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Feminists have engaged psychiatrists in a hot debate over

menses, masochism, and madness.

92 NOVEMBER 1986

MIND:
PSYCHOFASHION
By Gurney Williams III

Psychotherapists put themselves on the couch whenever they try to define mental illness. In a
current debate over several proposed new disorders, for instance, it seems clear whats on the
minds of psychologists and psychiatrists this year. Its women.

OMNI 93

MIND:
Diagnoses that affect women are the focus
of a controversy over revisions to the highly
influential third edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSMIII). The board of trustees of the American
Psychiatric Association (APA) will decide
before the end of the year whether to add
three new disorders to the official DSM-III
roster. One is premenstrual syndrome (PMS),
the constellation of mood and physiological
changes coincident with the rhythms of the
menstrual cycle. The two others are personality
disorders, self-defeating and sadistic.
Critics (psychologists are particularly vocal) say
the additions arent based on good science and
that their inclusion would actually hurt women.
Its not the first such flap, nor the last, because
the rewriting of DSM provides an arena for
battles over the mind. Therapists who normally
soothe their clients take to the picket lines and
turn militant over diagnostic issues. Disorders
come and go. Even Sigmund Freuds concept
of neurosis was dropped in the original DSMIII (1980). And in 1973 APA trustees voted to
wipe out almost all references to homosexuality
as a disorder. Before the vote, being gay was
considered a psychiatric problem. After the vote
the disorder was relegated to psychiatrys attic.
Its a matter of fashion, says Dr. John
Spiegel of Brandeis University, who was
president of the APA in 1973, when the debate
over homosexuality flared. And fashions keep
changing. Other psychiatrists agree that the
next full edition of the manualdue in 1993
will probably list some phantasms no one has
yet dreamed of. The basic DSM set of more than
200 disorders will probably burgeon between
now and the year 2000.
One major reason is money. Patients can get
insurance payments for treatment of disorders
on the DSM list. The more psychic demons
named, the greater the reimbursement for
having them cast out. A second reason for the
predicted growth is scientific advancement As
biologists delve more deeply into the roots of
psychoses, for example, they may discover
different ways to label mental ills. What we

94 NOVEMBER 1986

Its a matter of fashion, says

Dr. John Spiegel of Brandeis
University...

now call schizophrenia. says Dr. Robert Spitzer

of New York, head of the APA work group that
is currently revising DSM-III, may end up as
fifty different kinds of disorders.
Other clinicians are frightened at the
prospect of a major proliferation of new
disorders over the next couple of decades. It will
be impossible for two therapists to agree about
a diagnosis. Raymond Fowler, a senior research
psychologist with National Computer Systems
in Washington. DC, argues that therapy ought
to be divorced from the foibles of psychiatric
fashion. The danger is that some psychological
problem that shows up in a first-rate miniseries
on TV may shortly thereafter appear in a
diagnostic category because everybody feels like
theyve got it that week.
Fowler suggests an alternative. I think
we ought to do it the way they do in baseball.
A psychiatric condition ought to survive
for fifteen years before its allowed into the
DSM Hall of Fame.
But the current controversy shows that
survival of proposed new diagnoses is never
assured, even after theyre inscribed in the
official record book.
Critics began debating the proposals months
ago. They argued that sadistic personality would
become a ready-made defense for wife beaters.
Self-defeating personality would stigmatize

PSYCHOFASHION
women trapped in abusive relationships. And
elevating PMS to official recognition would
perpetuate myths that menstruating women are
pathological cases.
Its all a backlash against women trying to
become equal, says Lenore Walker, a Denver
psychologist. Theres little clinical evidence
to support any of the revisions. The drive to
revise, she argues, arose because many women
seeking therapy in recent years have gone to a
growing number of female psychologists. Often
operating out of crisis- counseling centers, these
new therapists are able to treat such problems
as marital violence more rapidly and less
expensively than male psychiatrists. The new
categories, she says, are part of an attempt to
win back business lost to the psychiatrists
couch, with its attendant long, costly Freudian
forays into the psyche.
In the face of critics like Walker, psychiatrists
last summer offered several compromises. The
new disorders would not be given official status.
Instead, theyd be listed in an appendix to DSM,
a reference guide that includes a classification of
proposed disorders. The task force completely
dropped a fourth new designation that would
have covered men who are sexually aroused
by fantasies of rape, conceding that it could
have become a legal shield for rapists. At the
urging of gay activists they edited out the last,

The danger is that some

psychological problem that shows
up in a first-rate miniseries on TV
may shortly thereafter appear in
a diagnostic category because
everybody feels like theyve got it
that week.

