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Wilhelm Wundt established the first experimental psychology lab.

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The first psychology clinic is established in America.

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In 1908, Witmer published the first edition of The Psychological Clinic. The lead article, "Clinical psychology," explained his work of the last 10 years and why the new term was needed.

Three members of the Psychological Clinic at the entrance, ca. 1923.

It also illustrated Witmer's clinical method. It was to perform little experiments on his cases (the term he used), in order to understand the nature of their difficulty. As Witmer understood more, he would attempt educational experiments, evaluating their effectiveness over days or weeks. He implicitly assumed that the correct educational approach was to "teach to weakness."

Although his method lent itself best to what we would today call "learning disabilities," articles in The Psychological Clinic attempt to extend the approach to more traditional topic in psychiatry, such as the nature of delusions.

Test materials used in the psychological clinic.

Here is a reproduction of the title page, table of contents, and lead article (the same one as listed above) of Volume 1.

The journal ceased publication in 1935, with a report on the status of clinical psychology in the United States. It reviewed the work of 150 clinics, and it attempted to say something about how psychologists should be educated.

Here is a reproduction of the section of the report about Witmer's clinic at that time.

Witmer as an older man.

Reflected both in the forumation of goals and the practice of clinical psychology is Witmer's oft-repeated conviction that "there is no valid distinction between a pure science and an applied science. ... What fosters one ... fosters the other." In the final analysis, he added, "The progress of psychology, as of every other science, will be determined by the amount of its contribution to the advancement of the human race."

Students of clinical psychology today, asked to name their intellectual forbears, surely think of Freud before Witmer. The reason for this is perhaps best summarized in an obituary in the American Journal of Psychology (1956, v. 69, pp. 680-682) by Robert I. Watson:

The applied emphasis, the centering on the problem of the individual, the collaborative approach of specialists to the task at hand, the mingling of quantitative and qualitative findings about the person concerned, and the use of diagnosis and treatment as integral parts of the process, are all typical aspects of clinical psychology as we now know it.

Two significant facets of clinical psychology, as we know it today, were, however, lacking then. The "dynamic approach," to use a convenient shorthand label, was almost completely ignored. He was little influenced by the French psychiatric thought of his day and not at all by Freud. The second missing piece from today's crazy-quilt that is clinical psychology arises from essentially the same omission. This was a lack of clinical collaboration with "analytically oriented" psychiatrists. ... Instead, he turned to men who were primarily neurologists in working out the medical phase of his professional collaboration.

As a result his major influence embodies a paradox. He had less influence upon that body of workers today called clinical psychologists, who in considerable number adopt a dynamic approach and work in psychiatric settings, than upon other psychologists. He was more influential with the workers in those other fields that use the method of clinical psychology but name their areas of endeavor differently. The lineal descendents of Lightner Witmer are found in the far-reaching application of basic clinical psychology to individual problems in education, in vocation and industry, in speech correction, in socio-individual adjustment, a span of interests affecting a wide range of human behavior.

Although Witmer's clinic and Journal are no longer in existence, his conception of clinical psychology forms an important part of the modern department. A clinical program is now an important part of the graduate program. In keeping with the tradition established by Witmer, this program has emphasized the application of the findings of experimental psychology to the study of psychopathology. The program was directed by Julius Wishner from 1957 to 1976, and then by David Williams, Martin Seligman, Robert DeRubeis, and Dianne Chambless.

Jonathan Baron
Last modified: Sun Apr 30 06:51:37 EDT 2006

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Lightner Witmer and the beginning of clinical psychology

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In 1908, Witmer published the first edition of The Psychological Clinic. The lead article, "Clinical psychology," explained his work of the last 10 years and why the new term was needed. Three members of the Psychological Clinic at the entrance, ca. 1923. It also illustrated Witmer's clinical method.

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Edward Thorndike developed the Law of Effect.

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The Law of Effect was a precursor to B.F. Skinner's operant conditioning, and was developed by psychologist Edward Thorndike. The Law of Effect states that responses that receive positive outcomes in a given situation will be repeated in that situation, while responses that lead to negative outcomes in a given situation will not be repeated in that situation.

Key Takeaways: The Law of Effect

Origins of the Law of Effect

While today B.F. Skinner and operant conditioning are known for demonstrating that we learn based on the consequences of our actions, this idea was built on Edward Thorndike's early contributions to the psychology of learning. The Law of Effect -also referred to as Thorndike's law of effect-came out of Thorndike's experiments with animals, typically cats.

Thorndike would place a cat in a puzzle box that had a small lever on one side. The cat could only get out by pressing the lever. Thorndike would then place a piece of meat outside the box to encourage the cat to escape, and time how long it would take the cat to get out of the box. On its first try, the cat would press the lever by accident. However, because the cat was rewarded with both its freedom and food following each lever press, every time the experiment was repeated, the cat would press the lever more quickly.

Thorndike's observations in these experiments led him to posit the Law of Effect, which was published in his book Animal Intelligence in 1911. The law had two parts.

Regarding actions that received positive consequences, the Law of Effect stated: "Of several responses made to the same situation, those which are accompanied or closely followed by satisfaction to the animal will, other things being equal, be more firmly connected with the situation, so that, when it recurs, they will be more likely to recur."

Of actions that received negative consequences, the Law of Effect stated: "Those [responses] which are accompanied or closely followed by discomfort to the animal will, other things being equal, have their connections with that situation weakened, so that, when it recurs, they will be less likely to occur.

Thorndike concluded his theory by observing, "The greater the satisfaction or discomfort, the greater the strengthening or weakening of the bond [between the response and the situation]."

Thorndike modified the law of effect in 1932, after determining both parts were not equally valid. He found that responses that are accompanied by positive outcomes or rewards always made the association between the situation and the response stronger, however, responses that are accompanied by negative outcomes or punishments only weaken the association between the situation and response a little bit.

Examples of the Law of Effect in Action

Thorndike's theory outlined one way people learn, and we can see it in action in many situations. For example, say you're a student and you rarely speak up in class even when you know the answer to the teacher's questions. But one day, the teacher asks a question that no one else answers, so you tentatively raise your hand and give the correct answer. The teacher commends you for your response and it makes you feel good. So, next time you're in class and you know the answer to a question the teacher asks, you raise your hand again with the expectation that, after answering correctly, you will once again experience your teacher's praise. In other words, because your response in the situation led to a positive outcome, the likelihood that you'll repeat your response increases.

Some other examples include:

You train hard for a swim meet and win first place, making it more likely you'll train just as hard for the next meet.

You practice your act for a talent show, and following your performance, the audience gives you a standing ovation, making it more likely you will practice for your next performance.

You work long hours to ensure you meet a deadline for an important client, and your boss praises your actions, making it more likely you will work long hours when your next deadline is approaching.

You get a ticket for speeding on the highway, making it less likely that you will speed in the future, however, the association between driving and speeding will probably only be weakened a little bit based on Thorndike's modification to the law of effect.

Influence on Operant Conditioning

Thorndike's Law of Effect is an early theory of conditioning. It is an unmediated stimulus-response model because there was nothing else that happens between the stimulus and the response. In Thorndike's experiments, the cats were allowed to operate freely, and made the association between the box and pressing the lever to gain their freedom on their own. Skinner studied Thorndike's ideas and conducted similar experiments that involved placing animals in his own version of a puzzle box with a lever (which is typically referred to as a Skinner box).

Skinner introduced the concept of reinforcement into Thorndike's theory. In operant conditioning, behaviors that are positively reinforced are likely to be repeated and behaviors that are negatively reinforced are less likely to be repeated. A clear line can be drawn between operant conditioning and the Law of Effect, demonstrating the influence Thorndike had on both operant conditioning and behaviorism as a whole.

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What Is the Law of Effect in Psychology?

