Psychiatry Adopts a Disease Model

Abstract

The modern era of psychiatry, in terms of its classification of mental disorders, dates to 1980, when the American Psychiatric Association (APA) published the third edition of its Diagnostic and Statistical Manual (DSM-III). This marked the moment that the APA moved away from psychoanalytic explanations for mental disorders and adopted what it considered to be a more scientific way to think about psychiatric difficulties. The disorders were to be diagnosed based on characteristic “symptoms,” a model that other medical specialties, when faced with illnesses of unknown causes, had long used. The public was encouraged to think of mental disorders as “diseases,” and very soon, with this concept in mind and the arrival of new psychiatric medications on the market, the use of these drugs soared. In the United States, spending on psychiatric drugs increased from around $800 million in 1985 to more than $40 billion in 2011, evidence of how the diagnosis of mental disorders and the prescribing of psychiatric medications have dramatically expanded since the publication of DSM-III.²

The struggle over the drafting and publication of the DSM-III appeared to be a clinical debate, but underlying it all was a vehement political struggle for professional status and direction.

—Rick Mayes, 2005¹