Can you imagine doctors referring to patients as idiots, morons, or imbeciles? And, doing so not because of disliking their patients but as actual diagnostic labels?
It is difficult to conceive, but just a few decades ago the use of these particular terms was completely acceptable. Each was used to describe individuals with varying degrees of mental retardation (MR).
In my work with some older individuals with developmental disabilities, I have had the opportunity to review medical records from 50-60 years ago. (I know it’s difficult to believe, but some records that old still exist!) It is a surreal experience to see these terms used as casually as “depression” or “diabetes” is used in charts today. Yes, that’s correct, progress notes began with phrases such as, “This 18 year-old female moron,” or “This 22 year-old male imbecile.”
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The “bible” of psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (DSM), has had a very interesting, and at times frightening, evolution. Intended to improve reliability and never intended to become a “cookbook,” the DSM has unfortunately been taken quite literally by the insurance industry, the legal system, and others.
The DSM-V is slated for release in May 2012. The original DSM was released in 1952, and the DSM II in 1968. These two early versions nearly went unnoticed and were not widely used clinically. However, the DSM III, and especially the DSM-III R, became much more recognized as providing some degree of standardization of psychiatric diagnosis.
In January 2005, The New Yorker published an article, “The Dictionary of Disorder,” which takes the reader on an interesting journey in the life of psychiatrist Robert Spitzer and his efforts to create the DSM-III and DSM III-R with the goal of improving the reliability of psychiatric diagnosis.
Spitzer assembled groups of data-oriented psychiatrists to complete the task. The problem was that
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