Gurney Williams III

vestigial references to homosexuality. And
they made several changes in the names of the
proposed disorders. Self-defeating personality,
for example, was originally called masochistic
personality disorder. The official name for
PMS would henceforth be the tongue-numbing
periluteal phase dysphoric disorder.
The chief advantage of the new name,
according to Spitzer, was again a matter of
current fashion. It doesnt invoke images
of menstruation, he says. And masochism
drives people up the wall because its often
taken to refer only to women who are
abused in marriage.
But Spitzer stood firm on other issues. He
says Walkers allegation that the revisions
were an attempt by psychiatrists to boost
sagging income is absurd. Women entering
crisis-counseling centers for short term
therapy probably never would have gone to
psychiatrists anyway.
Walker now says she is pleased at the deletion
of the last references to homosexuality and at
the withdrawal of the proposed rape disorder.
But its a sham that the APA is trying to pull the
wool over everyones eyes by claiming theres a
difference between the appendix and the regular
volume. She predicts that disorders relegated
to the appendix in this edition will be upgraded
in the future. The name changes, she says, are
cosmetic-Its the arrogance of psychiatrists
to think that if they change the names, the
controversy will go away. In any form they will
be pejorative to women.
There may be other alterations before the
APA board of trustees votes next month on the
final revisions.
In the middle of these swirling currents
of fashion, the beleaguered Dr. Spitzer
broke out in a rash. But his doctor said it
had nothing to do with trendy syndromes
or (mumble, mumble) personality disorders.
He says its just something I picked up in the
garden, Spitzer says.

OMNI 95

Feminists have engaged psychiatrists in a hot

debate over menses, masochism,
and madness.

MIND:
PSYCHOFASHION
By Gurney Williams III
Psychotherapists put themselves on the couch whenever they try to define
mental illness. In a current debate over several proposed new disorders,
for instance, it seems clear whats on the minds of psychologists and
psychiatrists this year. Its women.

93 OMNI NOVEMBER 1986

MIND: PSYCHOFASHION
Diagnoses

women

Even Sigmund Freuds concept of

for the predicted growth is scientific

are the focus of a controversy over

neurosis was dropped in the original

advancement As biologists delve

revisions to the highly influential

DSM-III (1980). And in 1973 APA

more deeply into the roots of

third

Diagnostic

trustees voted to wipe out almost

psychoses, for example, they may

and Statistical Manual of Mental

all references to homosexuality as

discover different ways to label

Disorders (DSM-III). The board of

a disorder. Before the vote, being

mental ills. What we now call

trustees of the American Psychiatric

gay was considered a psychiatric

schizophrenia.

Association (APA) will decide before

problem. After the vote the disorder

Spitzer of New York, head of the

the end of the year whether to add

was relegated to psychiatrys attic.

APA work group that is currently

edition

that

of

affect

Gurney Williams III

the

three new disorders to the official

Its

matter

of

fashion,

says

Dr.

Robert

Its a matter of fashion,

says Dr. John Spiegel of
Brandeis University...

revising DSM-III, may end up as

DSM-III roster. One is premenstrual

says Dr. John Spiegel of Brandeis

syndrome (PMS), the constellation

University, who was president of the

Other clinicians are frightened at

of mood and physiological changes

APA in 1973, when the debate over

the prospect of a major proliferation

coincident with the rhythms of the

homosexuality flared. And fashions

of new disorders over the nextcouple

menstrual cycle. The two others

keep changing. Other psychiatrists

of decades. It will be impossible

are

self-

agree that the next full edition of the

for two therapists to agree about a

Fowler suggests an alternative.

defeating and sadistic. Critics

manualdue in 1993will probably

diagnosis. Raymond Fowler, a senior

I think we ought to do it the way

(psychologists are particularly vocal)

list some phantasms no one has yet

research psychologist with National

they do in baseball. A psychiatric

say the additions arent based on good

dreamed of. The basic DSM set of

Computer Systems in Washington.

condition ought to survive for fifteen

science and that their inclusion would

more than 200 disorders will probably

DC, argues that therapy ought to

years before its allowed into the

actually hurt women.

burgeon between now and the year

be divorced from the foibles of

DSM Hall of Fame.