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The Law of Effect was a precursor to B.F. Skinner's operant conditioning, and was developed by psychologist Edward Thorndike. The Law of Effect states that responses that receive positive outcomes in a given situation will be repeated in that situation, while responses that lead to negative outcomes in a given situation will not be repeated in that situation.

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"Interpretation of Dreams" is published by Sigmund Frued

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"Experimental Studies of The Perception of Movement" is published which leads to the development of Gestalt psychology.

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Army Beta and Army Alpha tests were created by Robert Yerkes.

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Carl Rogers developed the practice of client-centered therapy.

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Wiley Blackwell published "The Journal of Clinical Psychology"

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Prior to submission, please carefully read and follow the submission guidelines detailed below. Manuscripts that do not conform to the submission guidelines may be returned without review.

Submission

To submit to the Editorial Office of Joanne Davila, please submit manuscripts electronically through the Manuscript Submission Portal.

Starting June 15, 2020, all new manuscripts submitted should be prepared according to the 7 th edition of the Publication Manual of the American Psychological Association. APA Style and Grammar Guidelines for the 7 th edition are available.
Submit Manuscript
General correspondence may be directed to the Editorial Office via email.

Journal of Consulting and Clinical Psychology® is now using a software system to screen submitted content for similarity with other published content. The system compares the initial version of each submitted manuscript against a database of 40+ million scholarly documents, as well as content appearing on the open web. This allows APA to check submissions for potential overlap with material previously published in scholarly journals (e.g., lifted or republished material).

Masked Review

This journal uses a masked reviewing system for all submissions. The first page of the manuscript should omit the authors' names and affiliations but should include the title of the manuscript and the date it is submitted.

Footnotes containing information pertaining to the authors' identities or affiliations should not be included in the manuscript, but may be provided after a manuscript is accepted.

Make every effort to see that the manuscript itself contains no clues to the authors' identities.

Please ensure that the final version for production includes a byline and full author note for typesetting.

Keep a copy of the manuscript to guard against loss.

Cover Letter

The cover letter accompanying the manuscript submission must include all authors' names and affiliations to avoid potential conflicts of interest in the review process. Addresses and phone numbers, as well as electronic mail addresses and fax numbers, if available, should be provided for all authors for possible use by the editorial office and later by the production office.

Length and Style of Manuscripts

Full-length manuscripts should not exceed 35 pages total (including cover page, abstract, text, references, tables, and figures), with margins of at least 1 inch on all sides and a standard font (e.g., Times New Roman) of 12 points (no smaller). The entire paper (text, references, tables, etc.) must be double spaced.

Authors submitting manuscripts that report new data collection, especially randomized clinical trials (RCTs), should comply with the newly developed Journal Article Reporting Standards for Quantitative Research in Psychology: The APA Publications and Communications Board Task Force Report (PDF, 222KB) (JARS; see American Psychologist, 2018, 73(1), 3-25 or Appendix in the APA Publication Manual).

For papers that exceed 35 pages, authors must justify the extended length in their cover letter (e.g., reporting of multiple studies), and in no case should the paper exceed 45 pages total. Papers that do not conform to these guidelines may be returned without review.

The References section should immediately follow a page break.

Brief Reports

In addition to full-length manuscripts, the JCCP will consider Brief Reports of research studies in clinical psychology. The Brief Report format may be appropriate for empirically sound studies that are limited in scope, contain novel or provocative findings that need further replication, or represent replications and extensions of prior published work.

Brief Reports are intended to permit the publication of soundly designed studies of specialized interest that cannot be accepted as regular articles because of lack of space.

Brief Reports must be prepared according to the following specifications: Use 12-point Times New Roman type and 1-inch (2.54-cm) margins, and do not exceed 265 lines of text including references. These limits do not include the title page, abstract, author note, footnotes, tables, or figures.

An author who submits a Brief Report must agree not to submit the full report to another journal of general circulation. The Brief Report should give a clear, condensed summary of the procedure of the study and as full an account of the results as space permits.

Commentaries

JCCP now publishes papers that are commentaries of previously published articles in this journal. Two types of commentaries will be considered:

Brief Comment

A Brief Comment would be written in response to a single article previously published in JCCP. The primary purpose would be to provide a meaningful insight, concern, alternative interpretation, clarification, or critical analysis. It is not intended to be pedestrian in nature (e.g., simply highlighting that a given study is statistically underpowered). Rather, its publication would provide for a richer and more comprehensive understanding of a methodological, conceptual, or professional issue that significantly adds to the literature.

Similar to a Brief Report, Brief Comments should not exceed 265 lines of text including references. This limit does not include the title page, abstract, or author notes. The title of a Brief Comment should include a subtitle reflecting the actual title and year of publication of the article that engendered the comment. For example - "The Importance of Focusing on External Validity: A Brief Comment on Testing the Efficacy of Two Differing Types of Stress Management Interventions for the Treatment of Essential Hypertension (Jones & Smith, 2012)."

Brief Comments should be submitted in a timely manner, no later than 9 months after publication of the original article. Upon acceptance of a Brief Comment, the author(s) of the original paper would be invited to submit a response, whereupon, if acceptable, both the Brief Comment and Response would be published together. Such Responses to a Brief Comment should also not exceed 265 lines of text including references.

Extended Comment

The purpose of this type of article is essentially similar to that of a Brief Comment (i.e., to provide a meaningful insight, concern, alternative interpretation, clarification, or critical analysis), but would be written in response to a series of articles previously published in JCCP or that involves a more extensive and far-reaching conceptual or methodological issue. An example might include describing and analyzing the limitations of a particular statistical or methodological procedure used in several studies previously published in JCCP, provided along with meaningful recommendations.

This type of article should not exceed approximately one half the length of the original paper (note that 1 journal page equals approximately 3-3.5 manuscript pages). Unless permission from the editor is received, no Extended Comment should exceed 20 manuscript pages inclusive of all references, tables, and figures.

Similar to a Brief Comment, where and when appropriate, if such a paper is accepted, the author(s) of the original article(s) will be contacted to write a response, whereupon, if acceptable, both the Extended Comment and Response would be published together. This Invited Response should not exceed approximately one half the length of the Extended Comment.

The title of this type of article need not include a subtitle representing the original article(s). One important review criteria involves the timeliness of the topic and its potential contribution to the scientific literature base relevant to the scope of JCCP content.

Conceptual/Theoretical Papers

Whereas the majority of papers published in JCCP will involve descriptions of quantitatively-based investigations, this journal also considers conceptual articles on topics of broad theoretical, methodological, or practical interest that advance the field of clinical psychology. Examples might include describing a new methodological or statistical procedure, delineating methods of enhancing dissemination of research findings from the lab to real-world settings, or advocating the need to increase the profession's research efforts regarding a traditionally underserved population.

Similar formatting guidelines for submitting a full length research article would apply for these types of papers.

Registration of Clinical Trials and Preregistration of Studies

As of March 1, 2019 registration will be required for all clinical trials (studies designed to examine the efficacy or effectiveness of a treatment or preventive intervention) reporting primary outcome findings. Prospective registration (i.e., pre-registration) is required if recruitment began on or after March 1, 2019. Retrospective registration will be accepted only if recruitment began before this date.

Clinical trials must be registered at ClinicalTrials.gov or at another recognized registry. A complete list of acceptable trial registries can be found via the WHO International Clinical Trials Registry Platform. Differences between registered and reported methods or outcomes must be explained clearly and transparently in the manuscript.

Trial protocols, including statistical analysis plans, must be made available to readers. Both published and unpublished protocols are acceptable. Published protocols should be cited in the manuscript. Unpublished protocols may be provided in online-only supplements or made available by request. Use of the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) checklist is recommended.

