Naming the problem that has no name: creating targets for standardized drugs

Many of the most common types of mental health problems that are found in outpatient psychiatric and general medical practices are diffuse, undifferentiated, and amorphous. Before the 1970s this lack of specificity did not conflict with the dominant theories and treatments of the American psychiatric profession or the demands of third party insurers and regulators. However, since that time the legitimacy and solvency of the psychiatric profession has come to depend on the perception that it treats specific disease entities. The establishment of the DSM-III in 1980 provided American psychiatry with many standardized disease entities that could be precisely measured, quantified, and abstracted from their particular contexts. In the late 1980s, these entities became the targets of the new class of psychoactive drugs, the Selective Serotonin Reuptake Inhibitors. Professional, political, economic, and cultural forces that arose in a particular historical era account for the standardization of mental illnesses.

► Targets of psychoactive medications do not fit dominant models of specificity. ► Social factors create suitable standardized conditions for medication to treat. ► A loss of professional legitimacy led to the standardized diagnoses of the DSM-III. ► The DSM-III categories led drug companies to focus on depression rather than anxiety.