In effort to understand how the mental health system got so out of whack, each Thursday we’ll revisit a moment in mental health history. At least until someone makes it into a period drama.
I couldn’t think of a better place to start than 1952 when the first DSM was published. The DSM is short for Diagnostic Statistical Manual. The book was created so that psychiatrists would have a standard list of specific mental disorders. It’s not exactly a page turner, but before you zone out, read these juicy tidbits from that first DSM, published by the American Psychiatric Association (APA).
- Homosexuality listed as a sociopathic personality disturbance.
- Hysteria was a catch-all diagnosis for women in distress. Symptoms ranged from “outbursts of emotion” to “discontentment.”
- All disorders were listed as “reactions” of the personality.
Let’s remember this was 1952. To set the scene, World War II was over and the Baby Boom was well under way. Americans were moving to the suburbs to watch I Love Lucy on TV (though not yet in color) and the polio vaccine had just been released. Good times all around, unless you were gay or a woman with emotions.
Here’s how it happened:
Number crunchers realized there were a lot of people who had been given the label of “idiocy,” which was the legit term for mental illness, in the 1840 Census. They began to tally and categorize types of disorders found in patients at mental hospitals.
A bunch of white men in the group now known as the APA (because in 1952, the people in power were all white men) decided they needed a book that wasn’t just about statistics, but with descriptions of symptoms for the each mental disorder. The U.S. Army had a lot of intel from treating soldiers during and after WWII, and their manual and a few other guides that had had cropped up became the foundation for the first DSM. Members of the APA discussed what to include in their big book of 106 disorders, which they bizarrely called “reactions.” Unlike physical illnesses, there were no blood tests or other ways to scientifically prove these illnesses, so the psychiatrists had to go off their own experiences from treating patients, and largely, their own opinions.
However flawed the first DSM was, it was still a major step towards legitimizing the new field of psychiatry. More than sixty years later, after four major revisions and many more controversies, it is still the guide that doctors, insurance companies, government agencies, drug companies, and the law uses to determine everyone’s state of mental health.