The Man Behind Psychiatry's Diagnostic Manual

[scotty]

This is long, but well worth the read. Spitzer is credited with creating the DSM. Folks, this is where all the "diagnoses" came from. Scary stuff!!



The Man Behind Psychiatry's Diagnostic Manual

This is All Things Considered from NPR News
I'm Robert Segal and I'm Melissa Block

Melissa Block: Millions of Americans are diagnosed each year with some
mental disease or another. Post Traumatic Stress Disorder,
Schizophrenia,
Seperation Anxiety. Each of these disorders, and many others are listed
in a
book called the DSM, or Diagnostic and Statistical Manual. It's the
bible
of mental health. Today the DSM is used by a wide variety of
institutions.
Courts use it to help determine guilt or innocence, insurance agencies
require it for reimbursement. Reporter Elise Speigal explains how one
man,
Robert Spitzer, an ambitious young psychiatrist at Columbia University
created the modern DSM .

Elise Spiegal: Robert Spitzer has defined more mental diseases than
any
other person living on the face of the Earth, began his study of human
emotion early.

Robert Spitzer: When I was 10, 11 or 12 I went to summer camp and my
bed
was against the wall and on the wall I made a graph of my feelings
towards 5
or 6 ladies and over time went up and down.

Elise Spiegal: Each day the young camper would carefully plot his
affections for the girls of Camp Robinson Caruso, scratching the
results
into the rough wooden panels besides his pillow.

Robert Spitzer: That's a strange thing for somebody to do but that's
the
kind of person that I guess that ends up doing what I did, in other
words
translating feelings into some kind of a system.

Elise Spiegal: You see, the little boy who graphed his passions onto
cabin
walls grew up to be the man who revolutionized the Diagnostic and
Statistical Manual, the American Psychiatric Association's official
listing
of mental disease. The DSM is a big book filled with long descriptions
of
close to 300 different mental disorders, each precisely defined with a
clear
checklist of all possible symptoms. The DSM is considered the bible of
psychiatry because today it's used by practically every mental health
professional in the country. But in 1974 when Robert Spitzer was
appointed
to direct its revision few in the profession knew about it and even
fewer
cared. At the time it was an obscure administrative handbook with 180
poorly
defined mental disorders. John Talbot is a former president of the
American
Psychiatric Associaton.

John Talbot: Bob Spitzer came into this field that no one was
interested
in, no one was interested in codifying diagnoses it was sort of a thing
that
got shoved onto people, I mean this was Botany for God's sake How do
you
tell the difference between a 3 leafed and 4 leafed flower ?

Elise Spiegal: For psychiatry the question was how to tell the
difference
between manic depression and schizophrenia. For years they'd been
unable to
make these distinctions to reliably identify mental illnesses. Patients
with
severe anxiety were identified as depressives, personality disorders
were
confused with gross stress reaction, there was no consistency. Everyone

agreed that diagnosis was a serious problem, but no one thought that
the DSM
was the answer, and while Spitzer saw an opportunity in the pages of
this
small unimposing paperback he was more or less alone.

Robert Spitzer: Nobody worried very much about what direction it was
gonna
take I guess because nobody expected anything that was going to be very

revolutionary I mean as evidence of that I was able to appoint anybody
that
I wanted not only on the task force but also on these individual
committees.

Elise Spiegal: To begin, Spitzer appointed himself head of all 25
committees charged with defining new mental illnesses. Then he filled
his
committtees with a new breed of psychiatrist.

Robert Spitzer: They were young mavericks, many of them were
mavericks, you
know represented a different kind of psychiatry then was I guess the
mainstream at the time or that had been the mainstream of the time.

Elise Spiegal: At the time, mental health was really dominated by
psychoanalysis, a discipline based on the nineteenth century theories
of
Sigmund Freud. Psychoanalysis is really as much art as science, not a
branch
of medicine at all. Psychoanalysts aren't even required to hold a
medical
license, but the men and women Spitzer appointed to his committee
weren't
interested in nineteenth century theories, they were interested in
twentieth
century science and words like data, and research and empiricism.

Robert Spitzer: The feeling was that the same techniques that were
useful in
medicine, which is you describe something, you do laboratory studies,
that
those same kind of studies were appropriate for psychiatry .

Elise Spiegal: But in 1974 there just wasn't a lot of psychiatric
research,
so the committees process was based less on the certainties of charts
and
graphs then on the expertise of the professionals charged with the DSM

revision. Columbia University professor David Shaffer was one of those

professionals.

David Shaffer : They would squeeze into a room which is about half the
size
of this one it was much too small and Bob would sit there with what was
then
a portable computer one of those enormous big things, and Bob would
raise a
provacative question, and people would shout out their opinions from
all
sides of the room and whoever shouted loudest tended to be heard, my
own
impression is coming straight from England is was more like a
tobacco auction then a sort of conference.

