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safe and reliable way that he or she can test, objectively speaking, whether the diagnosis given is the right one? I put this question to Pardes.
    â€œWell, one way to test whether the diagnosis is correct is to apply a scientific or biological test [such as a blood, urine, saliva test, or some other form of physical examination to assess, firstly, whether a patient has a mental disorder, and if so, precisely what disorder they suffer from]. But the crucial problem for psychiatry is that we still have no such objective biological tests.”
    In other words, unlike in other areas of medicine where a doctor can conduct a blood or urine test to determine whether he has reached the correct diagnosis, in psychiatry no such methods exist. And they don’t exist, as Pardes also intimated, because psychiatry has yet to identify any clear biological causes for most of the disorders in the DSM (this is a pivotal point, which I’ll talk about more fully in coming chapters). So the only method available to psychiatrists is what we could call the “matching method”: match the symptoms the patient reports to the relevant diagnosis in the book.
    Although at first glance they may appear innocuous, these facts are crucial for understanding why psychiatry in the 1970s fell into serious crisis. They help us explain why psychiatrists were not only guilty of branding sane people as insane (e.g., as the Rosenhan experiment revealed) but also guilty of regularly failing to agree on what diagnosis to assign a given patient (e.g., as the “diagnostic reliability” experiments showed).Psychiatry was making these errors because it possessed no objective way of testing whether a given person was mentally disordered, and if so, precisely what disorder he or she was suffering from. Without such objective tests, the diagnosis a psychiatrist would assign could be influenced by his subjective preferences, and as different psychiatrists were swayed by different subjective factors, it was understandable that they regularly disagreed about what diagnosis to give.
    This is why these early experiments were so dramatic for the profession: they produced for the first time clear evidence that psychiatric diagnosis was at best imprecise and at worst a kind of professional guesswork. And so, without any objective way of testing the validity of a diagnosis, psychiatry was in peril of falling far behind the diagnostic achievements of other branches of medicine.
    A solution was needed … and fast.
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    Under the leadership of the American Psychiatric Association (APA), the profession in the 1970s plumbed for a radical solution. It decided to tear up the existing edition of the DSM (then called DSM-II ) and literally start again. The bold idea was to write an entirely new manual that would solve all the problems beleaguering DSM-II . This new manual would be called DSM-III , and its central aim would be to improve the reliability of psychiatric diagnosis and thereby answer the mounting criticisms that were threatening to shatter the profession’s legitimacy. 5
    The first step the APA took was to set about finding someone to lead the writing of the DSM-III . The APA needed a person highly competent, energetic, and daring, but also someone who had experience with psychiatric classification. After sifting through countless candidates and enduring many frustrations, the APA finally settled on a man called Dr. Robert Spitzer, who was based at Columbia University’s medical school.
    Spitzer had been a young, up-and-coming psychiatrist when the earlier DSM-II had been written, and he had also been minimally involved in that project. But most important, he appeared to have the drive and vigor needed to get the job done. As the APA was sufficiently impressed with his qualities, they hired him in 1974 to start work on the new DSM-III . Little did Spitzer know at the time that his appointment as chair of DSM-III would ultimately make him the