The first section of the book is devoted to diagnosis and DSM-III-R provides the guidance. While this book is touted as a “new approach to anxious patients”, it doesn’t veer far from DSM and, to the credit of DSM, encourages a “comprehensive” diagnosis: “The DSM-II-R system of diagnosing anxiety and other mental disorders encourages the clinician to make a comprehensive diagnosis, using five axes to identify essential elements of the patient’s clinical profile.” (McGlynn and Metcalf, 1989, p. 21)
While the initial three categories in DSM-I has now expanded to five, there is still a focus on the symptoms manifest by the individual person and little is done regarding the pathology of the patient’s environment. What might induce and sustain the anxiety? This is a critical question that is not really addressed by these individual patient-oriented physicians.
By the 1970s, the National Institution of Mental Health in the USA was using DSM in its epistemological studies, while the Federal Drug Administration was using DSM as the major guideline for the use of specific drugs. Other federal dollars in the United States, being distributed to non-Washington based research firms, were closely tied in with DSM categorizations. With this increasing use of DSM as a research tool, there were now (in DSM-III) research criteria added to the growing volume of the DSM manual. Greater specificity was also to be found in DSM-III, resulting in a greater sense that this manual was credible and appropriate for use by these major government agencies in making important decisions regarding mental health in the United States.
While there were some folks outside the mental health establishment who were throwing stones at the mighty fortress protecting DSM, most of these stones just bounced harmlessly off the walls. The one set of stones that did seem to impact the fortress were thrown by those who were working with the soldiers returning from yet another war (Korea). The revisions of DSM-II were reflecting some of the concerns about the diagnosis of post-war trauma. The less influential dissenters included feminists who protested gender biases in DSM and those who declared that homosexuality was not a mental disease.
