Psychiatry’s influential Diagnostic and Statistical Manual of Mental Disorders is based on the consensus of opinions of a small number of American Psychiatric Association psychiatrists, rather than science.
The ‘neo-Kraepelin revolution’ of unproven theories
The theory has not resulted in psychiatry finding one actual biological cause of a mental illness or any cure for a mental illness. It is simply the opinion of a sociopath.
The origin of psychiatry in the 19th century is heavily influenced by Emil Kraepelin – ‘the father of modern psychiatry’. Kraepelin had an entirely perverse view of his fellow human beings and as a eugenicist, racist, antisemite and psychiatrist held considerable responsibility for the horrors of the NAZI’s ‘racial hygiene’ policies. Even using psychiatry’s own classification system, would give him a label of ‘anti-social personality disorder’ – a sociopath.
Yet, it is then all the more astonishing why his classification system became the basis of the DSM edition III, with it being described as the ‘neo-Kraepelin revolution in psychiatry’.
Yes, Kraepelin did put forth the first ‘classification system’ of mental illness in psychiatry and defined what became to be schizophrenia. He was the originator of the ‘biological theory’ of psychiatry; that all mental illness was due to biological causes and which all DSM editions from III forward are based around.
The only problem is that there is no evidence at all that this theory is correct. The theory has not resulted in psychiatry finding one actual biological cause of a mental illness or any cure for a mental illness. It is simply the opinion of a sociopath.
The ‘need’ for the DSM
None of the DSM editions have lifted psychiatry from its rabble of opinions to a science.
In the first half of the 20th century, there were two major schools of psychiatric thought. The German school of Kraepelin’s biological psychiatry and Freud and co’s psychoanalysis which held favour in the United States. Again it should be stressed that the theories of neither school could actually cure anyone of any mental illness and yet making a diagnosis of mental illness or even what was or wasn’t a mental illness was muddied and depended on the opinions of who you were talking to.
To solve this in a failed attempt to bring some credibility to the subject, the American Psychiatric Association produced the first DSM in 1952. 1
The first two editions had a definite psychoanalytic influence which was then wiped out from DSM III forward – the ‘neo-Kraepelin revolution in psychiatry’ again – based on nothing more than the opinions of the authors. 2
None of the DSM editions have lifted psychiatry from its rabble of opinions to a science.
Science by ‘popular vote’
“I think the majority of us recognised that the amount of good, solid science upon which we were making our decisions was pretty modest.“
Theodore Millon. DSM III Task Force
Psychiatric was facing another credibility problem in the late 1960s and 1970s. Papers were being published that found psychiatrists were misdiagnosing patients between 32% and 42% of the time – opening up psychiatry to a charge of wrongly medicalising life problems and condemning people to often appallingly damaging treatments.
“Research by Rosenhan (1973), Cooper et al. (1972) and Gurland et al. (1972) had exposed the problem of poor diagnostic reliability–namely that two psychiatrists would assign different diagnoses to the same patient between 32% and 42% of the time (Carlat 2010) – giving impetus to arguments that psychiatric diagnosis was wrongly medicalizing many problems of living.” 3
This and a few other factors prompted the American Psychiatric Association to urgently handle the situation through a review beginning in 1974 and finally the publication of the DSM III
Despite statements from the American Psychiatric Association that the DSM is based on empirical evidence, this simply isn’t true. The DSM III is the basis for the later two editions (the neo-Kraepelin revolution in psychiatry) and there is ample evidence that they are based on consensus – a popular vote – and only the opinions of the DSM Task Force members and others.
Quotes from interviews with DSM Task Force members by James Davies in his paper How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), 2016 give further insights: 4
“[As] psychiatry is unable to depend on biological markers to justify including disorders in the DSM, we looked for other things – behavioural, psychological – we had other procedures….Our general principle was that if a large enough number of clinicians felt that a diagnostic concept was important in their work then we were likely to add it as a new category. That was essentially it. It became a question of how much consensus there was to recognise and include a particular disorder. (Interview with author 2012)” Robert Spitzer, DSM III Task Force Chair.
“I don’t have specific recollections, some things were discussed over a number of different meetings, [which would sometimes be] followed by an exchange of memoranda about it, and then there would simply be a vote… people would raise hands, there weren’t that many people. (Interview with author, 2012)” Henry Pinsker, DSM III Task Force
“There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognised that the amount of good, solid science upon which we were making our decisions was pretty modest. (Angell 2009, 29).” Theodore Millon. DSM III Task Force
“There are very few disorders whose definition was a result of specific research data. For borderline personality disorder there was some research that looked at different ways of defining the disorder. And we chose the definition that seemed to be the most valid. But for the other categories rarely could you say that there was research literature supporting the definition’s validity. (Interview with author, 2012)” Robert Spitzer, DSM III Task Force Chair.
And on DSM IV simply keeping in place the opinions of DSM III (and yet expanding the DSM from 292 to 374 disorders):
“If we were going to either add new diagnosis or eliminate existing ones there had to be substantial scientific evidence to support that decision. And there simply wasn’t. So by following our own conservative rules we couldn’t reduce the system anymore than we could increase it. Now, you could argue that is a questionable approach, but we felt it was important to stabilise the system and not make arbitrary decisions in either direction. (Interview with author, 2012).” Allen Frances, DSM IV Task Force Chair.
Homosexuality and psychiatry
Bowing to activist pressure, in May 1973, the Kraepelin ‘opinion’ was trash binned as it should have been and the APA Board of Trustees VOTED to remove homosexuality from the DSM.
Probably one of the most astonishing examples of opinions being used as the basis of the pretended ‘science’ of psychiatry is its treatment of homosexuality.
The origins of homosexuality and psychiatry go right back to the pre-NAZI days of Germany which were dominated by Emil Kraepelin. In 1896 Kraepelin defined homosexuality as a psychosis. 5 6 7
This Kraepelin opinion of homosexuality as a mental illness persisted for 77 years.
Were any scientific studies reviewed or redone? No. Bowing to activist pressure, in May 1973, the Kraepelin ‘opinion’ was trash binned as it should have been and the APA Board of Trustees VOTED to remove homosexuality from the DSM. 8
Further references:
- Shorter E. The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders. Dialogues Clin Neurosci. 2015.
- Shorter E. The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders. Dialogues Clin Neurosci. 2015.
- James Davies. How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) 2016.
- James Davies. How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) 2016.
- Alan Felthous, Henning Saß. The International Handbook on Psychopathic Disorders and the Law: Diagnosis and Treatment, Volume 1 John Wiley & Sons. 2008.
- Mildenberger F. Kraepelin and the ‘urnings’: male homosexuality in psychiatric discourse. Hist Psychiatry. 2007.
- M M Weber , W Burgmair “Different from the others”. Kraepelin’s assessment of Hirschfeld’s educational film. A contribution to the history of psychiatry of the Weimar Republic. Sudhoffs Arch. 1997.
- JStor Daily. 2021. How LGBTQ+ Activists Got “Homosexuality” out of the DSM