DSM-5: a fatal diagnosis?

It isn’t every day that a new medical handbook attracts as much media attention as the latest blockbuster novel by a world famous author. But the controversy surrounding the publication on 22 May of the long awaited fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has generated international coverage on a scale to rival that afforded last week’s release of the latest sin and symbols thriller from the bestselling author Dan Brown.

And, though unlikely literary bedfellows, DSM-5 and Inferno—a romp through clues plucked from Dante Alighieri’s 14th century poem Divine Comedy—have something else in common: the authors of both have been going through hell at the hands of their critics.

The American Psychiatric Association produced the first DSM in 1952 and in the intervening 60 years there have been six subsequent iterations. The last was a text revision of 1994’s DSM-IV, published as DSM-IV-TR in 2000, which means that DSM-5 (the Roman numerals have been abandoned for this latest edition in deference to the demands of the digital age) has been 13 hard fought years in the making, during which its makers have come under unprecedented scrutiny and attack.

For the first few decades of its existence, the DSM had a fairly low public profile, although one of the seeds of discontent that has now reached full bloom—the suggestion that the World Health Organization’s International Classification of Diseases is the only manual the world of psychiatry and psychotherapy now needs—was in fact sown at the birth of DSM in 1952.

In 1948 …