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The Vote on DSM-IV-Reply

Robert L. Spitzer, MD; Janet B. W. Williams, DSW
Arch Gen Psychiatry. 1989;46(10):959-960. doi:10.1001/archpsyc.1989.01810100101023.
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In Reply.—  We also are in favor of motherhood, family, and an empirically based classification of disease. However, we do not agree with our colleague, Dr Taylor, about what has been accomplished by the development of DSM-III and DSM-III-R and, more importantly, what steps should be taken to develop a significantly better DSM-IV. Dissatisfaction With the Conceptual Framework of DSM-III and DSM-IIIR.—No one, including us, is entirely happy with our current nosologic system. Although Dr Taylor denigrates the little progress that has been made since Kraepelin, it is significant that he offers no alternative system or conceptual framework to replace the largely descriptive classification that is embodied in DSM-III and DSM-IIIR. The problem of an imperfect classification is not unique to psychiatry: Feinstein,1 a noted medical nosologist, has recently discussed the sad scientific status of the classification of clinical medicine as embodied in the International Classification of Diseases. His most


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