Vol. 15 No. 1 (2022): Winter of Variants
Mental Health

How psychiatry’s discontents became a sea of disdain, controversy and confusion. A review of DSM A History of Psychiatry’s Bible.

Robert M Kaplan
a:1:{s:5:"en_US";s:28:"University of Western Sydney";}

Published 2022-03-13


  • DSM; Psychiatry; Robert Spitzer; Classification; Allan Horwitz; Psychoanalysis

How to Cite

Kaplan, R. M. (2022). How psychiatry’s discontents became a sea of disdain, controversy and confusion. A review of DSM A History of Psychiatry’s Bible . Sushruta Journal of Health Policy & Opinion, 15(1), 1–10. https://doi.org/10.38192/15.1.2


The issue of DSM-111 (the little blue book) in 1980 changed the face of psychiatry. It was intended to put the discipline on a scientific footing, ensure reliability of diagnoses and provided the basis to elucidate the scientific causes of such disorders.


It has however failed in almost every task set out, with succeeding iterations leading to even more controversy, culminating in DSM-5 in 2013.


DSM has had enormous success in terms of distribution and income for the APA but led to great controversy as evidenced by the growing number of critical articles and books.


This review of Allan Horwitz’s book looks at the background to the controversy and the ongoing crisis for psychiatry.






  1. The name Psychiatry came from Johan Reill in 1807.
  2. De Saussure R. The influence of the concept of monomania on French medico-legal psychiatry (from 1825 to 1840). J Hist Med Allied Sci. 1946 Jul;1:365-97.
  3. Bergsholm P. Is schizophrenia disappearing? The rise and fall of the diagnosis of functional psychoses: an essay. BMC Psychiatry. 2016 Nov 9;16(1):387.
  4. Despite the best efforts of some figures in the UK, like Malcolm Sargant and Eliot Slater.
  5. For a review of these issues, focussing on the Antipodean scene, see: Laffey P. Histories of Psychiatry after Deinstitutionalisation: Australia and New Zealand. Health and History, Vol. 5, No. 2, (2003), pp. 17-36.
  6. Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179:250-8.
  7. Rosenhan DL. On being sane in insane places. Ibid.
  8. But, as Susan Cahalan has now shown, it was one of the greatest scientific frauds of the century; see: Susannah Cahalan. The Great Pretender: The Undercover Mission that Changed Our Understanding of Madness. Canongate, 2020; and https://www.spectator.co.uk/2020/01/how-david-rosenhans-fraudulent-thud-experiment-set-back-psychiatry-for-decades/. Accessed 4 February 2020.
  9. The damage however was done.
  10. Spitzer R L (1975). On pseudoscience in science, logic in remission, and psychiatric diagnosis: A critique of Rosenhan's "On being sane in insane places". Journal of Abnormal Psychology, 84(5), 442–452.
  11. This may explain why Rosenhan never wrote again about the experiment and had to return the royalty payment for a book he was commissioned to write about it.
  12. Alix Spiegel. The Dictionary of Disorder. The New Yorker. Magazine.https://www.newyorker.com/magazine/2005/01/03/the-dictionary-of-disorder. Accessed 30/12/2021. Accessed 2/1/2021.
  13. Amidst the many articles discussing Spitzer’s role in DSM-111, this article by Peter Tyrer is a useful summary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189982/. Accessed 28/12/2021.
  14. See: Frances, A. J. (2012b). “DSM-5 is a guide, not a bible—simply ignore its 10 worst changes.” https://www.psychiatrictimes.com/alcohol-abuse/dsm-5-guide-not-biblesimply-ignore-its-10-worst-changes; and Alan Frances (2013) Saving Normal: An Insider’s Revolt Against Out-of- Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalisation of Ordinary Life. William Morrow.
  15. Horwitz, A. V. (2015). “How did everyone get diagnosed with Major Depressive Disorder?” Perspectives in Biology and Medicine, 58, 105–19.
  16. Blumenthal, S., & Nadelson, C. (1988). Late luteal phase dysphoric disorder (premenstrual syndromes): Clinical implications. Journal of Clinical Psychiatry, 49, 469–74.
  17. For a review of the inanities, if not iniquities, involved in the psychoanalysis of schizophrenics, see Edward Dolnick. Madness on the Couch. Blaming the Victim in the Heyday of Psychoanalysis. Simon &. Schuster, 2007.
  18. It came in different sizes and versions, but the pocket edition was the big seller.
  19. It was decided to change from Greek to Roman numerals.
  20. Hannah Decker. The Making of DSM-III. A Diagnostic Manual's Conquest of American Psychiatry. Oxford University Press, 2013; and, Edward Shorter: What Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today. New York: Routledge, Taylor & Francis Group, 2015; Edward Shorter (2015). What psychiatry left out of the DSM. Historical Mental Disorders Today. Taylor and Francis. Kindle Edition.
  21. Amidst many articles, see Wakefield, J. C. (2001). “The myth of DSM’s invention of new categories of disorder: Houts’s diagnostic discontinuity thesis disconfirmed.” Behavior Research and Therapy, 39, 575–624.
  22. It was thus predicted that there would be massive cases of vicarious PTSD in New York after 9/11 when in fact it turned out to be quite the opposite.
  23. Rosen GM, Spitzer RL, McHugh PR. Problems with the post-traumatic stress disorder diagnosis and its future in DSM V. Br J Psychiatry. 2008 Jan;192(1):3-4; and Spitzer RL, First MB, Wakefield JC. Saving PTSD from itself in DSM-5. J Anxiety Disord. 2007;21(2):233-41.
  24. Quoted in: Allan V Horwitz. PTSD (Johns Hopkins Biographies of Disease) . Johns Hopkins University Press. Kindle Edition. Press. Kindle Edition.
  25. Lane, C. (2006). “How shyness became an illness: A brief history of social phobia.” Common Knowledge, 12, 388–409. Lane, C. (2007).
  26. Robert M. Kaplan. Trumping the shrinks: The risks for psychiatry in diagnosing a public figure. Sydney Morning Herald. 12 January 2018.