Here's to Hoping the DSM Will Grow and Flourish

John McManamy Health Guide
  • So why was Robert Spitzer MD, founder of modern psychiatry, so dismissive of me? (See my previous blogs, Robert Spitzer and the DSM, DSM: A Common Language for Understanding Mental Illness, What to Say to the Man Behind the DSM?, The DSM and Gender from a Patient's Perspective, At first, I thought it was because I was a mere patient who had presumed to call into to question the Master’s magnum opus. Later on, I discovered it had nothing to do with me.

    An article in the Jan 3, 2005 New Yorker explains: Those who had worked with him on the ground-breaking DSM-III of 1980 described him as difficult to get along with and lacking in people skills. Then, “emboldened by his success, he became still more adamant about his opinions, and made enemies of a variety of groups.”
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    Dr. Spitzer headed up the task force to revise the DSM-III (the DSM III-R which came out in 1987), but was not invited to lead the effort that resulted in the DSM-IV of 1994. Says Michael Frist MD of Columbia University, who was involved in the DSM III-R and DSM-IV: “A lot of what’s in the DSM represents what Bob thinks is right. He really saw this as his book.”

    Dr. Spitzer and others claimed the DSM III was based on science, but what passed for psychiatric science back in the 1970s was grounded in precious little data. The DSM III represents the best clinical observation of the time, but it is based in large part on opinion and wild stabs in the dark. Nevertheless, clinicians and patients came to accept the DSM as Holy Writ. After all, it looked authoritative.

    Thus, what began as a revolution ended in orthodoxy. The Gospel of Freud was replaced by the Gospel of Spitzer. In no time, the entire health industry worldwide became heavily invested in the DSM, which rendered meaningful revisions next to impossible.

    Back in 2000, Charles Nemeroff MD, PhD of Emory University told a DBSA conference that ninety percent of what we know about the brain we have discovered in the past ten years. I would venture the same observation holds true in the five and a half years since he made that statement.

    Yet the DSM remains wedded to the 1970s. Virtually all the literature for patients is based on a simplistic version of the DSM catechism. This literature does not take into account leading researchers and clinicians who have since identified large groups of patients who do not easily fit into standard DSM classifications. This includes an extremely wide virtual diagnostic Terra Incognita where clinical depression and bipolar disorder overlap.

    At best, the DSM can deliver an approximation of a patient’s clinical reality. For delivering us from the Dark Age of Freud, Dr. Spitzer deserves our eternal gratitude. But getting well and staying well involves looking past Spitzer. Future blogs and articles will examine what we really need to know, based on what the experts are telling us and amplified by our own experiences.

    When I unexpectedly found myself seated next to Dr. Spitzer I was hoping to find in a man who had initiated sweeping changes a visionary still open to change, who would view his life work as a living document that would continue to grow and flourish. But Dr. Spitzer was not that kind of man, and neither was the legendary Wizard of Id he had unseated a quarter century before. Today, Freud is treated with ridicule. Spitzer deserves a better legacy.
Published On: February 06, 2006