A 5 minute History of the DSM

As part of ITP's 35th anniversary celebration, I gave a Pecha Kucha on the DSM.  Here's the slideshow, talk, and transcripts. Enjoy!

my talk: 3:17:50 - 3.23.15

Hi everyone, my name is Crys and I’m going to talk really fast for 5 minutes about some research I did for an art project. For those of you who don’t know,  The DSM, Diagnostic and Statistical Manual for Mental Disorder, is an attempt to give clinicians, legislators, researchers, insurers, the courts, and organizations like the FDA, a common language for understanding and discussing human mental illness. The following is some highlights from what the DSM’s history:

 

The first known attempt at gathering statistics of American mental health came with the 1840 census.  Some example questions were "number of slaves and free colored persons...” and "number of insane and idiotic in public or private charge, by race”. Published results of the census indicated that alarming numbers of black  persons living in non-slaveholding States were mentally ill, in striking contrast to the corresponding figures for slaveholding States.” John Quincy Adams described the census as having a ‘multitude of gross and important errors’ but Secretary of State John C. Calhoun carefully examined the stats and maintained their correctness. 

 

The next stab at data gathering was the 1880 census.  The categories were expanded to include dementia, dipsomania, epilepsy, melancholia, monomania, and paresis. As I read through the ‘Defective, Dependant, and Deliquent, classes of the untied states’ report, I thought I had inadvertently discovered the first Data Viz!

A few wikipages later, I found, to my disappointment, the real first data visualizations. 

These come from the 1870 census and were made by Francis Amasa Walker. Walker was the superintendent of the 1880 census as well as the Indian Affairs Superintendent. Walker described native americans as "voluptuary," "garrulous," "lazy," "cowardly in battle," and "beggar-like”. He also recommended that Native Americans be kept on reservations of limited mineral or agricultural value so they could be educated and reformed. 

side note: butt plugs were invented 22 years after this census report by Frank E Young. 

 

Anyway, back to the DSM.  The next major player in the development of the standardized diagnostic criteria for mental health came with Medical 203

Medical 203 represented a shift away from Freudian psychoanalysis and instead introduced the idea that external circumstances could affect your mental life. 

It really brought our understanding of mental health into the 20th century.

The next big factor in the development of the DSM was the APA. The APA had its own ‘Standard Classified Nomenclature of Disease’ and was first headed up by this guy, G Stanley Hall. 

 some wiki highlights  about Hall: 

Hall had no sympathy for the poor, the sick, or those with developmental differences or disabilities. A firm believer in selective breeding and forced sterilization, he believed that any respect or charity toward those he viewed as physically, emotionally, or intellectually weak or "defective" simply interfered with the movement of natural selection toward the development of a super-race. 

also,

 Hall ‘theorized that African, Indians and Chinese were members of ‘adolescent races’ in stage of ‘incomplete growth”

Hall also coined the terms Knismesis and Gargalesis. The medical terms for tickeling

Lastly, Hall mentored this guy, Francis Cecil Sumner, the first African American to get a phD in psych as well as the father of ‘black psychology’. 

 

So, the first DSM is published in 1952, it has 106 Disorders and was heavily influenced by the concepts of Emil Kraeplin.  Kraeplin believed that genetics and biology played a key role in mental disorders. These ideas also played into the 3rd revision of the DSM

Kraeplin is quoted as being the founder of modern scientific psychiatry, as well as of psychopharmacology, and psychiatric genetics. 

From his wiki page:

"He was a strong and influential proponent of eugenics and racial hygiene…. He thought things like the school system and the welfare state broke the process of natural selection and undermined the German’s biological ‘struggle for survival’. 

The DSM II is published in 1968, has 182 disorders, and remains with largely the same underpinnings as previously outlined. The next revolution for the DSM comes in 1980 with the 3rd revision. 

 

DSM III contained now 265 disorders and was chaired by Robert Spitzer. 

Spitzer was described by his colleagues as a man who lacked empathy and is quoted in the New Yorker as having no idea what to get people for presents.  In other words, the man charged with writing the book on extreme human emotions doesn’t understand the simplest of human emotions. Anyway, The DSM III went through some significant structural changes, and began to favor a more empirical approach to diagnosis. It was also around this time that the ‘homosexualty’ diagnosis came into controversy. 

 

In the first DSM, the APA listed homosex as a sociopathic personality disturbance.

After a lot of activism, it was eventually taken out the seventh revision of the DSM II. Spitzer was actually a leading advocate on removing homosexuality from the list of mental disorders. However, In 2001, spitzer wrote a controversial paper entitled Can Some Gay Men and Lesbians Change Their Sexual Orientation?.  His take, if you were ‘highly motivated’ you could. 