Elise Spiegal: Tobacco auction or not, the process was incredibly
productive. Under Spitzer's direction, the number of mental diseases
included in the DSM increased dramatically. Added were some of
psychiatry's
greatest diagnostic hits like Post Traumatic Stress Disorder. The
committee
also revised existing definitions that were too vague to be useful.
For
example, psychiatrist Donald Klein who worked with Spitzer says that in

early versions of the DSM a wide variety of behaviors were grouped
under the
term anxiety neurosis.

Donald Klein: From somebody being chronically nervous, to somebody
having
panic attacks, to somebody who had to count everything that came past
and
multiplied by three, you know thats all anxiety neurosis.

Elise Spiegal: But under the direction of Klein and Spitzer anxiety
neurosis got a new name or rather several new names.

Donald Klein: Panic Disorder, Agoraphobia, Social Phobia, Generalized
Anxiety Disorder, and these were all distinctions within what was
formerly
lumped together that we thought had menaingful therapeutic
implications, and
those terms have held up very well.

Elise Spiegal: Some proposed changes didn't make it into the DSM,
Robert
Spitzer.

Robert Spitzer: There was some interest in having racism as a mental
disorder which we certainly never took very seriously.

Elise Spiegal: Spitzer says he rejected the proposal because it wasn't
clear
to him that racism was a mental dysfunction.

Robert Spitzer: Racism, its hard to say what wouldn't, what's not
working,
and also you'd have to include so many groups it would just be
ludicrous.

Elise Spiegal: Spitzer loved working on the DSM revision and as time
went on
he found himself increasingly obsessed with the process.

Robert Spitzer: I mean I was married, I had kids, but I was working you
know
12 - 16 hours a day.

Jean Endicott: He would come in on Mondays having clearly worked on it
all
weekend.

Elise Spiegal: Jean Endicott is a psychologist who worked on the DSM.

Jean Endicott: If you sat by him on the plane going to a meeting there
was
no question what you'd going to be talking about. Three or four of us
might
be discussing it until one of us would bail out and he'd say can I run
one
item by you and I'd say no, no, no you can't.

Elise Spiegal: Robert Spitzer also woke his wife in the middle of the
night
to discuss possible wording. He personally answered hundreds of letters

addressed to the committee no matter how trivial, and all this work
took a
toll on Spitzer.

Robert Spitzer: I ended up with a different family because of the DSM

Elise Spiegal: Do you feel like that?

Robert Spitzer: Well its not that I feel like that I did, I mean I did.

Elise Spiegal: During his work on the DSM Robert Spitzer fell in love
with
his text editor, a woman named Janet Williams, and left his wife and
children. Meanwhile his work on the DSM was plagued by political
controversies.

Robert Spitzer: The major controversy was over the use of the term
neurosis.
Neurosis was a term that for psychoanalysis was a key central concept
and
they felt this was a move against psychoanalysis.

Elise Spiegal: For the psychoanalysts, removing neurosis from the DSM
seemed
a little like removing the concept of God from the bible and the list
of
people offended by Spitzer's decisions grew. He alienated the
feminists by
supporting the idea that in certain cases pre-menstruation could be
classified as a mental disorder, and theVeterans Administration by
including Post Traumatic Stress Disorder which qualified huge numbers
of
soldiers for compensation.

Robert Spitzer: There was several times when the whole thing looked
like it
could be defeated which was pretty scary.

Elise Spiegal: Still at the APA meeting in the Spring of 1980 the new
DSM
was put before the Assembly.

Robert Spitzer: The Assembly had to approve it when the assembly had a
meeting in which I was at - I get so emotional - anyway when they
finally
voted to approve it they gave me a standing ovation which was very
meaningful .

Elise Spiegal: They were acknowledging that Spitzer's DSM was one of
the
most important innovations in Psychiatry in 30 years, in fact in almost

every quarter the DSM was an immediate popular success.

Robert Spitzer: It was wonderful for the mood of psychiatry. Psychiatry
felt
that now gee we are more scientific, we are part of medicine, we can
be
proud of this. In addition, the American Psychiatric Association found
out
it could make a lot of money by selling it They've made a tremendous
amount
of money.

Elise Spiegal: Still in 1988 when the APA decided it was time for yet
another revision, Spitzer was denied the job of director. The APA told
Spitzer it was because hed become too personally identified with the
DSM and
the document needed to represent all psychiatry, but some believe there
were
other reasons. Columbia professor David Shaffer.

David Shaffer : I think that the APA wanted a quieter time, and I think
that
they felt that by seperating DSM fom Bob it would make it a less
controversial process.

Elise Spiegal: As a concession Spitzer was made special advisor to the
DSM
which entitled him to attend every meeting which of course Spitzer did,
but
he often found these meetings emotionally exhausting.