For secondary analyses of existing data sets, where primary analyses have already been published (or are in press), registration is not required. For such analyses, registration status must be made transparent in the manuscript, and authors must follow guidelines about data transparency provided on the JCCP website. The article(s) reporting the primary outcomes, and the findings, must be cited in the manuscript.

Manuscripts reporting long-term outcomes of studies for which the primary outcomes have already been published also will not require registration, but authors must follow the guidelines above for secondary analyses.

For studies that are not clinical trials, preregistration is encouraged, but not required. If any aspect of the study is preregistered, include the registry link in the Author Note or Method section.

Authors must note registration status in their cover letter, in the manuscript, and in the submission portal.

Required Use of JARS and MARS Guidelines

In order to maintain consistency and fairness in the review process and in the reporting of scientific findings, JCCP requires that ALL manuscripts conform to Journal Article Reporting Standards (JARS) and Meta-Analysis Reporting Standards (MARS) as described in Applebaum et al. (2018):

Applebaum, Cooper, Kline, Mayo-Wilson, Nezu, & Rao (2018). Journal Article Reporting Standards for Quantitative Research in Psychology: The APA Publications and Communications Board Task Force Report. American Psychologist, 73(1), 3-25.

Upon submission, authors will be required to affirm (on the submission portal and in their cover letter) that they have followed JARS/MARS guidelines and that the submitted manuscript contains and/or addresses ALL required information as relevant for the study, including flow diagrams where relevant.

The editorial team will use consistency with the JARS/MARS guidelines as a review criterion, and manuscripts may be rejected if guidelines are not followed.

When deviating from JARS/MARS guidelines, authors must provide the rationale in their cover letter and describe the limitations of doing so in their manuscript.

Title of Manuscript

The title of a manuscript should be accurate, fully explanatory, and preferably no longer than 12 words. The title should reflect the content and population studied (e.g., "treatment of generalized anxiety disorders in adults").

If the paper reports a randomized clinical trial (RCT), this should be indicated in the title. Note that JARS criteria must be used for reporting purposes.

Abstract and Keywords

All manuscripts must include an abstract containing a maximum of 250 words typed on a separate page. After the abstract, please supply up to five keywords or brief phrases.

Manuscripts published in the Journal of Consulting and Clinical Psychology will include a structured abstract of up to 250 words.

For studies that report randomized clinical trials or meta-analyses, the abstract also must be consistent with the guidelines set forth by JARS or MARS (Meta-Analysis Reporting Standards) guidelines, respectively. Thus, in preparing a manuscript, please ensure that it is consistent with the guidelines stated below.

Please include an Abstract of up to 250 words, presented in paragraph form. The Abstract should be typed on a separate page (page 2 of the manuscript), and must include each of the following sections:

Objective: A brief statement of the purpose of the study

Method: A detailed summary of the participants (N, age, gender, ethnicity) as well as descriptions of the study design, measures (including names of measures), and procedures

Results: A detailed summary of the primary findings that clearly articulate comparison groups (if relevant), and that indicate significance or confidence intervals for the main findings

Conclusions: A description of the research and clinical implications of the findings

Public Health Significance Statements

Authors submitting manuscripts to the Journal of Consulting and Clinical Psychology are required to provide 2-3 brief sentences regarding the public health significance of the study or meta-analysis described in their paper. This description should be included within the manuscript on the abstract/keywords page. It should be written in language that is easily understood by both professionals and members of the lay public.

When an accepted paper is published, these sentences will be boxed beneath the abstract for easy accessibility. All such descriptions will also be published as part of the Table of Contents, as well as on the journal's web page. This new policy is in keeping with efforts to increase dissemination and usage by larger and diverse audiences.

Examples of these 2-3 sentences include the following:

"This study strongly suggests that (description of a given psychosocial treatment) is an effective treatment for anxiety, but only if it is of mild to moderate severity. For persons with severe anxiety, additional treatments may be necessary."

"When treating individuals of (name of a particular ethnic minority group) who are experiencing PTSD, this study demonstrated the importance of taking into account cultural factors, especially those that involve one's spiritual beliefs."

"This study highlights the importance of directly including one's family in treatment when helping adults diagnosed with cancer overcome their depression."

To be maximally useful, these statements of public health significance should not simply be sentences lifted directly out of the manuscript.

They are meant to be informative and useful to any reader. They should provide a bottom-line, take-home message that is accurate and easily understood. In addition, they should be able to be translated into media-appropriate statements for use in press releases and on social media.

Prior to final acceptance and publication, all public health significance statements will be carefully reviewed to make sure they meet these standards. Authors will be expected to revise statements as necessary.

Participants: Description and Informed Consent

The Method section of each empirical report must contain a detailed description of the study participants, including (but not limited to) the following: age, gender, ethnicity, SES, clinical diagnoses and comorbidities (as appropriate), and any other relevant demographics.

In the Discussion section of the manuscript, authors should discuss the diversity of their study samples and the generalizability of their findings.

The Method section also must include a statement describing how informed consent was obtained from the participants (or their parents/guardians) and indicate that the study was conducted in compliance with an appropriate Internal Review Board.

Measures

The Method section of empirical reports must contain a sufficiently detailed description of the measures used so that the reader understands the item content, scoring procedures, and total scores or subscales. Evidence of reliability and validity with similar populations should be provided.

Statistical Reporting of Clinical Significance

JCCP requires the statistical reporting of measures that convey clinical significance. Authors should report means and standard deviations for all continuous study variables and the effect sizes for the primary study findings. (If effect sizes are not available for a particular test, authors should convey this in their cover letter at the time of submission.)

JCCP also requires authors to report confidence intervals for any effect sizes involving principal outcomes (see Fidler et al., Journal of Consulting and Clinical Psychology, 2005, pp. 136-143 and Odgaard & Fowler, Journal of Consulting and Clinical Psychology, 2010, pp.287-297).

In addition, when reporting the results of interventions, authors should include indicators of clinically significant change. Authors may use one of several approaches that have been recommended for capturing clinical significance, including (but not limited to) the reliable change index (i.e., whether the amount of change displayed by a treated individual is large enough to be meaningful; see Jacobson et al., Journal of Consulting and Clinical Psychology, 1999), the extent to which dysfunctional individuals show movement into the functional distribution (see Jacobson & Truax, Journal of Consulting and Clinical Psychology, 1991), or other normative comparisons (see Kendall et al., Journal of Consulting and Clinical Psychology, 1999).

The special section of JCCP on "Clinical Significance" ( Journal of Consulting and Clinical Psychology, 1999, pp. 283-339) contains detailed discussions of clinical significance and its measurement and should be a useful resource (see also Atkins et al., Journal of Consulting and Clinical Psychology, 2005, pp. 982-989).

Discussion of Clinical Implications

Articles must include a discussion of the clinical implications of the study findings or analytic review. The Discussion section should contain a clear statement of the extent of clinical application of the current assessment, prevention, or treatment methods. The extent of application to clinical practice may range from suggestions that the data are too preliminary to support widespread dissemination to descriptions of existing manuals available from the authors or archived materials that would allow full implementation at present.

Data Transparency

In order to reduce the likelihood of duplicate or piecemeal publication, authors are required to provide, in their cover letter, a list of published, in press, and under review studies that come from the same dataset as the one in the submitted manuscript, as well as a narrative description of how the submitted manuscript differs from the others.

This narrative description should include how the manuscript differs (or does not) in terms of research question and variables studied.

Authors also are required to submit a masked version of the narrative description that can be provided to reviewers. Please add this as an appendix table on the last page of the submitted manuscript. Please base your description on the following examples, edited according to your specific data circumstances.

Do not provide the title of the manuscript, authors, or journal in which it was published. Do provide the names of the relevant variables (i.e., substitute the numbers in the examples below for actual names, such as depressive symptoms, therapeutic alliance, etc.).

