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The Paradox of Professional Success: Grand Ambition, Furious Resistance, and the Derailment of the DSM-5 Revision Process

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Making the DSM-5

Abstract

In 1980, Robert Spitzer and the DSM-III Task Force initiated a paradigm shift in psychiatric classification, effectively shoring up psychiatry’s legitimacy during a period of professional crisis. Thirty years after DSM-III, psychiatry once again finds itself in a precarious position, and once again, the DSM-5 Task Force is attempting to resolve its professional crisis by revising the DSM. However, the very success of DSM-III—both its integration into all facets of mental health and its centrality to psychiatry’s professional identity and authority—has made it impossible for the DSM-5 Task Force to duplicate Spitzer’s feat. As the DSM-5 revision process unfolds, it has become evident that vehement resistance within the profession has derailed the Task Force’s initial dream of introducing significant innovations and even realizing a paradigm shift through dimensional measurement. In recounting how and why the dimensional revisions were defeated, this chapter suggests the limitations of shoring up professional authority through a nosology. The vicissitudes of the DSM-5 process can only be understood by situating it within the professional politics of American psychiatry over the last three decades—a history dominated by the DSM.

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Notes

  1. 1.

    Robert Spitzer has focused his criticisms on the lack of transparency in the DSM-5 process, an ironic criticism coming from a man who, by his own admission, controlled every facet of the DSM-­III process, and who himself, was repeatedly lambasted for the close nature of his revision process.

  2. 2.

    The exception is the PHQ9, a self-reported depression scale sponsored by Pfizer, but now in the public domain.

  3. 3.

    Quote taken from author interview of Michael First, conducted on December 8, 2010, New York, NY.

  4. 4.

    Quote taken from author interview of Michael First, conducted on December 8, 2010, New York, NY.

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Author information

Authors and Affiliations

  1. Department of Sociology, University of New Mexico, Albuquerque, NM, USA

    Owen Whooley

  2. Department of Sociology and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA

    Allan V. Horwitz

Authors
  1. Owen Whooley
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  2. Allan V. Horwitz
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Correspondence to Allan V. Horwitz .

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Editors and Affiliations

  1. Jewish General Hospital, Department of Psychiatry, Sir Mortimer B. Davis, Côte Ste. Catherine Road 4333, Montreal, H3T1E4, Québec, Canada

    Joel Paris

  2. , Department of Psychiatry, Yale School of Medicine, Noble Avenue 88, New Haven, 06460, Connecticut, USA

    James Phillips

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Whooley, O., Horwitz, A.V. (2013). The Paradox of Professional Success: Grand Ambition, Furious Resistance, and the Derailment of the DSM-5 Revision Process. In: Paris, J., Phillips, J. (eds) Making the DSM-5. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6504-1_6

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  • DOI: https://doi.org/10.1007/978-1-4614-6504-1_6

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