Barry Blackwell: Treatingthe Brain: The End od the Beginning the Beginning of the End.(Chapter 19)

Barry Blackwell’s reply to Bruno Mueller-Oerlinghausen’s comment


         I thank Bruno for his vehement and kind affirmation of this posting which will become a chapter in my forthcoming book Treating the Brain; An Odyssey. Meanwhile, I would like to take this opportunity to elaborate further on the influence of the DSM system on psychiatric practice.

       As a sequel to Donald Klein’s sad death August 9, 2019, I wrote a eulogy, posted to INHN Dec. 5, 2019. This made clear to me a distinction between Klein’s creative role in the evolution of the DSM system from a psychoanalytic frame of reference in DSM-II to a bio-psycho-social one for DSM-III in 1980; contrasted with the subsequent corruption based on how the system came to be used in the following four decades (1980-Present).

       The DSM’s multi-axial format created an opportunity to include all the biological,  psychological and social features of a disorder in a formulation that could reflect and influence the natural history, treatment and outcome.

       Within two decades it became clear this opportunity was slipping away, provoking a collaboration between a psychopharmacologist, a psychoanalyst, a cognitive behavioral psychologist and a community psychiatrist to create a co-authored book, Psychiatric Case Formulations (Sperry, Gudeman, Blackwell and Faulkner 1992).

       The book was published by the American Psychiatric Press (an arm of the APA) and although a success it was never reprinted. The sad fact is that the DSM system became taken for granted, a money maker for the APA but seldom,  perhaps never,  properly taught in training programs, quickly shrunken and debased to an Axis 1 biological eponym used to medicalize and monetize the profession; a lucrative prop for the insurance and drug industries.



Sperry L, Gudeman JE, Blackwell B, Faulkner LR. Psychiatric Case Formulations. 1992, Washington DC, American Psychiatric Press.


December 12, 2019