Wilson M
Robert Wood Johnson Clinical Scholars Program, Stanford University School of Medicine, Calif.
Am J Psychiatry. 1993 Mar;150(3):399-410. doi: 10.1176/ajp.150.3.399.
The author traces the history of the development of DSM-III within the larger context--intellectual, economic, scientific, and ideological--of the development of American psychiatry since World War II. Data were obtained through a literature review, investigation of archival material from the DSM-III task force and APA, and interviews with key participants. This research indicates that from the end of World War II until the mid-1970s, a broadly conceived biopsychosocial model, informed by psychoanalysis, sociological thinking, and biological knowledge, was the organizing model for American psychiatry. However, the biopsychosocial model did not clearly demarcate the mentally well from the mentally ill, and this failure led to a crisis in the legitimacy of psychiatry by the 1970s. The publication of DSM-III in 1980 represented an answer to this crisis, as the essential focus of psychiatric knowledge shifted from the clinically-based biopsychosocial model to a research-based medical model. The author concludes that while DSM-III, and the return to descriptive psychiatry which it inaugurated, has had positive consequences for the profession, at the same time it represents a significant narrowing of psychiatry's clinical gaze.
作者在第二次世界大战以来美国精神病学发展的更广泛背景——知识、经济、科学和意识形态背景——中追溯了《精神疾病诊断与统计手册》第三版（DSM-III）的发展历程。数据通过文献综述、对DSM-III工作组和美国精神病学协会（APA）档案材料的调查以及对关键参与者的访谈获得。这项研究表明，从第二次世界大战结束到20世纪70年代中期，一种受精神分析、社会学思维和生物学知识影响的广义生物心理社会模型是美国精神病学的组织模型。然而，生物心理社会模型并没有明确区分精神正常者和精神疾病患者，这种失败在20世纪70年代导致了精神病学合法性的危机。1980年《精神疾病诊断与统计手册》第三版的出版代表了对这一危机的回应，因为精神病学知识的核心重点从基于临床的生物心理社会模型转向了基于研究的医学模型。作者得出结论，虽然DSM-III以及它所开创的回归描述性精神病学对该专业产生了积极影响，但与此同时，它也代表了精神病学临床视野的显著缩小。
