DSM ORIGIN:

The Diagnostic and Statistical Manual of Mental Disorders. It's sometimes called the Psychiatry Bible, and for good reason, it's
how most mental health professionals figure out if you have something they should be treating.
For a while, psychologists had a pretty limited definition of mental illness. They thought mental disorders were mostly physiological
problems you were born with, and it took a couple of world wars for them to realize just how wrong they were. One of the first times
anyone tried to identify people with mental illness, at least in the US, was in 1840.

It took until 1918 for the American Medical Psychological Association to write the Statistical Manual for the Use of Institutions
for the Insane, which had some of the first standardized descriptions of what counted as a disorder. It included things like manic
depressive psychosis or dementia precox, which today we would call bipolar disorder and schizophrenia, respectively. Since these
disorders were really poorly understood at the time and there weren't great treatments for them, they were common among people who'd
been institutionalized. But the manual's whole approach to mental illness was really narrow. Doctors thought these disorders came
entirely from physical problems, the same way a hard knock to the head can cause the symptoms of a concussion. Today, we know
bipolar disorder and schizophrenia are some of the most highly heritable mental disorders, so it makes sense that they'd think of disorders
as being physical, maybe even hereditary. It's true that mental illness can come with changes in brain chemistry, but it is not at all like a
concussion. Environmental factors are incredibly important when it comes to mental health, and not considering those factors meant that
doctors missed a lot.

Still, the system worked okay for a while until there was a problem, a pretty big problem in fact, a worldwide problem, World War
II. Suddenly, there were millions of soldiers returning from a war where they'd seen their friends die and witnessed some of the cruellest
possible treatment of others. Meanwhile, families were split, communities were torn apart, and there was a lot of anxiety about the future
of civilization in general. Many of these problems had come up in the aftermath of World War I, too, but they were generally diagnosed
as shell shock. Today, we call shell shock, posttraumatic stress disorder or PTSD, but back then, doctors didn't really think of it as a
mental illness. They thought it was caused by the physical effects of artillery shells on nerves, hence the name. So doctors treated it like
a neurological problem, not a psychological one. It wasn't until World War II that psychologists began to realize what had once been
known as shell shock might be a mental illness. They started calling it combat stress reaction and treating it as a psychological thing.
The thing was, all these people had previously been pretty healthy, so the manuals weren't much help.

All disorders were considered biological and lifelong. There were no categories describing problems that developed in response
to some life event. So the American Psychological Association, or APA, decided to write a new guide. But first, they went looking for
some help understanding what was happening to people. What they found was detailed in the inauspiciously titled War Department
Technical Bulletin Medical 203, a document published in 1943 that tried to explain how disorders could emerge from stressful life events.
It was written by a committee shared by a military psychiatrist, but it relied a whole lot on the theories of Sigmund Freud.
The symptoms of shell shock were very similar to symptoms of what Freud called a neurosis, which he thought was caused by childhood
trauma and the repressed emotions or complexes that came from it. The idea was that if something was too stressful to think about, it
would be pushed into your unconscious mind and then show itself through other anxieties or troubling behaviors.

It was also hard to tell if trauma was the real reason for the symptoms of neurosis, since by definition, the memories might be
repressed. But in the case of shell shock, it was obvious what the trauma was. So this War Department memo used Freud's ideas to
explain how life could lead to a combat stress reaction in someone who didn't have a history of mental illness. There were so many
patients who fit the description that when the APA started to write the first edition of the DSM, which was published in 1952, these ideas
became a major theme. They copied several passages verbatim from the War Department memo, including some about how disorders
could be reactions to social factors or the environment. Also like the memo, the first edition of the DSM divided disorders into neurotic,
psychotic, and character disorders, in addition to disorders that had a known physiological cause. The DSM has been through a lot since.
Removing some of Freud's theories for how disorders developed was one of the first orders of business. And today's DSM 5 focuses
much more on just describing and categorizing symptoms. We've kept some of the key lessons from the DSM's origin story that disorders
can have environmental and social causes, not just biological ones, and that mental illnesses can be much broader than what you'd find
in an early 20th century mental hospital.