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Am J Psychiatry 1993; 150:399-410
Copyright © 1993 by American Psychiatric Association
DSM-III and the transformation of American psychiatry: a history
M Wilson
Robert Wood Johnson Clinical Scholars Program, Stanford University School of Medicine, Calif.
The author traces the history of the development of DSM-III within the
larger context--intellectual, economic, scientific, and ideological--of the
development of American psychiatry since World War II. Data were obtained
through a literature review, investigation of archival material from the
DSM-III task force and APA, and interviews with key participants. This
research indicates that from the end of World War II until the mid-1970s, a
broadly conceived biopsychosocial model, informed by psychoanalysis,
sociological thinking, and biological knowledge, was the organizing model
for American psychiatry. However, the biopsychosocial model did not clearly
demarcate the mentally well from the mentally ill, and this failure led to
a crisis in the legitimacy of psychiatry by the 1970s. The publication of
DSM-III in 1980 represented an answer to this crisis, as the essential
focus of psychiatric knowledge shifted from the clinically-based
biopsychosocial model to a research-based medical model. The author
concludes that while DSM-III, and the return to descriptive psychiatry
which it inaugurated, has had positive consequences for the profession, at
the same time it represents a significant narrowing of psychiatry's
clinical gaze.
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