Diagnosis in American Psychiatry: A Brief History of the Diagnostic and Statistical Manual

Abstract

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, a nosology in its ontological status, continues to exert authority in the diagnosis and even conceptualization of mental disorders. This chapter recounts the evolution of American psychiatric nosology within a broader picture of scientific ideologies, sociopolitical environments, and cultural contexts. Specifically, we highlight the rationale, briefly describe the developmental process, and analyze the impact of each revision of the DSM on psychiatric research and practice. We touch upon controversies that led to, and arose from, successive editions of the DSM, and posit that many prevailing issues are rooted in the vagaries of conceptualization of what constitutes a mental disorder, and consider the possibility that revising or replacing the DSM classification system with the Research Domain Criteria (RDoC) may prove to be of demonstrable benefit for both psychiatric research and practice.