Descriptive Psychopathology: The Signs and Symptoms of ...

40 Section 1: Present, past, and futurepublished in 1952, was based on ICD-6. 103 Many leading psychoanalysts oversawthe drafting of the DSM-I and the document reflected Freudian and Meyerianviews of mental illness with syndromes labeled “reactions” and defined by egodefense mechanisms. The DSM-II, published in 1968 was similarly influenced. 104New treatments reveal a weak relationship betweendiagnosis and responseThe concepts of Freud, Meyer and their followers would not have been so widelyaccepted had there been a contemporary competing biological model of psychiatricillness or effective treatments for psychiatric disorders. Early twentiethcenturyneuroscience technologies and laboratory procedures were primitiveand no somatic treatment was established. In his 1907 Presidential Address tothe American Medico-Psychological Association, the beginnings of the AmericanPsychiatric Association, C.G. Hill noted that “our therapeutics is simply a pile ofrubbish”. 105The introduction of malarial fevers to treat central nervous system syphilisand its associated behavioral syndromes (1917), and the application of insulincoma (1933), convulsive therapy (1934), and leucotomy (1935) to treat patientswith psychotic and mood disorders, challenged the psychodynamic model. 106The initial success of these treatments in quickly relieving the most severepsychiatric conditions, and the sustained success of electroconvulsive therapy(ECT; introduced in 1938) changed clinical psychiatric practice and once againdirected attention to the brain as central to psychiatric disorders. 107 New typologieswere envisioned as the basis for more effective prescription of the availabletreatments. 108The therapeutic optimism, however, was of short duration, as the diagnosticcategories of DSM-II were quickly recognized as poor guides for choosing thenewly introduced medications. 109 Many psychopharmacologists described theirfrustration with DSM-II criteria for the selection of treatments. 110 One influentialreport examined 33 studies that had assessed medication treatments of depression,but could not find a diagnostic formulation that had predictive strength. 111The DSM-II and ICD-8 classifications also had poor reliability, dramaticallydemonstrated in international studies. 112World War II alters psychiatry in the USA and UKIn the 1930s many European psychiatrists fled the growing influence of NaziGermany. Some came to Great Britain and continued the continental interest inpsychopathology and classification. Mayer-Gross educated a generation of Britishpsychiatrists to the importance of clinical research. He, Elliot Slater, and MartinRoth incorporated rigorous scholarship in psychopathology in their classic