the psychodynamic mainstream, primarily due to their disorganization in the face of his focus, and their tardy engagement with the new DSM. Ultimately, psychodynamic approaches were excluded from the manual, and fell by the wayside.
Psychiatric diagnosis is more contingent and less scientific than those who treat it and suffer from it would like. In this book, Decker has done a masterful job of exploring how we move, not towards a perfect understanding of mental illness, but for what was the time a radically new and optimistic approach.
Decker has written a great book in the history of medicine; accessible, deeply researched, appropriately contextualized, and full of vital details. The DSM-III is the 'Bible of mental illnesses', a standardized descriptive approach that since its publication in 1980 has redefined how we understand and treat mental illnesses. Decker uses Kuhn's paradigm shift to explain psychiatry as a field in crisis in the 1960s and 1970s. Though psychodynamic and Freudian approaches had been dominant for decades, they were unable to answer the challenges of the antipsychiatry movement; that psychiatrists were unable to distinguish between insanity and sanity, unable to cure the insane, were not scientifically grounded, and were simply a reificiation of various forms of unjust power. In this charged atmosphere, Robert Spitzer, an energetic and iconoclastic psychiatric, lead a neo-Kraepelian revolution through the creation of a new DSM.
Roughly half the book describes the history and major players, the other half being a nearly day-by-day account of the campaign that Spitzer used to get his version of the DSM published. He was willing to compromise on many fronts (the specific language of disorders, particularly female specific problems like PMS and hysteria), even on the key issue of whether psychiatric disorders were a strict subset of medical disorders. However, on the core issue of including neurosis as an explanatory theory for mental illnesses, Spitzer was unable to reach an accord with the psychodynamic mainstream, primarily due to their disorganization in the face of his focus, and their tardy engagement with the new DSM. Ultimately, psychodynamic approaches were excluded from the manual, and fell by the wayside.
Psychiatric diagnosis is more contingent and less scientific than those who treat it and suffer from it would like. In this book, Decker has done a masterful job of exploring how we move, not towards a perfect understanding of mental illness, but for what was the time a radically new and optimistic approach.