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most influential psychiatrist of the twentieth century.
    The first thing Spitzer did to reform the DSM was to assemble a team of fifteen psychiatrists to help him write the new manual. This team was called the DSM Taskforce, and Spitzer was its outright leader. So in the mid-1970s, the taskforce set about writing a kind of New Testament, if you will, for psychiatry: a book that aspired to improve the uniformity and reliability of psychiatric diagnosis in the wake of all its previous failings. If this all sounds very intrepid, that’s pretty much what it was. Spitzer’s taskforce promised a new deal for psychiatry, and there was a lot of pressure on it to deliver.
    So what precisely did Spitzer do to try and set things right? How was he going to make psychiatric diagnosis more reliable and scientific? His answer was simple. The DSM needed to be altered in three major ways:
•Many existing disorders would be deleted from DSM-II .
•The definitions of each disorder in the old DSM would be expanded and made more specific for DSM-III .
•A new checklist would be developed for DSM-III to improve the reliability of diagnosis.
    Let’s briefly look at each of these alterations more closely. The first involved Spitzer deleting some of the more unpopular and controversial mental disorders. These included some of the disorders introduced into psychiatry by psychoanalysis. In the 1970s, psychoanalysis had fallen out of vogue in psychiatry, along with many disorders it had introduced to the previous DSM . One of the most controversial of these disorders was homosexuality. Indeed, in the DSM-II homosexuality was listed as a mental disease. It was described as a “sexual deviation” and was located in the same category as pedophilia. 6
    While some psychiatrists felt it was wrong to brand homosexuality an illness, the main push to remove the disorder largely came from outside pressure groups including the Gay Rights Movement. These groups asked why a normal and natural human sexual preference had been included in the DSM as a mental disease, especially when there was absolutely no scientific evidence to justify its inclusion. Surely it was prejudice rather than science that had placed homosexuality on the list?
    Many in the psychiatric community were not so sure, but the APA, perhaps sensing the change in public mood, decided to consult the wider psychiatric community for their views. So at the APA convention in 1973, all the attending members were asked to vote on what they believed: was homosexuality a mental disorder or not? The vote was closer than expected: 5,854 psychiatrists voted to take homosexuality out of the DSM , while 3,810 voted to keep it in. And because the “outers” were in the majority, homosexuality ceased to be a mental disorder in 1974 and was therefore not included in Spitzer’s DSM-III . It was politics and not science that had removed the disorder from this list. As we continue, it is worth holding that thought in mind.
    To turn now to Spitzer’s second alteration, this involved making the definitions of each mental disorder more specific and detailed. The idea was that if each disorder could be defined more precisely, psychiatrists would be less likely to misunderstand the disorders and therefore misapply them to patients.
    The problem with the earlier DSM-II , Spitzer argued, was that its definitions of disorders were too open to interpretation. So, for example, in DSM-II “depressive neurosis” was defined in a single sentence: This disorder is manifested by an excessive reaction of depression due to an internal conflict or to an identifiable event such as the loss of a love object or cherished possession . 7 Spitzer believed that such vague definitions explained why psychiatrists regularly gave different diagnoses to the same patient. If a word in the dictionary were poorly defined, people would not know how to use it properly. The same was the case with