The Diagnostic and Statistical Manual of Mental Disorders in the Courts

The DSM is designed with the intention that it will be used in clinical and research contexts, not as a guide for the courts. Increasingly, from DSM to DSM-Ill-R, the introductory cautionary statement in the manual has warned against its use in the judicial context. The drafters of the DSM faced a choice and might have chosen to address in some greater detail those disordered behaviors that do have legal relevance in that they arise with some degree of regularity in the courts. The following essay examines this choice and its consequences. The history of the Diagnostic and Statis-tical Manual of Mental Disorders, al-though relatively brief, reveals a signifi-cant and interesting change of approach by its drafters regarding its use in the courts. The first edition of the DSM,' published in 1952, contains no express reference to its use in the courts. DSM-1L2 published in 1986, however, con-tains in its foreword rosy words of opti-mism about its use in the judicial con-text: In publishing the Manual. the American Psy-chiatric Association provides a service to the psychiatrists of the United States and presents a nomenclature that is usable in mental hos-pitals, psychiatric clinics, and in office practice. It has, in fact. a wider usage because of the growth of psychiatric work in general hospitals. both in psychiatric wards and consultation services to patients in other hospital depart-ments, and in comprehensive communit