DSM-III and its reception: a European view

The author analyzes some elements in the reception of DSM-III in Europe. The worldwide success of a diagnostic classification originally presented as a purely American endeavor is associated with recurrent, albeit not often openly formulated, criticisms. In the history of psychiatric nosologies, the purely descriptive phase was succeeded by a period during which theories were dominant, as in the Kraepelinian system. DSM-III originated in recognition of the existence in the United States of contending psychodynamic and psychosocial orientations and problems of communication, which became even more evident with the growth of psychopharmacology and the influence of the biological school. Whereas ICD offered compromise solutions, DSM-III used a new paradigm based on diagnostic categories and a multiaxial format, which were on the whole easily accepted. Most criticisms involved three points. The first was the atheoretical syndromic approach, seen as a regression and an expression of an American preference for superficial facts and contempt for psychopathology, which was considered in Europe the source of future progress. The second was the introduction of quantification, which was rejected by some in the name of the clinical tradition, which emphasized understanding of the individual case. The third was DSM-III's adherence to alleged American values, such as pragmatism and novelty. The ambivalence of Europeans toward the world expansion of American culture was reinforced by use of English as the language of international scientific communication. The mostly irrational nature of the criticisms contrasts sharply with the general acceptance of DSM-III and its successors, which rests on their objective merits.