The Book of Woe: The DSM and the Unmaking of Psychiatry
Gary Greenberg
Blue Rider Press, 2013 ($27.95)
This is a landmark book about a landmark book. Psychotherapist and author Greenberg first took on the Diagnostic and Statistical Manual (DSM) in a blistering article in Wired in 2010. The Book of Woe is the nearly 400-page update, whose release coincided with the May 2013 release of the DSM-5, the fifth edition of the bible of mental health, which first appeared in 1952.
Relying heavily on interviews with distinguished insiders in the psychiatric establishment, Greenberg paints a picture so compelling and bleak that it could easily send the vulnerable reader into therapy. The basic message is this: everyone in the mental health profession knows full well that the DSM is a work of fiction—that the hundreds of “disorders” described therein are just labels for fuzzy, overlapping clusters of symptoms and that we have never found a definitive biological marker for even one of those disorders. Mental health professionals pretend that the disorders are real, but they're not, period.
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And then there's the money. The American Psychiatric Association, a shrinking and financially strapped organization of 36,000 psychiatrists, has made $100 million off sales of the fourth edition of the DSM, Greenberg says.* More than 400,000 licensed mental health professionals in the U.S. alone depend on the diagnostic codes in the DSM for insurance income. Prominent research psychiatrists who misused DSM diagnostic categories to open up the prescription drug market for children received more than $1 million each in kickbacks from pharmaceutical companies for their efforts.
Greenberg takes the reader deep inside the secretive world of the panels and personalities that have spent years arguing about which disorders and symptoms they would keep and which they would discard in the new DSM, focusing on one especially rancorous debate over the bereavement exclusion. Previous DSM editions advised therapists that people grieving over the loss of a loved one should not be labeled as clinically depressed; the DSM-5 eliminates the exclusion, potentially bringing therapists and drug companies eight million new customers a year.
Psychiatrists are in the business of pathologizing and throwing drugs at everyday problems, and given the money at stake, perhaps nothing can stop this trend.
*Erratum (9/9/13): This sentence was edited after posting to correct the name of the American Psychiatric Association.