2000.

psychiatric fashion. The danger is

personality

disorders,

Its not the first such flap, nor the

fifty different kinds of disorders.

But

the

current

controversy

last, because the rewriting of DSM

One major reason is money.

that some psychological problem

shows that survival of proposed new

provides an arena for battles over

Patients can get insurance payments

that shows up in a first-rateminiseries

diagnoses is never assured, even after

the mind. Therapists who normally

for treatment of disorders on the DSM

on TV may shortly thereafter appear

theyre inscribed in the official record

soothe their clients take to the picket

list. The more psychic demons named,

in a diagnostic category because

book.

lines and turn militant over diagnostic

the greater the reimbursement for

everybody feels like theyve got it that

issues. Disorders come and go.

having them cast out. A second reason

week.

94 OMNI NOVEMBER 1986

Critics

began

debating

the

proposals months ago. They argued

MIND: PSYCHOFASHION
that

sadistic

would

The drive to revise, she argues,

they edited out the last, vestigial

Walker now says she is pleased

become a ready-made defense for wife

arose because many women seeking

references to homosexuality. And

at the deletion of the last references

beaters.

personality

therapy in recent years have gone

they made several changes in the

to

would stigmatize women trapped in

to a growing number of female

names of the proposed disorders.

withdrawal of the proposed rape

abusive relationships. And elevating

psychologists. Often operating out

Self-defeating

personality,

for

disorder. But its a sham that the

PMS to official recognition would

of crisis- counseling centers, these

example,

originally

called

APA is trying to pull the wool over

perpetuate myths that menstruating

new therapists are able to treat such

masochistic

disorder.

everyones eyes by claiming theres a

women are pathological cases.

problems as marital violence more

The official name for PMS would

difference between the appendix and

Its all a backlash against women

rapidly and less expensively than male

henceforth be the tongue-numbing

the regular volume. She predicts that

trying to become equal, says Lenore

psychiatrists. The new categories, she

periluteal phase dysphoric disorder.

disorders relegated to the appendix

Walker,

says, are part of an attempt to win

The chief advantage of the new

in this edition will be upgraded in

evidence

back business lost to the psychiatrists

name, according to Spitzer, was

the future. The name changes, she

to support any of the revisions.

couch, with its attendant long, costly

again a matter of current fashion.

says, are cosmetic-Its the arrogance

Freudian forays into the psyche.

It

of

of psychiatrists to think that if they

And

change the names, the controversy

up

will go away. In any form they will be

Theres

personality

Gurney Williams III

Self-defeating

Denver

little

psychologist.

clinical

In the face of critics like Walker,

The danger is that some

psychological problem
that shows up in a firstrate miniseries on TV may
shortly thereafter appear
in a diagnostic category
because everybody feels
like theyve got it that
week.

95 OMNI NOVEMBER 1986

was

personality

doesnt

invoke

menstruation,

he

images
says.

psychiatrists last summer offered

masochism

several

new

the wall because its often taken

disorders would not be given official

to refer only to women who are

status. Instead, theyd be listed in

abused in marriage.

compromises.

The

an appendix to DSM, a reference

But

drives

Spitzer
issues.

people

and

at

the

pejorative to women.
There may be other alterations
before the APA board of trustees votes

stood

on

next month on the final revisions.

other

Walkers

In the middle of these swirling

of proposed disorders. The task force

allegation that the revisions were

currents of fashion, the beleaguered

completely dropped a fourth new

an

to

Dr. Spitzer broke out in a rash. But

designation that would have covered

boost sagging income is absurd.

his doctor said it had nothing to do

men who are sexually aroused by

Women

with trendy syndromes or (mumble,

fantasies of rape, conceding that it

centers

could have become a legal shield for

probably never would have gone to

He says its just something I picked

rapists. At the urging of gay activists

psychiatrists anyway.

up in the garden, Spitzer says.

by

says

firm

guide that includes a classification

attempt

He

homosexuality

psychiatrists

entering
for

short

crisis-counseling
term

therapy

mumble)

personality

disorders.