Narrative Example: Multiple uses of data collected from the same sample

The data reported in this manuscript have been previously published and/or were collected as part of a larger data collection (at one or more points in time). Findings from the data collection have been reported in separate manuscripts. MS 1 (published) focuses on variables 1, 2, and 3; while MS 2 (in press) focuses on variables 4, 5, and 6. MS 3 (the current manuscript) focuses on variables 8, 9, and 15. MS 4 (soon to be submitted) will focus on variables 10, 12, and 14.

Narrative Example: Publicly available dataset

The data reported in this manuscript were obtained from publicly available data, [name of project, along with website link to project description]. A bibliography of journal articles, working papers, conference presentations, and dissertations using the [name of project] is available at [website link to bibliography list]. The variables and relationships examined in the present article have not been examined in any previous or current articles, or to the best of our knowledge in any papers that will be under review soon. [Alternatively, clarify any overlap of variables, as done in the narrative example above].

Upon submission of the manuscript, authors will be required to attest to the provision of the required information described above.

Finally, upon acceptance of a manuscript, authors will be required to provide, as part of the Author Note, a list of related published papers that come from the same dataset, unless such papers are clearly described and referenced in the manuscript (specifically noting that findings come from the same dataset).

Data and Stimulus Materials

Should your paper ultimately be accepted for publication, JCCP would like to encourage you to determine if posting materials and/or data is right for your study and, if so, to make your data and materials publicly available, if possible, by providing a link in your paper to a third-party repository.

Making your data and materials publicly available can increase the impact of your research, enabling future researchers to incorporate your work in model testing, replication projects, and meta-analyses, in addition to increasing the transparency of your research.

The APA's data sharing policy does not require public posting, so you are free to decide what is best for your project in terms of public data, materials, and conditions on their use. Note, however, that APA policy does require that authors make their data available to other researchers upon request.

Manuscript Preparation

Prepare manuscripts according to the Publication Manual of the American Psychological Association using the 7th edition. Manuscripts may be copyedited for bias-free language (see Chapter 5 of the Publication Manual).

Review APA's Journal Manuscript Preparation Guidelines before submitting your article.

Double-space all copy. Other formatting instructions, as well as instructions on preparing tables, figures, references, metrics, and abstracts, appear in the Manual. Additional guidance on APA Style is available on the APA Style website.

Below are additional instructions regarding the preparation of display equations, computer code, and tables.

Display Equations

We strongly encourage you to use MathType (third-party software) or Equation Editor 3.0 (built into pre-2007 versions of Word) to construct your equations, rather than the equation support that is built into Word 2007 and Word 2010. Equations composed with the built-in Word 2007/Word 2010 equation support are converted to low-resolution graphics when they enter the production process and must be rekeyed by the typesetter, which may introduce errors.

To construct your equations with MathType or Equation Editor 3.0:

Go to the Text section of the Insert tab and select Object.

Select MathType or Equation Editor 3.0 in the drop-down menu.

If you have an equation that has already been produced using Microsoft Word 2007 or 2010 and you have access to the full version of MathType 6.5 or later, you can convert this equation to MathType by clicking on MathType Insert Equation. Copy the equation from Microsoft Word and paste it into the MathType box. Verify that your equation is correct, click File, and then click Update. Your equation has now been inserted into your Word file as a MathType Equation.

Use Equation Editor 3.0 or MathType only for equations or for formulas that cannot be produced as Word text using the Times or Symbol font.

Computer Code

Because altering computer code in any way (e.g., indents, line spacing, line breaks, page breaks) during the typesetting process could alter its meaning, we treat computer code differently from the rest of your article in our production process. To that end, we request separate files for computer code.

In Online Supplemental Material

We request that runnable source code be included as supplemental material to the article. For more information, visit Supplementing Your Article With Online Material.

In the Text of the Article

If you would like to include code in the text of your published manuscript, please submit a separate file with your code exactly as you want it to appear, using Courier New font with a type size of 8 points. We will make an image of each segment of code in your article that exceeds 40 characters in length. (Shorter snippets of code that appear in text will be typeset in Courier New and run in with the rest of the text.) If an appendix contains a mix of code and explanatory text, please submit a file that contains the entire appendix, with the code keyed in 8-point Courier New.

Tables

Use Word's Insert Table function when you create tables. Using spaces or tabs in your table will create problems when the table is typeset and may result in errors.

Academic Writing and English Language Editing Services

Authors who feel that their manuscript may benefit from additional academic writing or language editing support prior to submission are encouraged to seek out such services at their host institutions, engage with colleagues and subject matter experts, and/or consider several vendors that offer discounts to APA authors.

Please note that APA does not endorse or take responsibility for the service providers listed. It is strictly a referral service.

Use of such service is not mandatory for publication in an APA journal. Use of one or more of these services does not guarantee selection for peer review, manuscript acceptance, or preference for publication in any APA journal.

Submitting Supplemental Materials

APA can place supplemental materials online, available via the published article in the PsycARTICLES ® database. Please see Supplementing Your Article With Online Material for more details.

References

List references in alphabetical order. Each listed reference should be cited in text, and each text citation should be listed in the References section.

Examples of basic reference formats:

Journal Article:
Hughes, G., Desantis, A., & Waszak, F. (2013). Mechanisms of intentional binding and sensory attenuation: The role of temporal prediction, temporal control, identity prediction, and motor prediction.Psychological Bulletin, 139, 133-151. http://dx.doi.org/10.1037/a0028566

Authored Book:
Rogers, T. T., & McClelland, J. L. (2004).Semantic cognition: A parallel distributed processing approach. Cambridge, MA: MIT Press.

Chapter in an Edited Book:
Gill, M. J., & Sypher, B. D. (2009). Workplace incivility and organizational trust. In P. Lutgen-Sandvik & B. D. Sypher (Eds.),Destructive organizational communication: Processes, consequences, and constructive ways of organizing (pp. 53-73). New York, NY: Taylor & Francis.

Figures

Graphics files are welcome if supplied as Tiff or EPS files. Multipanel figures (i.e., figures with parts labeled a, b, c, d, etc.) should be assembled into one file.

The minimum line weight for line art is 0.5 point for optimal printing.

For more information about acceptable resolutions, fonts, sizing, and other figure issues, please see the general guidelines.

When possible, please place symbol legends below the figure instead of to the side.

APA offers authors the option to publish their figures online in color without the costs associated with print publication of color figures.

The same caption will appear on both the online (color) and print (black and white) versions. To ensure that the figure can be understood in both formats, authors should add alternative wording (e.g., "the red (dark gray) bars represent") as needed.

For authors who prefer their figures to be published in color both in print and online, original color figures can be printed in color at the editor's and publisher's discretion provided the author agrees to pay:

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The first Diagnostic and Statistical Manual of Mental Disorders was published.

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Introduction

Translated into over twenty languages, referred to by clinicians from multiple schools, as well as by researchers, policy-makers, criminal courts, and third-party reimbursement entities [ 1], the Diagnostic and Statistical Manual of the American Psychiatric Association ( DSM) enjoys a nearly hegemonic status as the reference for the assessment and categorization of mental disorders of all types - not only in the United States, but increasingly in Europe and more recently Asia. To be sure, the discipline and practice of psychiatry has changed since the first DSM was released, and with the fifth edition ( DSM-V) currently in field trials in preparation for general release in spring 2013, there is renewed discussion - and debate - about whether this latest volume represents 1) a work of lessons learned from prior editions, and in this way may be seen as an epistemologically iterative step in defining and characterizing the often ambiguous if not enigmatic qualities of "mental disorder(s)", or 2) merely an embellished version of previous volumes that perpetuates misnomers and vagaries and thus fails to be anything more than of nominal value.

