The Impact the DSM Has Had On All of Us: An interview with Sarah Fay and Allan Horwitz - Mad In America
I entered the field of mental illness in the early 1970s, when I was a graduate student in Sociology at Yale University. As it happened, the DSM was being developed at Yale at the time. I did my dissertation at the Connecticut Mental Health Center and this was the age before patient confidentiality. I had free access to the charts of people, which in retrospect, seems amazing to me. These charts didn’t have diagnoses, and they would go in detail into the problems that people were having. Diagnoses just weren’t an important aspect of how patients were being looked at and how they were being treated.
Then all of a sudden, in 1980, when the DSM-III is published, not only are diagnoses a critical part of psychiatry, they’re probably the most critical aspect. [Psychiatrists] start by getting a diagnosis for the person, and then that diagnosis guides how that person is treated, what kind of drugs they’re getting, what sort of psychotherapy they’re getting. It was such a tremendous transformation in a very short period of time, and it’s going from diagnosis playing almost no role to it being the central aspect of psychiatric treatment.
… the mainstream of the profession in the 1950s and 1960s was clearly psychoanalysis, and psychoanalysts couldn’t care less about diagnoses. It just wasn’t important if you were looking for the hidden unconscious factors that shaped who a person was. Then, beginning in the 1950s and intensifying in the 1960s, you have an entirely different type of psychiatry emerging, which is called biological psychiatry, and these were hardcore researchers who generally didn’t really see patients. But they were devoted to developing specifically targeted drugs, especially focused on depression.The analysts had this very global notion of anxiety, which drove their work, so the new biological researchers ceded anxiety to the analysts. They weren’t going to go there and instead took depression as their stronghold and strived to develop very targeted drugs.
Meanwhile, and this is happening simultaneously, the drug industry came out with a whole new class of what come to be called antidepressants, even though they’re not really antidepressants, but they have to be called that because the anti-anxiety drugs that were wildly popular in the 1950s and 1960s became discredited in the 1970s and there was this movement to strictly regulate the tranquilizers. So they don’t want to call the new selective serotonin reuptake inhibitors anti-anxiety drugs. Instead, they hit upon calling them—and it’s a brilliant marketing tactic—antidepressants.
At the same time, in the late ’80s, pharmaceutical companies are able to develop direct-to-consumer advertisements, and they spend tens of millions of dollars promoting these drugs, clearly aiming at the normal depressions that stem from everyday problems. You don’t see in these advertisements seriously depressed suicidal people who are in the hospital. You find the wives who are squabbling with husbands or having trouble raising their children. They’re targeted at everyday problems, and they are hugely successful.