At best, DSM is considered necessary for educational and insurance purposes, but it holds limited clinical utility. At worst, DSM is the product of a non-transparent and conflicted process. The Revision schedule is unpredictable. Furthermore, DSM establishes mental health diagnostic categorization and treatment options, that are United States centered, and not fully aligned with ICD (the International Statistical Classification of Diseases and Related Health Problems).
A Brief History and Critique of DSM
We offer a bit of historical background, as we have done throughout this series of essays on psychopathy. History tends to reveal something about the assumptive world that arises from specific events and social/political forces operating when and where emotional and mental disturbances are being identified, described, and treated.
Early 20th Century: The Pre-DSM Years
We can start by looking at the state of affairs operating in North America during the first years of the 20th Century. First, there were very few psychiatrists and virtually no psychologists or social workers focused on the treatment of those people with emotional or mental dysfunctions. The services that were provided tended to be offered in psychiatric hospitals. Only the most severely disabled men and women were sent to and confined in these facilities. The marginally “crazy” folks were tolerated in the community as “social deviants” (see our essay on the third assumptive world: Bergquist, 2019) and many were quite poor and homeless. Given the strong stigma associated with being “crazy”, those “afflicted” men and women who did have home (coming from lower, middle or upper social-economic classes) were often were isolated and protected by their families—as has been the case in most other countries (often up to the end of the 20th Century).
