The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), the third diagnostic manual of the American Psychiatric Association (APA), was mainly a response to the vehement, insistent, and often persuasive antipsychiatry movement that had developed in the 1960s and 1970s. Coming from a number of directions, sociologists, lawyers, judges, social critics, and even some psychiatrists themselves, the movement challenged the medical model of psychiatry, the involuntary commitment of patients to mental hospitals, the “warehousing” of patients in hospitals without receiving effective treatment, and even whether patients with mental disorders had any illness at all. Additionally, psychiatrists were accused by some authors of “controlling” people to accrue power over them. Psychiatry as a profession was thrown on the defensive. The publication of an article in the prestigious journal Science in 1973 charging—through seemingly inspired experiments—that psychiatrists could not even diagnosis a mentally ill patient, created a sensation. This was the last straw for the beleaguered APA. Though only five years had passed since the last revision of the DSM, and little had changed, the Board of Trustees of the APA commissioned a revision that would show that psychiatry was a legitimate medical and scientific endeavor and thus counter the attacks of the antipsychiatry movement. The irony here is that in 2019, the Science article was shown to be in large part fraudulent. DSM-III turned out to be not a revision but a large, brand-new manual based solely on observable signs and symptoms, the “diagnostic criteria.” It upended the diagnosis and treatment of mental disorders in North America and in many other places as well. The Task Force that produced the manual was led by Robert Spitzer, a talented and energetic man, with an empirical bent, who never shied away from a fight. The Task Force he led shared his empiricism, and many of its members were determinedly antipsychoanalytic. There is no doubt that DSM-III helped to dethrone psychoanalysis as a leading method of thought and treatment in North America. Analysts had relied heavily on the diagnosis of neurosis, which Spitzer removed from the manual. Spitzer and the Task Force were strongly supported in their decisions by Melvin Sabshin, the APA’s new medical director, who himself wanted to rid psychiatry of “ideology,” and promote the profession more clearly as scientific and medical. The manual itself featured many new diagnoses because Spitzer wanted to include diagnoses that were important to clinicians. Thus, he prized reliability (psychiatrists agreeing on the same diagnosis) over validity (the accuracy of the diagnosis). A positive feature of DSM-III was its five-pronged diagnostic system, which, if used properly and completely, helped psychiatrists arrive at a deeper knowledge of their patients, as well as a more accurate prognosis. On the other hand, relying solely on diagnostic criteria encouraged some clinicians to practice a relatively quick “checklist” psychiatry instead of taking time to understand patients as human beings in all their complexity. Another shortcoming was the strict categorical approach of the diagnostic system which often led to comorbidity or “not elsewhere specified” diagnoses. Nevertheless, since the appearance of DSM-III, the DSMs have achieved an outsized influence over many key areas of life.
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Hannah S. Decker
Alan C. Tjeltveit
How has ethics been connected with the science and profession of psychology? Has ethics been essential to psychology? Or have psychologists increasingly developed objective psychological understandings free of ethical biases? Is ethics in psychology limited to research ethics and professional ethics? Understanding the various connections among ethics and psychology requires conceptual clarity about the many meanings of ethics and related terms (such as moral, ideal, and flourishing). Ethics has included, but goes beyond, research and professional ethics, since ideas about what is good or bad, right or wrong, obligatory or virtuous have shaped psychological inquiry. In moral psychology, psychologists have sought to understand the psychology of ethical dimensions of persons, such as prejudice or altruism. Some psychologists have worked to minimize ethical issues in psychology in general, but others embraced psychologies tied to ethical visions, like advancing social justice. Many ethical issues (beyond professional ethics) have also been entangled in professional practice, including understanding the problems (“not good” states of affairs) for which clients seek help and the (“good”) goals toward which psychologists helped people move. Cutting across the various ways ethics and psychology have been interconnected is an enduring tension: Although psychologists have claimed expertise in the science of psychology and in the provision of psychological services, they have had no disciplinary expertise that equips them to determine what is good, right, obligatory, and virtuous despite the fact that ethical issues have often been deeply intertwined with psychology.
Feminist psychology as an institutionalized field in North America has a relatively recent history. Its formalization remains geographically uneven and its institutionalization remains a contested endeavor. Women’s liberation movements, anticolonial struggles, and the civil rights movement acted as galvanizing forces in bringing feminism formally into psychology, transforming not only its sexist institutional practices but also its theories, and radically challenging its epistemological and methodological commitments and constraints. Since the late 1960s, feminists in psychology have produced radically new understandings of sex and gender, have recovered women’s history in psychology, have developed new historiographical methods, have engaged with and developed innovative approaches to theory and research, and have rendered previously invisibilized issues and experiences central to women’s lives intelligible and worthy of scholarly inquiry. Heated debates about the potential of feminist psychology to bring about radical social and political change are ongoing as feminists in the discipline negotiate threats and dilemmas related to collusion, colonialism, and co-optation in the face of ongoing commitments to positivism and individualism in psychology and as the theory and practice of psychology remains embedded within broader structures of neoliberalism and global capitalism.