Whether endorsed as a reasonable gold-standard or criticized as limited in scope and utility, what cannot be ignored is the effect - if not power - that the DSM has exerted, and continues to exert, both within psychiatry and society at-large. Therefore, it is important to consider if, and how the DSM-V will manifest impact in and upon the character and conduct of psychiatry, medicine and the social sphere. Toward this end, we pose a Socratic question - from where have the DSM and psychiatry come, and to where are they going? Thus, this essay seeks to analytically scrutinize - and contextualize - the major developments that have occurred in various editions of the DSM, focusing upon factors that motivated its development in 1952, and the multiple changes and repercussions various editions have effected in psychiatry over the past sixty years. Inquiry to the history of such a prominent standardized nosology of mental disorders may be a means of probing (at least in contours and highlights) the intellectual landscape of psychiatry throughout the second half of the twentieth century. In this light, three major "phases" will be addressed: first is the period encompassing the formulation and release of the first and subsequent second edition of the DSM; second is the period of the rather 'revolutionary' DSM-III, and third is the post- DSM-III period to the present, during which the DSM-IV and DSM-IV Text-Revised (DSM-IVTR) editions were released. Particular emphasis shall be upon the development of the DSM-III, as the major trends it embodied have been largely accentuated throughout all subsequent editions of the manual.

However, it may first be worth noting one of the most pervasive, yet often elusive characteristics of any historiological recollection, including this one. Namely, that by the very selection of key historical phenomena deemed to be worthy of inclusion in any account, and by the differential emphasis on, and chronological linkages between the diverse components of such an account, the final product is often far from being wholly "objective" and\or comprehensive. We recognize this, and acknowledge that such implicit tendencies may indeed have affected the scope and tenor of the present essay. Still, we hope to shed light on critical developments within and around the DSM throughout its history, and to attempt to make sense of this progression through a didactic approach. We shall also attempt to avoid cursory generalizations, by instead seeking a leveled appraisal of multiple, if at times conflicting, interpretations of the same historical phenomena.

A beginning: Nosological attempts culminating in the DSM-I

Some of the first attempts to formally classify psychopathology in the United States were undertaken during the early nineteenth century. For the most part, such efforts were collections of demographic data by the Bureau of the Census, and were intended more for mental health policy to regulate the treatment of the institutionalized mentally ill, rather than for diagnostic purposes [ 2]. Uncertainty surrounding the etiological bases of psychopathology, and psychiatrists' contention that abnormal behavior involved complex, variable, and often obscure interactions of internal and external factors, compelled formulation of a uniform nosological system of acknowledged clinical utility (notable exceptions to such general uncertainties include the late nineteenth century association between syphilis and general paresis, and the early twentieth century identification of the link between vitamin B deficiency and pellagra) [ 3].

As the perceived role of psychiatry broadened to include mental health beyond the boundaries of mental institutions, interest in devising a viable classification system for psychopathological conditions was strengthened within the psychiatric community. In 1918, under the auspices of the Bureau of the Census and the National Committee for Mental Hygiene, the American Medico-Psychological Association (now the American Psychiatric Association), first attempted the creation of a formal, standardized nomenclature of psychopathological conditions. These efforts culminated in the publication of the Statistical Manual for the Use of Institutions for the Insane, what can be considered to be the predecessor of the Diagnostic and Statistical Manual of Mental Disorders series. The volume included 22 diagnostic categories, most of which were psychotic conditions associated with presumed somatic etiology. This biologically-oriented classification approach, consistent with then-dominant Kraepelinian constructs linking abnormal behavior to organic brain dysfunctions, echoed the nature of the psychiatric profession at the time: the overwhelming majority of clinicians practiced in mental asylums, where patient populations were predominantly afflicted with severe mental disturbances associated with conspicuous physical impairments and disease [ 2].

Nine subsequent editions of the Statistical Manual followed during the interwar years, all of which emphasized the somatic viewpoint, offered relatively broad categorizations of mental disorders, and were of limited diagnostic utility. The psychodynamic approach (mostly reflecting the work of Freud in Europe, and Meyer in the United States), which originated at the beginning of the twentieth century but had maintained an initially marginal role, ascended in dominance after the relative successes of this approach in treating military patients who suffered neuropsychiatric trauma [ 2]. Growing recognition of the role environmental stressors in mild psychological disturbances - "psychoneuroses" in the verbiage of the psychodynamic tradition - expanded psychiatrists' role in treating the milder emotional and behavioral disorders that were relatively common in society at-large. The conceptualization of psychopathology had largely shifted from recognizing mental conditions as discrete disease entities distinct from mental health, to considering mental health and illness on a continuum of variable severity [ 4].

Psychodynamic theory gained rapid acceptance in both the clinical and academic arenas of psychiatry, and by 1946, was officially acknowledged as the leading school of thought by the American Board of Psychiatry [ 2]. Respective of changing conceptualizations of mental disease, and a broadening of psychiatric clientele - both of which being for the most part incompatible with earlier nosological frameworks, the APA Committee on Nomenclature and Statistics sought to create a new classification system: the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which was officially released in 1952 [ 5]. This compendium included 102 broadly-construed diagnostic categories that were based upon psychodynamic etiological explanations, and were accordingly subdivided into two major groups of mental disorders: 1) conditions assumedly caused by organic brain dysfunction (associated with somatic disturbances such as intoxication, trauma, or a variety of physiological diseases), and 2) conditions presumed to result from the effect(s) of socio-environmental stressors on individuals' biological constitution and patients' inability to adapt to such pressures [ 6]. The latter group was further subdivided into psychoses - that is, those disorders constituting relatively severe conditions such as manic-depressive disorder or schizophrenia, and, at the other end of the scale, psychoneuroses, which included conditions such as anxiety, depressive disorders, and personality disorders [ 6]. A notable figure in the development and promotion of the psychodynamically-oriented "maladjustment model" fostered by the DSM-I was Adolf Meyer, a neurologist by training, whose interests shifted to psychiatry upon his move from Switzerland to the United States in 1892 [ 7, 8]. While hailed as meaningful by its authors, the DSM-I actually had only limited bearing on psychiatric practice [ 9], although it did in fact set the stage for increasingly standardized categorization(s) of mental disorders, if not an implicit standardization of psychiatric approaches to diagnosis and treatment.

To compensate for perceived inadequacies of the DSM-I, the second edition of the Diagnostic and Statistical Manual of Mental Disorders was published in 1968, and was still largely reflective of the psychodynamic tradition [ 10], although this school of thought was already on the decline by the end of the 1960s, and subtle amendments made to DSM-II hinted (albeit somewhat inconspicuously) at such change. Two major trends can be noted in the content modifications to the DSM-II. The first was a further expansion of the definitions of mental illness that was arguably in line with a broadening of psychodynamic theory to be more inclusive of milder conditions seen in the general population. This was indicated by the addition of diagnostic categories such as "Conditions Without Manifest Psychiatric Disorder" for "... individuals who are psychiatrically normal but who nevertheless warrant examination by a psychiatrist", and "Transient Situational Disturbances" for "... disturbances of psychotic proportion ... when they are considered clearly transient reactions to overwhelming environmental stress" [ 11]. The second trend was an increased systematic categorization and specificity that suggested a return to the Kraepelinian tradition. This was evidenced by multiple subdivisions of former disorder categories, such as the addition of eight new "alchoholic brain syndromes", an increased number of "qualifiers" from four in the DSM-I to nine in the DSM-II - namely, "acute; chronic; not psychotic; mild; moderate; severe; in remission", and the explicit advocacy that clinicians "... diagnose every disorder that is present, even if one is the symptomatic expression of another" [ 11]. Yet another alteration in the DSM-II was the removal of the psychodynamic term "reaction", referring to the maladaptive response of an individual to socio-environmental sources of distress. A disclaimer accompanied the announcement of such modification:

"Some individuals may interpret this change as a return to a Kraepelinian way of thinking, which views mental disorders as fixed disease entities. Actually this was not the intent of the APA Committee on Nomenclature and Statistics: "[The Committee] tried to avoid terms which carry with them implications regarding either the nature of a disorder or its causes [...]. In the case of diagnostic categories about which there is current controversy concerning the disorder's nature or cause, the Committee has attempted to select terms which it thought would least bind the judgment of the user." [ 11]

While significant discrepancies existed between the classification schemes of the DSM-I and the International Classification of Diseases, 6th revision (ICD-6) of the World Health Organization (WHO), The DSM-II And the ICD-8 were more closely aligned, reflecting a collaborative effort between the WHO and American psychiatrists sent to Europe prior to the publication of both the ICD and DSM manuals that same year [ 11]. It is interesting that Spitzer was an influential consultant to the DSM-II, a primary author of the "revolutionary" third edition of the DSM, and chaired the task force overseeing DSM-III development [ 12].

