DSM: A History of Psychiatry’s Bible
Allan V. Horwitz
(Johns Hopkins University Press, $43, 215 pages)
Allan V. Horwitz is a sociology professor emeritus at Rutgers known for his numerous books on psychiatry. His latest is DSM: A History of Psychiatry’s Bible, a slim but thorough look at the Diagnostic and Statistical Manual of Mental Disorders and how this handbook for psychiatrists has evolved from a brief pamphlet in 1952 to the modern-day comprehensive compendium of mental disorders. The evolution of the DSM – they are on DSM-5 — is a pretty good recent history of how psychiatry has treated mental disorder, describing the debates that led to the acknowledgement (some might say creation) of new mental illnesses to diagnose. Horwitz often paints the recognition of new disorders in the language of struggle, sometimes political struggles by various interest groups (feminists, homosexual activists, veteran’s groups).
The trend since the 1960s has been to consistently medicalize previously nonmedical conditions.
A notable exception to this has been the evolution of the DSM’s treatment of homosexuality, which Horwitz says led to the demise of DSM I and DSM II, as attitudes in both society and the industry began to pushback against the idea that homosexuality was a form of sexual deviation, a subclass of sociopathic disturbances. In the first two editions of the DSM, homosexuality was a neurosis to be treated, and debate over whether homosexuality was a disorder or an alternative sexual orientation in the early 1970s broke out of the staid conferences of medical specialists into the public consciousness. Homosexual activists did not appreciate the idea that their predilections were a sign of neurosis and no doubt the reconsideration of homosexuality from a mental disorder to an alternative sexual orientation did much to normalize it to the public.
The expansion of disorders, some worry, “pathologizes normal experiences, stigmatizes the recipients of diagnoses, and generations unnecessary and often harmful treatments for people who don’t need them.” Horwitz appears to disagree with those concerns and expects further medicalization of various behaviours in the future and suggests it is progress.