Robert Spitzer: I had this image of you know of each category being a
child
and they were being abused or messed up.

Elise Spiegal: Eventiually Spitzer stopped going to the meetings all
together, he says it took years to get over. Still he has a lot to be
proud
of. He's had a tremendous impact on the way that people all over the
world
understand themselves and their pain. What's odd is that Robert Spitzer

doesn't see himself as someone who has much insight when it comes to
other
people's emotions.

Robert Spitzer: Um.. No I don't know that I do. You know that's just
not
me.

Elise Spiegal: Yet you've been intimately involved in mapping, in
mapping
human emotion.

Robert Spitzer: But its a different knack, my knack is taking some
things
that are kind of like a puzzle and figuring some way to make them into
a
system, I think it must be a different skill.

Elise Spiegal: And its not only human emotion that Spitzer's turned
into a
system. Late in life Spitzer has taken up ballroom dancing. Like human
emotion ballroom dancing is something most people see primarily as a
form of
expression, but that's not how Spitzer approaches it. He approaches it
like
a science. He's developed an elaborate notation system carefully
breaking
down each gesture into its component parts.

Robert Spitzer: And I tried to get one of these teachers to use my
system
because I thought if he could use it he could hand out you know the
system
for that particular step that he taught and he very kindly said no he
was
not interested.

Elise Spiegal: And as with the DSM, Spitzer focuses obsessively on
ballroom
dancing. His wife says that recently the family went on vacation to the

beach and one afternoon she found her husband on the sand at the lip of
the
ocean meticulously practicing each move, his arms raised to embrace the

empty air, a look stern concentration on his face .....for NPR news
this is
Elise Spiegal in Washington.

Looking forward to getting back to this article later

translating feelings into some kind of a system.

You see, the little boy who graphed his passions onto
cabin
walls grew up to be the man who revolutionized the Diagnostic and
Statistical Manual, the American Psychiatric Association's official
listing
of mental disease. The DSM is a big book filled with long descriptions
of
close to 300 different mental disorders, each precisely defined with a
clear
checklist of all possible symptoms. The DSM is considered the bible of
psychiatry because today it's used by practically every mental health
professional in the country. But in 1974 when Robert Spitzer was
appointed
to direct its revision few in the profession knew about it and even
fewer
cared. At the time it was an obscure administrative handbook with 180
poorly
defined mental disorders.

Robert Spitzer: There was some interest in having racism as a mental
disorder which we certainly never took very seriously.

Elise Spiegal: Spitzer says he rejected the proposal because it wasn't
clear
to him that racism was a mental dysfunction.

It was wonderful for the mood of psychiatry. Psychiatry
felt
that now gee we are more scientific, we are part of medicine, we can
be
proud of this. In addition, the American Psychiatric Association found
out
it could make a lot of money by selling it They've made a tremendous
amount
of money.

Robert Spitzer: I had this image of you know of each category being a
child
and they were being abused or messed up.

So the "inventor" of the DSM thinks that feelings can be translated into a kind of "system" ?... What a crock of crap.... Human beings are not robots , we dont function like computers, you cant graph a human life on a scale ...

The only funtion for this system of categorising human emotions is for the convenience of psychiatry to diagnose and drug patients , plain and simply.. sick....

[thecaracal]

DSM 666.1 Psychiatric Induced Mood Disorder

A mood disorder that is induced by seeing a Psychiatrist, and from Drugs prescribed during the course of disablement, er, treatment.

Common symptoms:

Irritation
Alienation
Frustration
Malaise (a general feeling of being unwell, from exposure to above)
Anger

[scotty]

"Elise Spiegal: Some proposed changes didn't make it into the DSM,
Robert
Spitzer.

Robert Spitzer: There was some interest in having racism as a mental
disorder which we certainly never took very seriously.

Elise Spiegal: Spitzer says he rejected the proposal because it wasn't
clear
to him that racism was a mental dysfunction.

Robert Spitzer: Racism, its hard to say what wouldn't, what's not
working,
and also you'd have to include so many groups it would just be
ludicrous."

Hmmmmmmm, no drug available for racism... diagnosis declined.

Originally Posted by scotty

"Elise Spiegal: Some proposed changes didn't make it into the DSM,
Robert
Spitzer.

Robert Spitzer: There was some interest in having racism as a mental
disorder which we certainly never took very seriously.

Elise Spiegal: Spitzer says he rejected the proposal because it wasn't
clear
to him that racism was a mental dysfunction.

Robert Spitzer: Racism, its hard to say what wouldn't, what's not
working,
and also you'd have to include so many groups it would just be
ludicrous."

Hmmmmmmm, no drug available for racism... diagnosis declined.

Exactly Laurie !!!