A "turning point" in psychiatry: The DSM-III

Negative critique of psychiatry mounted considerably during the 1960s and early to mid 1970s; perhaps most notable was Thomas Szasz's 1961 challenge to the fundamental premise that all psychiatric conditions were "true illnesses", which by extension, cast skepticism upon the legitimacy of psychiatry as a medical discipline [ 12]. Moreover, the lack of clear demarcations between mental health and illness, and the relatively low reliability of psychiatric diagnoses, were sharply criticized both within the psychiatric community and from without [ 13]. In addition to the rising discontent towards psychodynamic psychiatry was a significant restriction of resource funding. Diminished research support from the National Institute of Mental Health (NIMH), and reduced resource allocations by the federal government and insurance providers were prevalent throughout the 1970s, based, at least in part, upon the perception that psychodynamic psychiatry's lack of uniformity in classification fostered non-rigorous investigations, and superfluous healthcare expenditures [ 12, 14]. In particular, psychiatrists' non- medically licensed competitors (e.g.- psychologists, social workers, and counselors) were offering psychodynamically-based therapeutic services at significantly less expensive rates, and this challenged the psychiatric community to prove that its diagnoses and therapies were (more) efficacious and represented treatment of legitimate medical diseases [ 14]. Concomitantly, a neo-Kraepelinian "invisible college" of more biologically-oriented psychiatrists increasingly and more ardently criticized psychodynamically-oriented psychiatric research and practice [ 13].

Substantive advances in psychometric instruments for quantitative psychiatric assessment, such as rating scales and checklists for anxiety and depression, had become something of a standard in mental health research and practice. Progress in therapeutics had also ensued, with increasingly more efficient behavioral and brief psychotherapeutic approaches [ 13], and notably, progress in psychopharmacology, which by the 1960s had developed a significant armamentarium of mood- and behavior-altering agents [ 15]. In fact, by the mid 1970s, prescribing psychotropic medications had become de rigueur for much of psychiatric practice [ 16]. Posturing against the challenges facing psychiatry, the research community engaged series of responses; among the most significant being 1) a 1965 conference addressing psychiatric classification that was sponsored by the Psychopharmacology Research Branch of the NIMH, 2) the formulation of the Washington University criteria for operational diagnosis in the early 1970s, and 3) the development of the Research Diagnostic Criteria (RDC) by the NIMH Psychobiology of Depression Collaborative Study, in 1978 [ 17]. Thus, a multitude of factors created a propitious climate for change that culminated in the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980 [ 18].

Many of the modifications incorporated into the DSM-III constituted a veritable paradigm shift in psychiatry. Perhaps the most telling feature of this trend was the official removal of the psychodynamic term "neurosis". Confronted by an outcry from psychodynamically-oriented psychiatrists, the decision to ban the term from the DSM was only mildly amended: the DSM-III's Nomenclature Task Force eventually decided to include the term parenthetically as "neurotic disorder" after renaming mental disorder categories that corresponded to the earlier "neurosis" classifications. Additionally, an explanation of the distinction between "neurosis" as an etiological explanation, and the expression "neurotic disorder" as a discrete entity was underscored in the Introduction of the DSM-III [ 19]. This decision involved a categorical reorganization of many of the disorders previously conceptualized in psychodynamic terminology.

The increased number of mental disorder categories (from 182 in the DSM-II to 265 in the DSM-III) was posed to reflect the increase in psychiatric knowledge accrued since the DSM-II, as well as amplification in the specificity of and in diagnosis sought by the DSM-III Task Force. The latter often entailed ramifications from previous, more broadly construed categories into several individual "subtypes", each considered as a separate and discrete mental disorder. For instance, the number of disorders under the umbra of Schizophrenia changed from 14 categories in the DSM-II to 18 in the DSM-III. Several single disorders were divided into a number of distinct categories; for example, the DSM-II category "Specific Learning Disturbance" was divided into five different "Specific Developmental Disorders", the category "Tic" gave way to three distinct "Stereotyped Movement Disorders," and the single category "Feeding Disturbance" was replaced by four specific "Eating Disorders". This trend of subdivision and reclassification was most pronounced, however, for the categories previously classified as "neuroses". For instance, three classes of "Hysterical Neurosis" in the DSM-II gave way to six renamed "daughter disorders" in the DSM-III. The single category "Phobic Neurosis" was divided into five classes of "Phobic Disorders", and the single category "Depressive Neurosis" was substituted by four categories of "Major Depression" [ 20].

Additionally, many novel disorder categories (that were absent in the DSM-II) were formalized as mental illness in the DSM-III. These included Post-Traumatic Stress Disorder, an array of childhood and adolescence disorders (such as three categories of Attention-Deficit Disorder), seven classes of "Psychosexual Dysfunctions", and four "Disorders of Impulse Control Not Elsewhere Classified" (such as "Pathological Gambling"). Controversy has arisen over the legitimacy of several of these categories as "true illnesses" since their incorporation in the DSM-III and perpetuation in successive editions of the DSM-IV.

One of the amendments that was of greatest impact was the permanent removal of the category "Homosexuality" from the DSM-II. The change was originally made upon the publication of the seventh printing of the DSM-II in 1973, following a vote by the American Psychiatric Association earlier that year [ 14]. The decision was provocative (if not controversial) within camps of both advocacy and antagonism: in the former because it was contended (and in retrospect rightly so) that the earlier classifications of homosexuality-as-disorder were largely shaped by politically and socio-culturally contingent notions of deviance, rather than scientific corroboration [ 13], and in the latter because it was claimed that the change was based on consensus between figures representing "expert opinion" and Gay Rights' lobbying efforts.

In addition to content modifications, several other novel features of the DSM-III merit mention. Specifically, elaborate and more explicitly defined operational criteria for inclusion and exclusion were formulated for each disorder. These included standards for differential diagnosis of several categories of disorder that share similar characteristics, and the minimum duration of signs and symptoms required for a clinical diagnosis to be made. Another unique feature of the DSM-III was the adoption of a "multi-axial system" of diagnosis to account for patients' multi-factorial presentation and multi-dimensional experience of mental illness, and to facilitate a more comprehensive depiction of the patient's condition [ 21]. Finally, prior to adoption, the diagnostic categories developed in the DSM-III were subjected to NIMH-sponsored field trials between September 1977 and September 1979 in order to assess inter-rater reliability. While not compared to inter-rater agreement(s) on earlier nosologies, the DSM-III classification system was reported to have relatively good diagnostic reliability [ 11, 22].

Taken together, the multiple amendments introduced to the DSM-III demonstrate a shift in the conceptualization of mental disorders from psychological "states" to discrete, operationally defined disease categories, and a return to a descriptive, symptom-based classification. In essence, the DSM-III inaugurated an attempt to "re-medicalize" American psychiatry.

