by William Van Ornum, Ph.D. on
In the latter part of the 20th century a dramatic shift occurred regarding the manner in which psychiatrists and other mental health professionals described and diagnosed psychological problems.
DSM I, the first version of the Diagnostic and Statistical Manual, was a modest size paperback handbook providing broad categories of mental health problems. It was the job of the therapist to extensively interview the client and to discover the unique strengths and weaknesses of this person, a full background history, and to work to discover how treatment could help give the person greater psychological freedom. This assessment was something that couldn’t be done in an hour. If one were to read different assessments by a master therapist, one would be truly amazed how each was different and captured in writing a unique human being who was striving for psychological health. DSM II continued in this manner.
By the 1980s, insurance began to require more specific diagnoses in order to provide reimbursement. DSM III–a much larger book than either of its predecessors–offered more categories for “illnesses” and very specific criteria for identifying these. “Symptoms” might be very behavioral, such as “obsessions and compulsions for more than one hour per day” or “a chronic disturbance in which 15 or more of the following were present.”
It was the intention of the Task Force creating this manual that the diagnoses continue to be a first step and that highly detailed individual descriptions of each disorder would follow.
Unfortunately, the pragmatics of how this manual was used led to shorthand definitions–often with the clinician going no further than the symptoms in the book. Sadly, sometimes the numerical code became the most important part of the assessment.
Under this system, 500,000 people could receive a diagnosis of Major Depression, and a detailed historical and contemporary exposition of the experience (phenomenology) was lost.
The PSYCHODYNAMIC DIAGNOSTIC MANUAL, created by a task force of the American Psychoanalytic Association, offers clinicians with ways to shift away from the specifically behavioral symptoms and to produce a full phenomenology. The book is readily understandable and free from jargon and offers clinicians a companion resource to use when working with the DSM IV TR.
One hope for a future edition of this work is to offer discussion and treatment approaches for older clients and the complex mental health problems they and their families grapple with.
The citation for the book is: Psychodynamic Task Force. Psychodynamic Diagnostic Manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, 2006.