The American psychiatrist Robert Spitzer, who has died aged 83, took a homegrown system for classifying psychiatric disorders to world prominence. In 1974, the American Psychiatric Association (APA) asked Spitzer to take responsibility for a new edition of its Diagnostic and Statistical Manual of Mental Disorders, which had begun in 1952. This new edition, the third, known as DSM-3, was published in 1980 and quickly became the “world bible” of psychiatric diagnosis.
The DSM acquired increasing importance in those years because of the new prominence of drugs in treating psychiatric patients. Before the 1950s, psychiatry had few effective drugs. Yet with the opening of the vast new cornucopia of psychopharmacology, it did make a difference what agent was prescribed: different disorders responded to different treatments. Accordingly, which diagnoses were included or excluded in the classification had great financial consequences. Billions of dollars in pharmaceutical profits were at stake, and some of the diagnoses, such as “major depression”, could be profitable indeed.
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