Repercussions

The release of the DSM-III in 1980 has been perceived as a nothing short of a momentous phenomenon. The APA's executive officer Melvin Sabshin heralded it as the victory of "science over ideology" [ 23], and Gerald Klerman, a leading psychiatrist at the time of the DSM-III's inception, termed its development a "fateful turning point in the history of the American psychiatric profession" [ 24]. Effects of the DSM-III rapidly pervaded psychiatric practice, research, and teaching. As early as 1982, Klerman asserted that "... there is not a textbook of psychology or psychiatry that does not use DSM-III as the organizing principle for its table of contents and for classification of psychopathology". In fact, as Young has stated, "American medical schools and residency programs routinely expected students and physicians to pass examinations based on DSM-III criteria. [...] Both referees and journal editors expected manuscripts submitted to scholarly journals to be written in its language, and it was simply assumed that psychiatric research proposals would conform to its conventions" [ 25].

In an appraisal of the DSM-III a mere six years after its publication, Klerman noted a number of repercussions within several schools of thought in psychiatric research and clinical practice. Klerman claimed that the DSM-III had provided a formal common language that facilitated communication between multiple mental health professionals. While contending that the DSM-III had not become "the final consensus" with which to unify divergent perspectives regarding psychopathology, he acknowledged the "increasing acceptance of this diagnostic framework as the basis for teaching and research" [ 13]. Even proponents of the psychodynamic tradition, some of DSM-II's major critics, gained a greater appreciation for the manual's classification system, while hoping for the addition of another "Axis" that would be more aligned with psychodynamic theory in the next edition of the DSM-III (an aspiration which, while explicitly suggested to the DSM-III's Task Force and tentatively agreed upon by Spitzer and colleagues, never actually materialized) [ 13]. Indeed, while a torrent of criticism met the publication of the DSM-III, the "revolution" it fostered was quick and its effects durable, and psychiatrists who wished to retain their roles and credibility in the field soon had to conform to its newly introduced, government-sanctioned nosology of mental disorders [ 14].

The delineation of operationally defined diagnostic categories for mental disorders incurred a surge in epidemiological morbidity studies. Perhaps the most significant was the NIMH Epidemiological Catchment Area Project, which sought to assess the incidence and prevalence of mental disorders, as classified by the DSM-III, within the United States' general population [ 26]. Furthermore, while the DSM-III classification system did not explicitly link diagnostic categories to any particular treatment options, the symptom-based, somatically-oriented nature of the classification scheme was particularly compatible with biological therapies customized to discretely constructed disease entities. For any medication to be approved by the FDA, a drug needs to be proven effective in the treatment of a specific disease [ 14]. The clear demarcation of standardized, purportedly more reliable psychopathological diagnostic categories thus provided researchers, and pharmaceutical companies, an incentive to launch randomized controlled trials (RCT) to test newly developed psychopharmacological agents in the treatment of specific DSM-III disorders [ 14]. In the years following the publication of the DSM-III, billions of dollars were allocated by the government and pharmaceutical companies for psychopharmacological research [ 27]. For example, during the 1980s, the federal research budget allocated to the NIMH increased by 84 percent, to about $484 million annually [ 28]. Insurance providers equally welcomed the arrival of the new nosology, and adopted the DSM-III (and its subsequent editions) as the standard diagnostic categorization upon which to base reimbursement of therapeutic modalities (particularly, psychopharmacologic interventions) [ 14].

After DSM-III: Accentuation of the "revolutionary textbook's" orientation?

Subsequent editions of the Diagnostic and Statistical Manual of Mental Disorders all displayed characteristics that are congruent with the orientation of the DSM-III. The number of categories of disorders has increased from 265 disorders in the DSM-III, to 292 in the DSM-III-R, to 297 in the DSM-IV [ 6, 10, 18, 29- 31]. The trend toward enhanced specificity of operational criteria has likewise become more pronounced throughout successive editions of the DSM, and information regarding prevalence, age- and sex -differential characteristics, and co-morbidity with other disorders has been added and regularly updated since the DSM-III-R. The significant increase in epidemiological studies based upon DSM criteria following the publication of the DSM-III has allowed for the incorporation of empirical data into the classification of several disorders [ 18, 29- 32]. Additions to the DSMs have also included information gathered from studies of the pathophysiology of mental disorders, and most recently have included data obtained from and based upon neuroimaging studies. The trend toward increased subdivisions of disorders that was originally initiated in the DSM-III has been evident in all subsequent editions of the manual. For instance, the eight categories of "Psychosexual Dysfunctions" in the DSM-III evolved to ten categories of "Sexual Dysfunctions" in the DSM-III-R, and to seventeen different "Sexual Dysfunction" classes in the DSM-IV and its text revised edition, the DSM-IV-TR [ 18, 29- 31]. Other major amendments included the incorporation of a section dealing with "Culture-bound Syndromes" in the DSM-IV and DSM-IV-TR, thereby acknowledging cultural variability in the ways that mental health and illness are expressed and construed [ 30, 31]. In all, the changes to editions of the DSM following the DSM-III have essentially revolved around an accentuation of a "medicalizing" trend in psychiatry.

Rogler has attempted to interpret the increasing size and complexity of the DSM since its first edition until the DSM-IV, and has identified five major changes in its evolution; these are: 1) a theoretical shift in the conceptualization of mental disorders from a bio-psychosocial model to a research-oriented, medical model; 2) development of the multi-axial diagnostic system that facilitated a rise in biomedical findings based upon the five axes and the relation(s) between them; 3) the inclusion of new disorders and expansion of previously defined disorders; 4) a "lateral" reorganization of disorders into discrete, broad categories that entailed merging a number of disorders and eliminating others; and 5) a neo-Kraepelinian paradigm shift that was first evidenced in the DSM-III, that reinforced the descriptive, somatic orientation that then became the norm in all subsequent DSMs [ 33]. Indeed, this last point is important, as Rogler's analysis highlighted the iterative dominance of the medical model since the DSM-III - and, in parallel, the growth of this model in throughout almost all of psychiatric practice, education, and training.

At present, field trials of the DSM-V are underway, and the objectives outlined in " A Research Agenda for DSM-V" (2002) are largely concordant with the trends observed throughout the manual's evolution. Of particular interest is the continuing emphasis on the (at least implicit) incorporation of biological data into the classification of disorders in the DSM, with the intended elaboration of findings from studies in behavioral genetics and neuroimaging in the disorder classifications in the DSM-V. However, the Manual does not explicitly specify what and how neurogenetic, neuroimaging, and neurochemical data can or should be employed in establishing differential diagnoses of mental disorders. Moreover, the possibility of employing these largely experimental neuroscientific and neurotechnological methods for diagnostic purposes is not without contention and has become the focus of considerable neuroethical debate (see [ 34] for overview).

Critical deliberations

The history of the DSM series may certainly be viewed as an attempt to integrate scientific progress to the categorization of psychopathology, thereby reflecting an increased epistemological capital, and compelling psychiatric diagnoses to be better aligned with the medical model. Yet, while elaboration of a standardized nosology for mental disorders may have afforded a major impetus for research on psychopathology, it has also generated particular problems, abuses and possibly unforeseen consequences in the manner in which psychiatric disturbances are understood, diagnosed, and treated [ 35].

