Robert Spitzer and the DSM

John McManamy Health Guide
  • Psychiatrists appreciate a free meal as much as I do, which may explain why dinner symposia sponsored by various pharmaceutical companies are the most popular events at psychiatric conferences. The tables near the front tend to fill up fast, which is where I need to be in order to better take notes and follow the PowerPoint presentations. I cannot recall what the topic was at this particular symposium three years ago at the American Psychiatric Association annual meeting in San Francisco, nor who the speakers were, but I can never forget who grabbed the empty seat next to me. “Robert Spitzer,” read his name tag.
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    Forget Sigmund Freud! Robert Spitzer is arguably the most influential psychiatrist of the 20th century, and is bound to remain so for the first decades of the new millennium. It was Robert Spitzer who banged the final nail into Freud’s coffin back in 1980, and led psychiatry into the modern era.

    Now the history lesson: The pioneering German clinician Emil Kraepelin believed mental illness stemmed from biological causes. But Kraepelin, who lived in a steam-driven age, knew the brain was not about to reveal its secrets to the technology of the day. Instead, he took a systematic inventory of the symptoms of patients, discovered certain patterns, and classified these into an elegant diagnostic system. It was Kraepelin who coined the term “manic-depression.” His investigations spanned several decades, and culminated in major publications in the 1920s (he died in 1926).

    Unfortunately, this was right around the time when psychiatry was being hijacked by Freud and his followers, and Kraepelin was quickly forgotten. All but the most serious cases of mental illness were attributed to neurosis. Psychiatry had no system for distinguishing anxiety from depression, from bipolar disorder, from schizophrenia, from various personality disorders.

    By the 1970s, reform was in the air. The American Psychiatric Association had already published two versions of the Diagnostic and Statistical Manual (DSM) for classifying mental illness, but these were timid attempts that conceded far too much to Freud. Freudians and non-Freudians alike ignored the early DSMs.

    Consequently, when Robert Spitzer drew the assignment of overseeing the DSM-III, no one in psychiatry had high expectations. The influence of Freud was receding, but Kraepelin wasn’t exactly banging down the ramparts. But then Robert Spitzer would marshal his forces and change history.

    Here he was seated next to me, and I was looking up from my salad trying to think of something to say.

    To be continued …
Published On: January 13, 2006