A similar portrayal was more recently offered in the Television series called House. The protagonist in this series, Gregory House, is a physician who was himself hospitalized for a short period of time. During his residency in the mental institution, House terrorizes everyone—staff and patients. You certainly want to keep someone like McMurphy or House out of your mental hospital. If they were admitted during the 1950 and 1960s, then constraint of their behavior was critical. During the time of Cuckoo’s Nest, heavy medication (often Thorazine), electroshock and eventually lobotomization were often (tragically) used for this constraint and control.
Later DSM
Up to this point, we have been focusing on the foundation of DSM and its initial three-fold categorization system. We turn now briefly to the fortress that was being built around DSM as it became a central player in the American mental health community—and eventually in other mental health communities around the world. First, it is important to note that the fortress was indeed built by the medical community. The psychologists, social workers and other mental health workers had little clout and controlled none of the purse strings. The medical schools were teaching DSM (now in its third iteration). A substantial number of other publications were being prepared to supplement and provide interpretations of DSM. By the time that DSM-III was published, it had become the “Bible” of American mental health.
Let’s take, for example, a short manual published by the American Psychiatric Association (APA), called Diagnosis and Treatment of Anxiety Disorders: A Physician’s Handbook (McGlynn and Metcalf, 1989). First, it is noteworthy that this manual is intended from use by physicians and was edited by two medical doctors with all articles written by physicians. An expansive APA editorial board populated by physicians and an association with the US Food and Drug Administration ensures that everything is credible and aligned with APA’s assumptive world of “mental health”. The world of mental health and DSM is well fortified in this handbook. Published as a spiral-bound guide with thick, lacquered pages, the Anxiety Disorders handbook is meant to be used—rather than put on the shelf. This handbook exemplifies the important role played by interpretative texts as companions to and fortifiers of the “biblical” DSM.
