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Since the inception of DSMTII in 1980 (The Diagnostic and Statistical Manual of Mental Disorders III), most psychoanalysts have disliked the DSM. In fact, when the DSM-III first appeared, the manual was commonly perceived as an assault on the hegemony of psychoanalysis and an indication that psychiatry was abandoning its psychodynamic orientation (Shorter 1997). Nevertheless, the DSMTII nomenclature for mental disorders prevailed and continues to be the almighty gateway, at least in the USA, into third party payments for those clinicians who qualify.
The overall philosophy of the DSM is of a descriptive and criteria-driven system in which most causes for a particular disorder are assumed unknown unless a known medical condition can be established. For the last 25 years clinicians of all persuasions have had to live with this system. In important respects, however, it is a system of identifying and reporting problems of mental health that refuses to define what mental health is.
Psychoanalysts have not been alone in voicing displeasure with the situation. Family therapists have been especially troubled by the fact that the manual, presently in use as DSMTV , only recognizes what can be observed in an individual patient, not