John C. Gibbs
Males and females differ—but only moderately—in moral judgment and morally relevant social behavior such as caring for others and aggression. Females more frequently use care-related concerns in their moral judgment. Research has to some extent supported traditional stereotypes of males as more assertive or independent (agency) and females as more relational or affiliative (communion). Males are on average more aggressive than females even after relational aggression is taken into account. In the expression of empathy and prosocial behavior, situational context plays a larger role for males than females. Males’ gender tendencies have been characterized as instrumental (“report talk,” object oriented, etc.) and females’ as socially and emotionally expressive (“rapport talk,” people oriented, etc.). In social relationships, adolescent girls generally engage in more intimate self-disclosure and active listening, provide more emotional support to one another, and emphasize affiliation and collaboration. Both biological and social experiential or cultural factors are involved in the formation of these morally relevant gender differences. Although average gender-linked differences in emphasis remain evident, a blend of instrumental and expressive characteristics may contribute to optimal morality for both genders. Sandra Bem termed the mixture of expressive (traditionally feminine) and instrumental (traditionally masculine) attributes in gender style “androgyny.” Highly androgynous adolescents and adults of both genders evidence more mature moral judgment and more adequate mental health.
Jean Piaget (1896–1980) is known for his contributions to developmental psychology and educational theory. His name is associated especially with Stage Theory. That we believe him to have focused solely on cognitive development, however, is not because he did. This is instead the result of the popularization of his writings in the United States during the Cold War. (A period of crisis and subsequent education reform.) The overpowering influence of those interests blinded us to his larger framework, which he called “genetic epistemology,” and of which his stages were just a part. To address the resulting and continuing misunderstandings, this essay presents original historical scholarship—distilling over a thousand pages of archival documents (correspondence, diary entries, budgets, and reports)—to provide an insider’s look at Piaget’s research program from the perspective of the Rockefeller Foundation: genetic epistemology’s primary funding agency in the United States from the mid-1950s through the early-1960s. The result is an examination of how a group of interested Americans came to understand Piaget’s writings in French in the period just prior to their wider popularization in English, as well as of how Piaget presented himself and his ideas during the reconstruction of Europe after World War II. My goal, however, is not to summarize the whole of this misunderstood program. Instead, I aim to provide a source of archivally-grounded perspective that will allow for new insights about the Genevan School that are unrelated to American Cold War interests. In the process, we also derive new means to see how Piaget’s experimental examinations of the development of individual knowledge served to inform his team’s investigations of the evolution of science (and vice versa).
Critical psychology comprises a broad range of international approaches centered around theories and practices of critique, power, resistance, and alternatives of practice. Although critical psychology had an axial age in and around the 1970s, many sources can be found decades and even centuries earlier. Critical psychology is not only about the critique of psychology, which is a broader historical and theoretical field, but about doing justice in and through theory, justice with and to groups of people, and justice to the reality of society, history, and culture as they powerfully constitute subjectivity, as well as the discipline and profession of psychology. Doing justice in and through psychological theory has a strong basis in Western critical approaches, representing a privileged position of reflection in Euro-American research institutions. Critical psychologists argue that traditional psychology is missing its subject matter and hence is not doing justice in methodology, and its practices of control and adjustment are not doing justice to the emancipatory possibilities of human agency or human science. Critical psychologists who are attempting to do justice with and to human beings are not neglecting the onto-epistemic-ethical domain, but are instead focusing on people, often marginalized or oppressed groups. Critical psychologists who want to do justice in history, culture, and society have argued that traditional psychological practice means adaption and adjustment. This means that not only subjectivity, but also the discipline and profession of psychology need to be connected with contexts. Psychologists have attempted to conceptualize the relationship between society and the individual, as well as the ability of humans not only to adapt to an environment but to change their living conditions and transform the status quo. This conceptualization also means providing concrete analyses of how current society, based in neoliberal capitalism, not only impacts individuals but also the discipline of psychology. Despite the complexities of critical psychology around the world, critical psychologists emphasize the importance of reflexivity and praxis when it comes to changing the conditions of social reality that create mental life. Given that subjectivity cannot be limited to intra-psychological processes, critical psychologists attend to relational and structural societal realities, requiring inter- and transdisciplinarity in the discipline and profession.
