What to Say to the Man Behind the DSM?

John McManamy Health Guide
  • I looked at the name on the name tag and concealed a gasp of surprise.

    Had I known I would be sitting at dinner next to the man who put the final nail in Freud’s coffin, I would have prepared for the meeting the way a law grad crams for the bar exam. But I’m not sure it would have done me much good.

    They say it takes a good five years to become competent at one’s profession and another five to master it. I had paid my dues as a financial journalist, but I was only just finishing my third year as an apprentice editor-publisher of a depression and bipolar newsletter and website when none other than Robert Spitzer, MD, pulled up a chair next to me.
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    Dr. Spitzer is the man responsible for the modern DSM, viewed worldwide as the diagnostic bible. In my two previous blogs, "Robert Spitzer and the DSM" and "DSM: A Common Language for Understanding Mental Illness," I reported how he led psychiatry kicking and screaming into the modern era. Those must have been exciting times back when Jimmy Carter was President, when the new kids on the block came to challenge the authority of Freud.

    The DSM-III of 1980 turned out to be the Manhattan Project of modern psychiatry. In the process, manic-depression got a make-over and the new name, bipolar disorder. Conceivably, Spitzer’s team could have split the atom into more pieces and come up with the name tripolar and even quadripolar. Or they could have fused the illness with clinical depression or even schizophrenia.

    That’s how fluid things were back then. But did Dr. Spitzer’s pioneering spirit live on, or had the DSM become static? The DSM was never meant to be cast in stone, one of Dr. Spitzer’s former acolytes told me a couple of years earlier. It was meant to be constantly updated to reflect changes in current psychiatric thinking. But that hadn’t really happened.

    I was still new at the game. My critical faculties were a long way from being honed, and there were appalling gaps in my knowledge. Out of deference, I waited for the psychiatrists at the table to open the conversation. I would just be a fly on the wall. But no one spoke. This was the ultimate irony. The learned men and women at my table had all the expert knowledge, but apparently lacked basic people skills (a double irony). As a journalist, I could start a conversation and keep it going, but I really did not know what I was talking about.

    Dr. Spitzer introduced himself and explained who he was, then – silence. Just the clinking of glasses and the rattling of plates. It was up to me to set the conversational table.

    “So, Dr. Spitzer,” I asked, “Do you think the Red Sox will ever win a World Series?”

    Just kidding.

    To be continued …
Published On: January 31, 2006