Many years ago, I was introduced to the DSM (Diagnostic and Statistical Manual of Mental Disorders) as a young medical librarian. Little did I know that this Bible of the psychiatric profession was of relatively recent vintage and the virtual creation of Robert Spitzer. "The Dictionary of Disorder" by Aliz Spiegel (The New Yorker, January 3, 2005) provides an interesting glimpse into the history of Spitzer's creation.
In 1949, Philip Ash, a psychologist published a study showing that "three psychiatrists faced with a single patient, and given identical information at the same moment, were able to reach the same diagnostic conclusion only twenty percent of the time." Another study in 1962 found similar results. Needless to say, there were many in the profession who were dismayed by these results.
Spizer had, in his childhood, undergone Reichian psychoanalysis until he became suspicious of its validity. (Reich, a student of Freud, had marketed the "orgone accumulator," a mechanism the size of a telephone booth that he claimed could enhance sexual prowess and cure cancer.) He fell into the job of editing the DSM almost by accident, but this proved a fortuitous event, for Spitzer was a genius at summarizing and digesting research and synthesizing a mass of information into digestible portions.
In any event, the DSM is now absolutely required by insurance companies and has brought some rational thinking to what had been confused non-science. Ironically, recent studies have shown that it has not brought about the changes in reliability that had been hoped for, and that "there are lots of studies which show that clinicians diagnose most of their patients with one particular disorder and really don't systematically assess for other disorders." Some critics have complained that that "it often characterizes everyday behaviors as abnormal, and that it continues to lack validity, whether or not the issue of reliability has been definately resolved."