The Diagnostic & Statistical Manual of Mental Disorders version IV (DSM-IV) under review.

Are You mad?

Are You Mad?
Are You Mad?

DSM-IV Under Review


First published in 1952 by the American Psychiatric Association (APA), the Diagnostic & Statistical Manual of Mental Disorders is a particularly insidious publication that stands as the ‘Bible’ of Psychiatry in the Western world. Since the first edition there have been five major revisions and each revision expanded to include an ever increasing number of neatly classified mental disorders along with symptoms and diagnoses. The DSM is widely used by clinicians, researchers, pharmaceutical companies, health insurance firms, and policy makers both in the United States and worldwide.


The second version of the manual, DSM-II, published in 1968, was 134 pages long and listed 182 disorders. Some diseases previously included in earlier editions of the DSM were later removed, most notably homosexuality. Pioneering research into human sexuality in the 1940’s and 1950’s by researchers like Kinsey and others added the weight of empirical data to the development of a politically active gay community in the United States and this placed mounting pressure on the APA to remove homosexuality from the DSM. So, largely as a result of the earlier work of researchers in sexuality coupled with changing social norms and increasing socio-political protests by gay activists, the APA were more or less forced to remove homosexuality as a discrete mental disorder. Although it was dropped from the DSM in the seventh printing of DSM-II in 1974 its diagnosis was replaced with a new category of ‘sexual orientation disturbance’ which is now known as ‘Gender Identity Disorder (GID).’ If the English have rarely been inclined to accept normal human (sexual) behaviour, our more fundamentalist American cousins have been even less so!


DSM-II was followed in 1980 by DSM-III, 494 pages long and listed 265 diagnostic categories. Subsequently, categories were renamed, reorganized, significant changes in criteria were made and a revised version, DSM-III-R, was published in 1987. The last major revision of the manual, the fourth edition (‘DSM-IV’), was published in 1994, although a ‘text revision’ was released by the APA in July 2000.


DSM-IV is currently under review and DSM-V is scheduled for publication in 2012. An early draft of DSM-V, cleverly titled DSM-IV-TR(!), was released for comment in 2009 and  the primary goal of this interim text version was, according to the APA website ‘to maintain the currency of the DSM-IV text’ and in addition ‘some of the diagnostic codes were changed to reflect updates to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) coding system adopted by the U.S. government.’ 


Well isn't that good news? Now there will some parity between the two major classifications of mental diseases used both in the USA and Europe. This should make things much easier for mental health professionals so that those from opposite sides of the pond will, on publication of DSM-V, be singing from the same hymn-book but, it is suspected, the tune will be somewhat different! Scheduled for publication in 2012 what new deep humanitarian insights into human behaviour DSM-V will bring remains to be seen Mmmmm.... ?


Is Hypnosis Dangerous?: Beliefs About Hypnosis and Expectations of Negative Effects
Is Hypnosis Dangerous?: Beliefs About Hypnosis and Expectations of Negative Effects

A detailed study of the available literature and evidence from clinical, experimental and entertainment hypnosis including a comprehensive analysis of hypnosis in popular art and culture.

A detailed study of the available literature and evidence from clinical, experimental and entertainment hypnosis including a comprehensive review and detailed analysis of hypnosis in popular art and culture which, the author suggests, has historically given rise to exaggerated beliefs and many widespread myths and misconceptions about hypnosis that contribute to expectation of negative effects.

This work attempts to answer the questions pertaining to the alleged incidence of negative effects arising from the use of hypnosis in clinical, experimental, therapeutic and entertainment contexts.

It is argued that any such negative effects arising from the application of hypnosis do so not because of any dangers inherent in hypnosis itself or its techniques and applications but are due almost entirely to pre-existing beliefs about hypnosis and expectations of possible negative effects based on widespread misunderstanding about hypnosis as a discrete altered state of consciousness.

The author suggests that in fact hypnosis is not such an altered state but a psycho-social context in which compliance and belief are integral factors.

This argument is presented within the context of the academic dispute between physiological 'state' and social compliance 'non-state' theories.

Poetry in Flesh Songs of Melancholia and Dark Obsessions: An Anthology
Poetry in Flesh Songs of Melancholia and Dark Obsessions: An Anthology

An anthology of selected poetical works now available in digital format for Kindle devices, and on Kindle apps for iPad, iPhone, iPod touch, PC, Mac, Blackberry, Android-based devices, and Windows Phone 7 from AMAZON and from WRITERSOUT.COM


Comments 7 comments

ncmonroe1981 profile image

ncmonroe1981 6 years ago from West Virginia

Do I detect your tongue in your cheek? Since I'm currently finishing up my DSM course, I'm interested in knowing how you feel about the use of DSM diagnosis in patient treatment?

Wytchewoode profile image

Wytchewoode 6 years ago from Bohemia Author

Mmmmm .... well, yes, slightly tongue in cheek with a hint of irony maybe. The DSM may be useful as a guide, and a very rough one at that, much like a tourist guide to a foreign country that lays out some possibilities for the traveller who then chooses their own direction. I'm not convinced DSM is useful in diagnosis; 'psychiatric' disorders do not fall into neat and precise categories and take no account of personality or other psycho-sociological factors in atiology which, to my mind, are far more important than diagnosis. Furthermore, professionals with different backgrounds will diagnose according to their own theoretical framework and frequently will disagree on the 'condition', its aetiology and treatment. My position is clearly in line with the thoughts of RD Laing and others who follow the notion that 'Diagnoses are not diseases' (Mindham et al, 1992) and that perhaps what are termed psychiatric conditions are not in fact 'abnormal' but maybe natural responses to abnormal situations. Put simply (and oversimplyifying a complicated view), it is not the patient who is mad but society which manufactures the madness.

ncmonroe1981 profile image

ncmonroe1981 6 years ago from West Virginia

Thank you for the prompt and thorough answer! It's taken me a while to get back here. I can see your point, and really like what you said about diagnoses not being diseases.

One of the things that has been bothering me about DSM diagnosis is that there seems to be some evidence (in the form of MRI and SPEC scan pictures) of organic (and brain-centered) origins for many of disorders listed (including multiple types of AD/HD, Bipolar I Disorder, Major Depressive Disorder, and Schizophrenia (various types)).

This leads me to believe that A. some of the things in the DSM may have clear etiology, which would also mean that there is a better way to diagnose them, and B. the things that don't fall into that category may be the result of abnormal societal conditions.

lisa brazeau profile image

lisa brazeau 6 years ago from Canada

I work in emergency and have always found it 'uncomfortable' to say the least, that a type of diagnosis depends on the doctor on duty!

Thanks for a great article!

Lita P. profile image

Lita P. 6 years ago from Chicago/ Midwest

Great tongue-in-cheek, informative and subtle article. Lita P.

Lita P. profile image

Lita P. 6 years ago from Chicago/ Midwest

I just wrote my own little Hub about the DSM.


meloncauli profile image

meloncauli 4 years ago from UK

Great hub!

I have seen a DSM and my thoughts were instantly this:

Imagine if you were to put every single physical ailment in a book ( a bible like the DSM), for all doctors to reference for diagnosis. Imagine how thick and almost impossible that would be?

Now consider the DSM and the amount of mental illnesses there are.

Psychiatrists are doctors first who have specialized in psychiatry. Imagine how simple their diagnosing is as compared to a medical general practitioner! I went into the wrong career!

    Sign in or sign up and post using a HubPages Network account.

    0 of 8192 characters used
    Post Comment

    No HTML is allowed in comments, but URLs will be hyperlinked. Comments are not for promoting your articles or other sites.

    Click to Rate This Article