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The Diagnostic and Statistical Manual of the American Psychiatric Association has been both a blessing and a curse. It was produced originally to serve as an instrument to aid researchers in trying to understand the panoply of emotional disorders that confront psychiatrists in their everyday work with patients. This was a laudable endeavor. Like so many such endeavors, however, it has evolved in directions that were hardly anticipated at the outset. For one thing, it has grown enormously, both in size and influence.
DSM-I, which was prepared by the APA's Committee on Nomenclature and Statistics and presented to the public in 1952 as a variant of the sixth edition of the World Health Organization's International Classification of Diseases (the first one that contained a section on Mental Disorders),1 was inexpensive and a modest 132 pages in length. DSM-II, published in 1968, was equally inexpensive, only two pages longer, and very little different in content—at least on the surface. The main difference was that the word reaction was removed. To quote from the introduction to DSM-IV: “The use of the word reaction throughout DSM-I reflected the influence of Adolph Meyer's psychobiological view that mental disorders represented reactions of the personality to psychological, social, and biological factors” (p. xvii). This seemingly minor change was actually far from minor, as it signaled the beginning of a major shift in outlook within American psychiatry.
Work on DSM-III began in 1974 under the chairmanship of Robert L. Spitzer, and it appeared in print in 1980. It contained considerable