1 Boring Old Man

World War II saw the large-scale involvement of US psychiatrists in the selection, processing, assessment and treatment of soldiers. This moved the focus away from mental institutions and traditional clinical perspectives. A committee that was headed by psychiatrist Brigadier General William C. Menninger developed a new classification scheme called Medical 203 that was issued in 1943 as a War Department Technical Bulletin under the auspices of the Office of the Surgeon General. The foreword to the DSM-I states the US Navy had itself made some minor revisions but "the Army established a much more sweeping revision, abandoning the basic outline of the Standard and attempting to express present day concepts of mental disturbance. This nomenclature eventually was adopted by all Armed Forces", and "assorted modifications of the Armed Forces nomenclature [were] introduced into many clinics and hospitals by psychiatrists returning from military duty." The Veterans Administration also adopted a slightly modified version of Medical 203.

In 1949, the World Health Organization published the sixth revision of the International Statistical Classification of Diseases (ICD) which included a section on mental disorders for the first time. The foreword to DSM-1 states this "categorized mental disorders in rubrics similar to those of the Armed Forces nomenclature." An APA Committee on Nomenclature and Statistics was empowered to develop a version specifically for use in the United States, to standardize the diverse and confused usage of different documents. In 1950 the APA committee undertook a review and consultation. It circulated an adaptation of Medical 203, the VA system and the Standard’s Nomenclature, to approximately 10% of APA members. 46% replied, of which 93% approved, and after some further revisions [resulting in it being called DSM-I], the Diagnostic and Statistical Manual of Mental Disorders was approved in 1951 and published in 1952. The structure and conceptual framework were the same as in Medical 203 and many passages of text identical. The manual was 130 pages long and listed 106 mental disorders…

^{Although the APA was closely involved in the next significant revision of the mental disorder section of the ICD [version 8 in 1968], it decided to go ahead with a revision of the DSM. It was published in 1968, listed 182 disorders, and was 134 pages long. It was quite similar to the DSM-I. The term "reaction" was dropped, but the term "neurosis" was retained. Both the DSM-I and the DSM-II reflected the predominant psychodynamic psychiatry, although they also included biological perspectives and concepts from Kraepelin‘s system of classification. Symptoms were not specified in detail for specific disorders…}

ICD vs. DSM
APA Monitor. 2009 40[9]:63.

What is the difference between the ICD and DSM?

The ICD is a core function of the World Health Organization, spelled out in its constitution and ratified by all 193 WHO member countries. The ICD has existed for more than a century, and became WHO’s responsibility when it was founded in 1948 as an agency of the United Nations. Before 1980, psychiatric diagnostic systems reflected the dominant psychoanalytic ideas of the time, emphasizing the role of experience, downplaying biology. "The American Psychiatric Association can really be credited with a revolution in psychiatric nosology with the publication of DSM-III by introducing a descriptive nosological system based on co-occurring clusters of symptoms," said WHO psychologist Geoffrey Reed, PhD.

There was very little international participation in the DSM-III, but at the time it may have been impossible to make such a big shift at the international level, he explained. As a result, DSM-III and ICD-8 (the version in effect at the time) were quite different from one another but as the descriptive phenomenological approach to diagnose mental disorders became dominant, the DSM and ICD have become very similar, partly because of collaborative agreements between the two organizations. Still, there is widespread sentiment that it is not helpful to the field to have two separate classification systems for mental disorders. Many important distinctions between the two systems remain, Reed said:

•The ICD is produced by a global health agency with a constitutional public health mission, while the DSM is produced by a single national professional association.
•WHO’s primary focus for the mental and behavioral disorders classification is to help countries to reduce the disease burden of mental disorders. ICD’s development is global, multidisciplinary and multilingual; the primary constituency of the DSM is U.S. psychiatrists.
•The ICD is approved by the World Health Assembly, composed of the health ministers of all 193 WHO member countries; the DSM is approved by the assembly of the American Psychiatric Association, a group much like APA’s Council of Representatives.
•The ICD is distributed as broadly as possible at a very low cost, with substantial discounts to low-income countries, and available free on the Internet; the DSM generates a very substantial portion of the American Psychiatric Association’s revenue, not only from sales of the book itself, but also from related products and copyright permissions for books and scientific articles.

Will the DSM be superseded by the ICD? There is little justification for maintaining the DSM as a separate diagnostic system from the ICD in the long run, particularly given the U.S. government’s substantial engagement with WHO in the area of classification systems. But, said Reed, "there would still be a role for the DSM, because it contains a lot of additional information that will never be part of the ICD. In the future, it may be viewed as an important textbook of psychiatric diagnosis rather than as the diagnostic ‘Bible.’"

hegemony [hɪˈɡɛmÉ™nɪ]
  — noun

ascendancy or domination of one power or state within a league, confederation, etc, or of one social class over others.

^{[from Greek hēgemonia authority, from hēgemōn leader, from hēgeisthai to lead]}