● The Book of Woe: The DSM and the Unmaking of Psychiatry
By Gary Greenberg
Blue Rider Press, 416 pages, $28.95
Any psychiatrist who is not too stupid or too full of himself to notice what is going on knows that what he does is morally indefensible.
Substituting the word “psychiatrist” for the original word, “journalist,” the sentence above is the famous opening of Janet Malcolm’s book “The Journalist and the Murderer,” about convicted murderer Jeffrey MacDonald’s lawsuit against “journalist” Joe McGinnis. It is relevant here because in “The Book of Woe,” Gary Greenberg, a psychotherapist and journalist, has done for (or perhaps to) psychotherapy what Malcolm did for journalism: He exposes the myths it perpetuates, and the secrets it doesn’t want outsiders to know.
Malcolm’s book used the lawsuit as a microcosm of journalistic ethics. Similarly, Greenberg structures his book around a single process: the preparation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM: the bible of the American Psychiatric Association. In evaluating the revision process, Greenberg shows how ignorant, shallow and downright dangerous the psychiatric profession can be to those it claims to be helping.
The DSM’s first edition, compiled by a consensus of APA members and published in 1952, was simply an attempt to create a common nomenclature for psychiatric disorders. Since then, it has been revised several times, and with each revision it has accrued more definitions of disorders, more criteria, a lot more pages and — starting with the DSM-III (published in 1980) — more power and authority.
By now, the DSM is the final word on what constitutes a mental illness — in this country, at least — and as such is used by policymakers, drug regulation agencies, clinicians, researchers, pharmaceutical companies, health insurance companies, and state and federal bureaucracies to determine whether and what research is funded; what treatments are covered by insurance, and whether people with certain disorders qualify for government services.
It’s also the source of many people’s understanding of themselves: For example, people who have been diagnosed with Asperger’s syndrome (an inability to read social cues) have said the diagnosis not only allowed them to comprehend why they felt alienated in social situations, but also made it possible to find other people like themselves.
Asperger’s syndrome first appeared in the DSM-IV, published in 1994, setting off an explosion of diagnoses that has yet to level off: Current estimates of people with Asperger’s in North America range from 600,000 to 2.1 million.
Nevertheless, the syndrome has been expunged from the DSM-5. A last-minute compromise between APA editors and irate Asperger’s groups permits those who were diagnosed previously to keep their diagnosis. But in the future, people who would have met the criteria for Asperger’s might find themselves under the umbrella category autism spectrum disorder — or not diagnosed at all, and thus ineligible for government services.