Perhaps one of the most striking corollaries of the symptom-based, somatically-oriented descriptive approach fostered by the DSM-III is the increase in psychopharmacological interventions, applied to conditions ranging from the severest of mental disorders to much milder DSM categories that had previously been treated with psychotherapeutic and behavioral approaches. Research in the neurochemistry and pharmacology of specifically defined psychopathological conditions has enabled the pharmaceutical industry to develop drugs targeting biological markers associated with such conditions. While this has led to the relatively successful treatment of a number of neuropsychiatric conditions (e.g., anxiety, depression, certain forms of psychosis) and provided appreciable therapeutic benefit to scores of patients, the pharmacological approach has been less than wholly successful in the treatment of other psychiatric conditions (e.g., type I bipolar disorder, schizophrenia, personality disorders). As well, the potential for misusing the pharmaceutical approach has been decried by several critics [ 36- 39], and the phenomenon of "disease mongering" has been noted in the marketing of various drugs (e.g.- the selective serotonin reuptake inhibitors, SSRIs) for such conditions as "mild social anxiety", which is been described as a "medicalization of shyness" [ 36]. Similarly, the medicalization of cognition, emotion, and behavior has also generated discourse- if not controversy- about the interpretation of subjective variables, such as what constitutes "normal" or "optimal" function within the context and expectations of society and culture [ 40].

In this light, the broadening categorization of mental disorders, both in terms of what constitutes "un-health", and who may be a target of psychopharmacological intervention (including young children), has paralleled the increase in the number of individuals considered to possess a mental illness [ 41]. The perplexing conclusion drawn from a recent National Comorbidity Survey for mental disorders in the United States asserts that: "...about half of Americans will meet the criteria or a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth" [ 42], and this prompts a renewed interest in questions of what constitutes treatment, enablement, or enhancement- and what metrics, guidelines, and policies need to be established to clarify such criteria [ 40, 43].

Problematic issues arising in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to the difficulties of formulating a standardized nosology of psychopathology. Charles Rosenberg has posited that the formulation of standardized and clearly delineated diagnostic classifications, based on the conceptualization of dysfunctions as discrete disease entities, serves to legitimize existence of named and defined disease(s), and can obscure the 'constructedness' of the categories themselves [ 44]. It may be worth pondering the extent to which such a phenomenon could be particularly problematic with regard to a number of behavioral and emotional conditions that might be mere extensions of normal behavior or simple "eccentricities" that would then construed as medical diseases. The "pathologization of deviance" and the "medicalization of social ills" are potential effects of psychiatric diagnoses and treatment trends. While such categorizations may arise from, and be directed toward benevolent intentions, caution is required to insure against socio-political usurpation of these diagnoses, and repetition of historical instances of bastardization of medicine by capricious agenda [ 45- 49].

Conclusion

The history of the DSM has been characterized by a shift in the conceptualization of mental health and illness, reflecting an attempt to adhere to the ontological claims and canon of "biomedicine" and sustain psychiatry's medical identity. The evolution of the DSM illustrates that what is considered to be "medical" and "scientific" is often not an immutable standard, but rather, may be variable across time and culture, and in this way contingent upon changes in dominant schools of thought. The elaboration of a standardized nosology of mental disorders has had diverse impact(s) on the manner in which psychopathology is conceived, on the definition of who constitutes a psychiatric patient, and how cognitions, emotions, and behaviors are regarded and treated. The act of diagnosis in and of itself validates the very disease it names and defines [ 44, 50]. As such, current classifications of mental disorders must be understood, at least to some extent, as "constructed concepts" that are amenable to modification, as evidenced by the various transmutations within the DSM throughout its successive editions, rather than incontestable facts. The development of the DSM has evidenced values and assumptions reflective of the Zeitgeist of each edition. As noted by John Sadler, "...values, not cognitions, determine what we select as 'important', 'crucial', 'central', 'decisive', or 'related'. In other words, values lend structure to the field of attention, predefining background and foreground, and clustering disparate items into groups. Consequently, descriptive statements about psychopathology issue from presupposed value stances that conceal their own deeper sources, compatibilities, and incompatibilities" [ 51].

While such values and assumptions may be neither inherently "good" nor "bad", and may be enmeshed within scientific pursuits of all types [ 52], awareness of their existence and of their contribution to the shaping of what is regarded as scientific knowledge is imperative. Even if we were to presume that scientific knowledge were wholly objective and free of any values or bias whatsoever, it is nonetheless critical to recognize that new information adds to, and may subordinate, older knowledge in an iterative, self-corrective process. Thus, adherence to a doctrinal stance must be flexible to adapt to new insights and revision, lest it become anachronistic and dogmatic. While the changes to the DSM are based upon scientific strides and humanitarian intent, it's important to measure such claims by the purported objectives to improve diagnosis and treatment in accordance with both psychiatry's professed medical identity, and the new dimensions of the discipline and its practice that are enabled by neuroscience, neurotechnology, genetics, the social sciences, and the humanities. If, and how such claims are realized by the DSM-V remain questions for contemporary users of this new edition - and scholars, researchers and practitioners of psychiatry, the aforementioned fields, and ultimately patients and the public to address and decide. Clearly, both the DSM and psychiatry will remain a work-in-progress, and we must be ready and responsible for the potential benefits - and possible problems - that such progress may foster.

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A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice

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Translated into over twenty languages, referred to by clinicians from multiple schools, as well as by researchers, policy-makers, criminal courts, and third-party reimbursement entities [ 1], the Diagnostic and Statistical Manual of the American Psychiatric Association ( DSM) enjoys a nearly hegemonic status as the reference for the assessment and categorization of mental disorders of all types - not only in the United States, but increasingly in Europe and more recently Asia.

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The Bobo doll experiment is conducted by Albert Bandura.

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The third DSM is published.

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Abstract

The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) published by the American Psychiatric Association in 1980, and now translated in many languages, has raised a great interest in the whole world. It has probably had on psychiatric thinking as important an impact as the Treatise of Psychiatry of E. Kraepelin at the beginning of the century. The evolution of psychiatric nosology and the circumstances of the birth of DSM-III are described. In discussing the general principles and the technical aspects, the influence of several currents of thought are emphasized: recent remedicalization of psychiatry in the United States, suspicion about speculative theories, return to an a-theoretical clinical descriptive nosology, influence of quantitative differential psychology and of the models provided by computer diagnosis. The nature of the two basic principles: the necessity of attaining a proven high interjudge reliability in diagnosis, and the descriptive a-theoretical nature of the description of each category is analyzed. From those principles derive the most original features of the DSM-III: the use of stringent diagnostic criteria, of a possible quantitative nature and the adoption of a multi-axial system. Some of the most striking changes introduced are the logical consequences of the principles e.g. the deletion of the term "neurosis". Others changes such as the introduction of new diagnostic categories or changes in the limits of classical ones (especially schizophrenia and manic-depressive psychosis) reflect a reaction against previous trends of American psychiatry and a strict adherence to a pragmatic and empirical thinking. In addition, the flexibility of its structure allows for the incorporation of new empirical results. In spite of many criticisms, either against the general orientation or against specific positions, some of which are presented in the course of this article, it is concluded that the success of the DSM-III results from a trend in psychiatric thinking not confined to the United States. Its controversial nature has stimulated the reappraisal of old concepts, and it can be considered as an important contribution towards a closer integration of psychiatry to medicine.

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national center for biotechnology information

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[DSM-III: the 3d edition of the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association] - PubMed

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The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) published by the American Psychiatric Association in 1980, and now translated in many languages, has raised a great interest in the whole world. It has probably had on psychiatric thinking as important an impact as th ...

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An article (by Steven Pinker) is published on why children acquire language.

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Steven Pinker on How Children Learn Language

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DSM-IV is published.

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The 7 intelligences are suggested by Howard Gardner. (mathematical, verbal, intrapersonal, interpersonal, kinesthetic, spatial and musical)

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The first evidence of genetics being associated with a childs response to maltreatment.

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Researchers finished mapping human genes in order to isolate the chromosomes which are responsible for physiological and neurological conditions.

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A book is published which talks about how your sexual orientation from prenatal differentiation in the brain.

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"Gender identity disorder" is removed and replaced with "gender dysphoria" on the list of mental disorders.

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DSM 5 is the last and final one to be released.

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A prize is won for the discovery of which pattern the cells position in order to represent memory and navigation in the human brain.