1980

American Psychiatric Association publishes DSM-III, developed by Robert Spitzer (influenced by Columbia colleagues, especially Donald Klein) and with a third of the task force’s members trained at Washington University. Central principle of DSM-III was reliability, arrived at through a “Chinese menu” approach: “it was an innovation to define disorders entirely on the basis of clinical symptoms and their course, rather than on the basis of any theory. (This is more or less what Kraepelin had in mind.) . . . Ironically, the DSM solution to diagnostic unreliability created a new problem. We don’t know if its categories are real, and reliability has trumped validity. To be fair, DSM was never meant to describe diseases in the same way as internal medicine or surgery might, but only to provide a common language for the discipline” (Paris, 86-88; Kirk & Kutchins, 1-12). “DSM-III and ‘the new psychiatry’ that it reflected were important features in the effort made by a new generation of psychiatrists to gain control over the infrastructure of the psychiatric profession and to reverse the diffusion of power to other professions in the mental health enterprise” (Kirk & Kutchins, 7-8). DSM-III included as new entities “social phobia” (which provided a rationale for use of the MAOI phenelzine), which blossomed into “avoidant personality disorder” and Donald Klein’s “panic disorder” (which helped Upjohn find a market for its novel benzodiazepine, alprazolam) (Healy, 187-199). It also introduced PTSD.