DSM-III and the paradigm shift in psychology

Half of volume 89 of the Mars Hill Audio tape series is devoted to the topic of the DSM-III (published in 1980)-- Diagnostic and Statistical Manual of Mental Disorders - Third Edition-- and its impact on the field of psychology and its practice.

Ken Myers interviews:

Jerome C. Wakefield on how psychiatry began ignoring causes of mental suffering and so defined sadness as a disease (from his co-authored book The Loss of Sadness: How Psychiatry Transformed Normal Sadness into Depressive Disorder);

Christopher Lane on the complex characteristics of anxiety and the tendency to treat the absence of ease with drugs (from his book Shyness: How Normal Behavior Became a Sickness); and

Dan Blazer on why psychiatric disorders require attention to the story of patients' lives (from his book The Age of Melancholy: "Major Depression" and Its Social Origins).

All of these sound like fascinating books. But I want to focus on the broader picture-- Myers' primary interest as well. In talking with Wakefield, they describe the changes that went into the DSM-III and its impact on the field.

In an effort to become more objective in diagnoses and more scientific as a field, the editors of the DSM decided to drop discussions of cause and effect-- in order to focus exclusively on developing criteria for defining various conditions. They focused on symptoms but ignored context-- for example, circumstance, worldview, culture. (The one exception was bereavement, but that experience is notably "clean" and universal-- and thus, still valid in a reductionistic approach.)

The results? First, the DSM became more precise but less valid-- more accurate but less true. Second, the DSM pointed toward a greater emphasis on medicine-- as objective ways to deal with objective symptoms. Third, the DSM implicitly reduced its purview to materialism, by ignoring the role of story and focusing on objective criteria.

We see the same sort of shift in the field of economics and somewhat within science. Starting in the 1950s, economists moved away from story and context toward mathematical modeling. With the increasing power of computers in the 1970s, the shift accelerated. Although the extent of modeling vs. story has leveled off or improved since, say, the mid-1990s, it remains at a very high level. (The renaissance of story-telling in recent years among economists can be seen in the publication of Freakanomics and similar books.)

This is frustrating for story-telling economists, because many "economists" don't understand economics. An extreme example: in grad school, one of my peers had a PhD in Math &/or Physics-- and moved into Econ. He was astoundingly successful in publishing papers but had little clue about economic theory or public policy.

Within science, we see the same reductionistic impulse at play-- most notably, in the debate about evolution and Evolution. Knocking God out of the picture for the purpose of better explaining the world is confused with actually knocking God out of the world, or even out of the realm of possibility.

The funny thing about modeling (and any statistic) is that the practice is inherently reductionistic. And that's fine-- as long as one recognizes the subsequent limitations. Models are useful if they abstract from reality enough to simplify things appropriately-- but not so much that they deviate (incredibly) from reality. When backed by ignorance, the results are unfortunate. When backed by motives, we move to fundamentalism.

All of this is ironic and surprising in the face of post-modernism and its (healthy) emphasis on narrative. Or perhaps, the blowback we're seeing is a positive fruit of post-modernism-- in its war against reductionism.