Fundamental to this psychodynamic perspective is the assumption that some (though probably not all) forms of mental illness can be attributed not to physiological dysfunctions, but rather to early life experienced. Inspired, in particular, by the work of Adolf Meyer, the psychiatric and psychological community in the United States was turning toward what today is often identified as a biopsychosocial model of mental illness (Satterfield, 2013). While there was an emphasis in DSM-I on organic and psychotic disorders, the world of mental illness that was not physically based had entered the picture.
This more comprehensive model, in turn, meant that some mental illnesses could be treated with something other than medications and physical interventions. A broad categorization of mental illnesses was required. Thus, of great importance, was the division in DSM of mental illness into three categories that were associated closely with the psychoanalytic perspective. These three categories were (1) neurosis, (2) psychosis and (3) character disorder. The foundation for this tripartite categorization was firmly established for it was used not only in DSM-I but also Medical 203. Underlying this fundamental categorization are a set of assumptions about the appropriate treatment (or nontreatment) modalities associated with category—and these assumptions are directly related to the state of psychoanalytic practices at the time.
It was during the 1950s and 1960s that an assumption was often made that anything categorized as psychosis would require formal medical intervention and often institutionalization. It is inside a mental hospital that a heavy medical regiment can be implemented, often complemented with other physical interventions, such as electro-shock and even surgery (lobotomies). By contrast, a mental illness that was categorized as neurosis could be treated through use of “talking cures” (psychotherapy) and institutionalization was rarely required (usually only with the threat of self-harm).
Only a few psychoanalytically oriented therapists, such as Harry Stack Sullivan, would dare suggest that a talking cure could be used to successfully cure a psychosis (such as schizophrenia) (Sullivan, 1974). Thus, the diagnosis of someone seeking assistance with their emotional or mental disturbance make a big difference regarding not only the treatment method being engaged, but also the residency of the person being treated. Diagnosis suddenly became very important – and a valid and consistent diagnostic tool such as DSM had to be invented and fortified given the critical nature of this point of decision.
