American Psychiatric Revolution of 1980: USA embraces Bipolar Disorder (British) and Multiple Personality (French) as it abandons Psychoanalysis.

The third edition of the psychiatric diagnostic manual, DSM-III, was published in 1980. Whereas previous editions had used psychoanalytic terms (e.g., “neurosis”) and assumed the validity psychoanalytic concepts (e.g., “repression” and “the unconscious”), the 1980 edition prided itself on its scientific objectivity. Psychoanalytic terms were no longer used; psychoanalytic theory was no longer assumed; and all diagnoses now had diagnostic criteria (a list of specific signs and symptoms).

Prior to DSM-III in 1980 (and the 1970s leading up to it), USA psychiatry had had an overly broad concept of schizophrenia. Some patients who actually had bipolar disorder (aka manic-depression) or multiple personality had been misdiagnosed as having schizophrenia.

Two events, the introduction of lithium in 1970 (to treat bipolar disorder) and a study that compared British and USA psychiatric diagnosis, convinced USA psychiatrists that they had been misdiagnosing some patients as having schizophrenia, who actually had bipolar disorder.

Another medical awakening in the 1970s was the prevalence of child abuse. Until 1970, psychiatric textbooks had stated that, literally, only one child in a million was the victim of child abuse. But now it was found to be much more common than that.

USA doctors had had blind spots for bipolar disorder and childhood trauma.

Also in the 1970s, some psychiatrists, who may have wondered what else psychiatry had missed, began to recognize cases of multiple personality and its connection to childhood trauma. I was not one of those psychiatrists. My focus in the 1970s was on bipolar disorder. I did not realize that any of my patients had multiple personality until 1986.

The reason I give credit to French psychiatry for multiple personality is that the origin of its basic concept, dissociation, is most associated with French psychiatrists like Pierre Janet (1859-1947). Unfortunately, for most of the 20th century, Janet’s concept of dissociation was eclipsed by Freud’s concept of repression. Since Freud’s concept could not explain the occurrence of even one case of multiple personality, so long as Freud was popular, the diagnosis of multiple personality would likely be missed.

However, DSM-III (1980)—and subsequent editions of the American Psychiatric Association’s official diagnostic manual (the latest edition is DSM-5, published in 2013)—do have a chapter devoted to dissociative disorders, including multiple personality (aka dissociative identity disorder), but do not have a chapter for “repression disorders,” because Janet was right and Freud was wrong.