October 14, 2013By 

Dr Ron Pies makes many insightful comments in the accompanying analysis. My view about why DSM revisions have been unscientific is based on concepts of science that are in agreement with much of what he describes. If science is defined as some kind of systematic study of observed experience applied to hypotheses or theories, and then confirmation or refutation of those hypotheses or theories, followed by new hypotheses or theories that are further tested and refined by new observations – if this is the core of any scientific inquiry, I think that no objective observer can attribute the history of DSM-III, IV, and 5 to anything that approximates this process.
Let’s review this history, so well documented now by historian Hannah Decker with archival, often unpublished evidence for DSM-III.1 In the 1970s, scientific studies that meet the above definitions were collected mainly by researchers centered at the Washington University of St. Louis, and about 2 dozen diagnoses were found to be definable based on such empirical evidence. These were published a few times, lastly in 1978, as the Research Diagnostic Criteria. Within 2 years, Robert Spitzer had taken those scientifically-based diagnoses as the basis for DSM-III, but, through an immense amount of political wheeling-and-dealing (documented in painful detail by Decker), he produces 292 diagnoses. Obviously, in 2 years, a huge amount of scientific research did not suddenly identify 270 new diagnoses. Fourteen years later, with DSM-IV, 365 diagnoses were produced, but the original 270 were little changed. Now, about 20 years later, we still have almost 400 diagnoses, with little change in the original 292 from the Groundhog Year of 1980.