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A composition researcher and psychiatrist report findings from their 3-year study of the revision of the most important book in the mental health profession: the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This 500-page diagnostic taxonomy defines some 250 mental disorders, and it functions for the field as a charter document, shaping the way mental illness is understood, treated, and studied. The revision project, which culminates in 1994 with the publication of DSM-IV, is a 6-year project involving some 1,000 psychiatrists and other mental health professionals. In this study the authors examine the DSM revision using three methodologies: in Part I they trace the history of the DSM classification system; in Part II they analyze published accounts of the revision by project leaders; and finally, in Part III they observe the revision process as it was actually carried out in one of the 13 work groups. The authors conclude that the revision of DSM functions less to change the text than to achieve certain social and political effects. They find the revision works to further entrench the biomedical model of mental disorder, to maintain the dominance of psychiatry within the mental health field, and to enhance the prestige of psychiatry in relation to other medical specialties.

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