During the 19th century and early 20th century, American psychiatry shared many intellectual
traditions and values with Great Britain and Europe. These include principles derived
from the Enlightenment concerning the dignity of the individual and the value of careful
observation. During the 20th century, however, American psychiatry began to diverge,
initially due to a much stronger emphasis on psychoanalytic principles, particularly
in comparison with Great Britain. By the 1960s and 1970s, studies such as the US-UK
study and the International Pilot Study of Schizophrenia demonstrated that the psychodynamic
emphasis had gone too far, leading to diagnostic imprecision and inadequate evaluation
of traditional evaluations of signs and symptoms of psychopathology. Diagnostic and
Statistical Manual of Mental Disorders, Third Edition (DSM-III) was developed in this
context, under the leadership of representatives from institutions that had retained
the more traditional British-European approaches (eg, Washington University, Iowa).
The goal of DSM-III was to create a comprehensive system for diagnosing and evaluating
psychiatric patients that would be more reliable, more valid, and more consistent
with international approaches. This goal was realized in many respects, but unfortunately
it also had many unintended consequences. Although the original creators realized
that DSM represented a "best effort" rather than a definitive "ground truth," DSM
began to be given total authority in training programs and health care delivery systems.
Since the publication of DSM-III in 1980, there has been a steady decline in the teaching
of careful clinical evaluation that is targeted to the individual person's problems
and social context and that is enriched by a good general knowledge of psychopathology.
Students are taught to memorize DSM rather than to learn complexities from the great
psychopathologists of the past. By 2005, the decline has become so severe that it
could be referred to as "the death of phenomenology in the United States."