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The storm brewing over the latest edition of psychiatry’s so-called bible is “not merely a matter for eggheads,” said Dwight Garner in The New York Times. The Diagnostic and Statistical Manual of Mental Disorders “holds vast sway over human lives.” It separates the sick from the well. It determines what kind of drugs and other treatment millions of people receive—and whether insurance and government aid programs will support those treatments. Yet the first DSM in 19 years is due to arrive next week amid spreading doubts about whether the manual’s vast authority is merited. With The Book of Woe, psychotherapist Gary Greenberg adds a fresh, funny voice to the chorus lined up to belittle psychiatry’s 1,000-page taxonomy.
By focusing on the messy committee work that produced the new DSM-5, “Greenberg builds a splendid and horrifying read,” said David Dobbs in Nature. Psychiatry’s great problem has been that science has been unable to identify the biochemical causes of mental disorders, and Greenberg trots out some “gruesome sausage-making stories” about how the American Psychiatric Association—which produces the DSM and profits greatly from its sales—goes about codifying disorders based merely on clusters of symptoms. He’s “not evenhanded in recounting all this,” said Martha Stout in The New Republic. But he’s “better than any other critic I have seen” in explaining how a group of smart, seasoned people were lured by the love of money and power into persuading themselves that they were proceeding scientifically on a project that was instead built on fictions.
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On that point, Greenberg has a noteworthy ally, said Benjamin Nugent in Slate.com. One of the principal characters in his account is Duke University psychiatrist Allen Frances, who was the lead author of the fourth DSM. Frances regrets the way much of that work was produced, and has waged a fierce campaign to discredit DSM-5 and persuade the APA to order a rewrite. Greenberg instead questions whether a manual is even needed, and that’s where he loses me. As someone who as a teenager was diagnosed with Asperger’s syndrome—a disorder expected to be struck from DSM-5—I share his skepticism about all labels based on current science. But people suffering from serious mental disorders need help from professionals who are working within an agreed-upon language of some kind. Though a perfect DSM would still be a lie, it at least would be a noble lie.