G.E. Jarvis and Laurence J. Kirmayer
Culture and society shape the symptoms, course, and outcome of mental disorders. Cultural frames—including conceptual models, values, norms, attitudes, and practices—influence the experience and expression of psychological distress. These frames reflect community history, ethnicity, religion, gender, politics, and the identity of individuals in specific social contexts. While some aspects of cultural frames are conveyed through explicit norms, values, ideologies, and practices, much remains implicit in a way of life and social environment that shape beliefs and practices through cultural affordances. Over time, cultural frames evolve, such that the expression of psychological disorders changes as new narratives and categories gain credibility and dominance. Understanding the dynamic impact of these frames on behavior and experience in illness and health requires a systemic or ecosocial approach. Category fallacies may occur when the observer interprets symptoms exclusively through categories derived from one cultural frame that preclude discovering local ways of characterizing distress. By failing to consider local meanings and modes of expression, category fallacies can result in diagnostic error. Looping effects result from the tendency for social categories to reshape human experience and behavior, as well as social institutions and practices, so that they conform to the category. In this way, cultural categories and constructs become self-vindicating social realities and contribute to the creation and maintenance of cultural frames. Cultural frames may be understood at multiple levels: (a) individual cognitive models or schemas that shape illness experience, (b) professional models and modes of practices that shape clinical interactions, and (c) broader societal paradigms, derived from cultural-historical institutions, that influence general attitudes to illness and suffering. Cultural frames invoke particular ontologies to explain illness, ascribing causal efficacy or agency to material (biological or social), psychological, or spiritual entities or forces . Cultural frames may focus on historical, political, or economic structures to explain the causes and forms of mental disorders (e.g., colonial ideologies). Cultural framings of concepts of mental disorder are readily identified in historical and contemporary settings. At the individual level, Joseph Smith, the American Prophet (1805–1844), exemplifies how intense religious experiences could be interpreted as revelation or as psychotic symptoms, depending on the cultural frame. At the professional level, the rise and fall of American psychoanalysis from 1909 to 2000 represents a paradigm, or cultural frame, shift such that the way that mental health professionals understand distress has changed from a focus on the inner theatre of the mind, accessed through intimate personal inquiry and talking therapy, to a focus on disordered machinery of the brain, in which the pathology requires treatment with medication. At the societal level, research on rates of psychosis among Black people in the United States and United Kingdom has been approached differently owing to differences in history, demography, and cultural frames, with U.K. studies emphasizing elevated rates among Black immigrants and U.S. studies focusing on diagnostic bias. These three levels influence each other through looping effects that give rise to new, hybrid forms of disorder that challenge standard psychological theories.
Peter Hegarty and Emma Sarter
Between the late 1960s and early 1980s, gender became an important topic in U.S. social psychology, raising questions about the conceptual relationship between “sex” and “gender.” A second-wave feminist project to describe differences between women and men as previously exaggerated and currently changeable was aligned with social psychology’s emphasis on the distorting power of stereotypes and the strong influence of immediate situations on human behavior. Feminism and social psychology both suggested psychology could foment social transformation, and the authors and participants of psychological research have undoubtedly become far less “womanless” in the past half-century. By the late 1980s several incommensurate social psychologies of gender existed, creating debates about the meaning of emphasizing gender differences and similarities and the gendered social psychology of psychological science itself. However, psychology remained largely a “white space” in the 1970s and 1980s, which were also “difficult decades” in transgender history. The increasing recognition of intersectional feminism and trans-affirmative perspectives in the 2010s set the context for regarding this history from different contemporary standpoints.
Stirling Moorey and Steven D. Hollon
Cognitive behavioral therapy (CBT) has the strongest evidence base of all the psychological treatments for depression. It has been shown to be effective in reducing symptoms of depression and preventing relapse. All models of CBT share in common an assumption that emotional states are created and maintained through learned patterns of thoughts and behaviors and that new and more helpful patterns can be learned through psychological interventions. They also share a commitment to empirical testing of the theory and clinical practice. Beck’s Cognitive Therapy sees negative distorted thinking as central to depression and is the most established form of CBT for depression. Behavioral approaches, such as Behavioral Activation, which emphasize behavioral rather than cognitive change, also has a growing evidence base. Promising results are emerging from therapies such as Mindfulness Based Cognitive Therapy (MBCT) and rumination-focused therapy that focus on the process of managing thoughts rather than their content. Its efficacy-established CBT now faces the challenge of cost-effective dissemination to depressed people in the community.
Julia Browne, Corinne Cather, and Kim T. Mueser
Common factors, or characteristics that are present across psychotherapies, have long been considered important to fostering positive psychotherapy outcomes. The contextual model offers an overarching theoretical framework for how common factors facilitate therapeutic change. Specifically, this model posits that improvements occur through three primary pathways: (a) the real relationship, (b) expectations, and (c) specific ingredients. The most-well-studied common factors, which also are described within the contextual model, include the therapeutic alliance, therapist empathy, positive regard, genuineness, and client expectations. Empirical studies have demonstrated that a strong therapeutic alliance, higher ratings of therapist empathy, positive regard, genuineness, and more favorable outcome expectations are related to improved treatment outcomes. Yet, the long-standing debate continues regarding whether psychotherapy outcomes are most heavily determined by these common factors or by factors specific to the type of therapy used. There have been calls for an integration of the two perspectives and a shift toward evaluating mechanisms as a way to move the field forward. Nonetheless, the common factors are valuable in treatment delivery and should be a focus in delivering psychotherapy.