The adoption of DSM-III by the American Psychiatric Association has been viewed as representing a major advance for psychiatry and as an indication of the emergence of a broad professional consensus on diagnostic issues. The process of drafting the new manual was not, however, free of conflict. This article presents a narrative account of the controversies over the role of psychodynamic formulations in DSM-III and the more focused, though sharply contested, symbolic dispute over the inclusion of neurosis in the nomenclature. It traces the evolution of these disputes and focuses on the interplay of scientific and political considerations as psychiatrists committed to differing professional and therapeutic paradigms confronted each other for more than two years as the profession sought to develop a new manual that would improve the level of reliability of psychiatric diagnosis.