Am J Psychiatry 1997; 154:47-54
Copyright © 1997 by American Psychiatric Association
DSM-III and its reception: a European view
PJ Pichot
Academie Nationale de Medecine, Paris.
The author analyzes some elements in the reception of DSM-III in Europe.
The worldwide success of a diagnostic classification originally presented
as a purely American endeavor is associated with recurrent, albeit not
often openly formulated, criticisms. In the history of psychiatric
nosologies, the purely descriptive phase was succeeded by a period during
which theories were dominant, as in the Kraepelinian system. DSM-III
originated in recognition of the existence in the United States of
contending psychodynamic and psychosocial orientations and problems of
communication, which became even more evident with the growth of
psychopharmacology and the influence of the biological school. Whereas ICD
offered compromise solutions, DSM-III used a new paradigm based on
diagnostic categories and a multiaxial format, which were on the whole
easily accepted. Most criticisms involved three points. The first was the
atheoretical syndromic approach, seen as a regression and an expression of
an American preference for superficial facts and contempt for
psychopathology, which was considered in Europe the source of future
progress. The second was the introduction of quantification, which was
rejected by some in the name of the clinical tradition, which emphasized
understanding of the individual case. The third was DSM-III's adherence to
alleged American values, such as pragmatism and novelty. The ambivalence of
Europeans toward the world expansion of American culture was reinforced by
use of English as the language of international scientific communication.
The mostly irrational nature of the criticisms contrasts sharply with the
general acceptance of DSM-III and its successors, which rests on their
objective merits.