 

DSM III up to DSM IV went through a number of revisions but the real shift occurred when federal bans against direct-to-consumer marketing were lifted. ADD rates tripled ...bipolar rates doubled in adults and increased fortyfold in children. 

 

The DSM came into public awareness with the highly controversial DSM 5. clinical professionals have bashed this revision as unnecessarily pathologizing and medicalizing. DSM IV’s chair, Allen Francis  cites the removal of the ‘bereavement exclusion ‘ for depressive disorders as potentially labeling a parent loosing a child after a few weeks of mourning.  I won’t even go into Premenstrual dysphoric disorder. 

The largest most troubling thing that changed with the DSM 5 wasn’t the shift from roman numerals, but Big Pharma’s relationship to the creation of diagnosis, its subsequent research, as well as its labeling of Americans.

 

A 2012 report clearly showed the Conflict of Interest between DSM task force members and the  companies with which they received money for speaking engagements, research grants, things like that. To this day, even though this is transparent, there are no regulations to mitigate this relationship. 

 

The DSM is also being used in clinical assessments of individuals looking to immigrate to the US. This report from the ACLU outlines about what you would expect in the misuse of the “psychiatrists’ bible’ in relation to border issues and xenophobia. Especially considering what we just learned from its history. 

 

I’ll end with some actual disorders from the DSM as it is now. They themselves are a great reflection of the complex and contradictory history of the DSM itself. 

Lets see, we have

Erectile Dysfunction

Female Orgasmic Disorder , Female Sexual Interest / Arousal Disorder

Gender Dysphoria

Oppositional Defiant Disorder

Alcohol Intoxication Disorder

Caffiene Withdrawel

Fetishistic Disorder (body parts, non living others, things like that)

Transvestic Disorder

and on

and on

and on

 

thank you….     



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A Virtual Friend of Bill

A month or so ago, a simple and obvious thought occurred to me: I wonder if there are 12 step meetings in Second Life?'. After a couple of minutes of Googling, I had the Second Life software downloaded and an avatar complete with ironic username - WYSIWYG1. It was my first time on Second Life. The only thing I really knew about SL were my judgmental assumptions and the work of artist Micha Cardenas. Cardenas did a performance where s/he spent 365 hours in SL as a dragon as a way of exploring the very real lives of transgender folk through a Deleuzian framework .  Cardenas has a great essay up on Cnet here expounding the philosophy behind the work. 

 

Micha Cardenas - Becoming Dragon  - Installation View - 2008

What surprised me most about the interactions in SL was the need for social mores. When I got to the meeting room, I was understandably anxious. I walked around the room, checked out the literature and AA paraphernalia. I wasn't  really sure what to do with myself. I noticed a character/lady/person/avatar/state vector sitting on the couch and I walked up to her. Because I was still learning the controls. I kind of awkwardly stood in front of her and immediately felt embarrassed at my avatar's rude behavior. Eventually I figured out how to appropriately address her and we were able to converse.

S/he was very welcoming and gave me the run down: format of the meeting, meeting lists for future meetings, shorthand code for 'sharing', and the conventions around cross talk. Cross talk is something to be avoided in a 12 step meeting. Its when you address another person or something someone's said. Its a way to make sure everyone has a safe space to share what they want.

Instagram of my SL avatar  

12 step meetings are interesting entities in themselves. Some say they are a cult while others say that without a 12 step, their lives would inevitably end in jails, institutions, and/or death. They have no mandatory rules, but do have 'Traditions' which are a set of  guidelines that are meant to act as a way to structure the group and maintain its clarity of purpose. Some see these as nefarious, but they function in the same way as any other social contract - some individual liberties are sacrificed for the greater good of the whole. The greater good of AA always boils down to the individual member, especially the new member. The power structure of AA is rather anarchic in that its power distribution is horizontal. Even though there are committees, decisions are made by individual groups.  

More people teleported into the meeting. One did a twirling dance routine before she sat down, another just lounged the whole meeting. Most people were awkward and shy, which I can only assume is how they are in the physical world. The meeting progressed awkwardly but smoothly. Once it was over, people teleported back to wherever they came from. I spoke with my mysterious friend and thanked her/him for their generosity and for making me feel welcome. 

The contents of the meeting itself weren't that interesting and I left feeling as unaffected as if I had played a video game for an hour. I did have an interesting impulse to do something shady, like see what sex in SL is like. I didn't end up looking for it, but I'm sure its there and I'm sure there's a large community around it.  No one wants to fantasize about doing something good for yourself, like going to an AA meeting (if you're an alcoholic). Fantasy is more about living out those things that we can't in 'real' life.  It won't be long before Virtual or simulated Realty becomes indistinguishable from what we think of as the 'real' world.  We are getting closer and closer to the blurry line that we are already questioning with what is reality and what isn't. A defining question, for me, in that debate, will be something along the lines of If an AA drinks in SL, is it considered a relapse? 

 


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