Medicine and Society, New Perspectives in Continental Philosophy by Darian Meacham

Author:Darian Meacham
Language: eng
Format: epub
Publisher: Springer Netherlands, Dordrecht

3 The Early DSM and the Paraphilias (1952–1980)

Many of Krafft-Ebing’s ideas on sexual deviance have been immensely influential in twentieth-century psychiatry. His nomenclature and general biomedical perspective, for example, still pervade many contemporary psychiatric classifications of sexual deviations, including the Diagnostic and Statistical Manual of Mental Disorders (DSM). In this section, I will briefly discuss the origins and early editions of this manual, while focusing on their dealings with sexual deviance.

The DSM originated from the need for a uniform reporting of statistics of the many mental hospitals in early twentieth-century America (Grob 1991). Its predecessor, the Statistical Manual for the Use of Hospitals for Mental Diseases, first published in 1918, reflected the then population of these hospitals, as it concentrated mostly on severe brain disorders, often with an organic etiology (National Committee for Mental Hygiene [NCMH] 1918). One of the manual’s clinical groups was given the enigmatic name “Not Insane”, and included a disease category called “constitutional psychopathic personality (without psychosis),” which in its turn referred to “criminal traits, moral deficiency, tramp life, sexual perversions and various temperamental peculiarities” (27). In a way, then, DSM’s predecessor did not consider the sexual perversions as mental disorders. The message was more ambiguous, however, since “perverts” and tramps and criminals were also referred to as “pathological” and even “abnormal personalities” (27).

The origin of the Statistical Manual as an instrument to collect mental hospital data was predictive of the difficulties it was about to encounter. The strains and rigors at the fronts of World War II brought back shipments of American soldiers whose illnesses were nowhere to be found in the manual. Combat fatigue and shell shock produced relatively mild mental disorders, at least when compared to the grave afflictions found in mental hospitals. Faced with an enormous new patient population, the American Psychiatric Association quickly understood the need to expand its stock of disease categories. In 1952, it published the first edition of the Diagnostic and Statistical Manual: Mental Disorders (DSM-I; APA 1952). Among its novelties was an extensive category of Transient Situational Personality Disorders.

DSM-I had very little to say about the sexual deviations. They were catalogued as one of the “sociopathic personality disturbances” that, in their turn, were part of the general category of “personality disorders.” Interestingly, the description of “sociopathic personality disturbance” reads: “Individuals to be placed in this category are ill primarily in terms of society and of conformity with the prevailing cultural milieu, and not only in terms of personal discomfort and relations with other individuals” (APA 1952, p. 38). It is one of the rare occasions where the editors of DSM-I hint at a definition of mental disorder. Unlike later editions of the manual, the first DSM did not provide an explicit definition of mental disorder (and neither did DSM-II), but its general outlook suggested that mental illness be understood either in terms of some organic defect, as in the case of the many brain disorders listed, and/or in terms of personal distress, as in the case of the neuroses.

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