As a defense mechanism, the third edition of the Diagnostic and Statistical Manual of Mental Disorders was equal parts identification and repression. Having weathered a decade of attacks from the general public and the insurance companies signing the checks, the guide was published in 1980 as psychiatry's claim to âcarving the mind at its joints.â
But as author Gary Greenberg shows in The Book of Woe: The DSM and the Unmaking of Psychiatry (Blue Rider, 416 pages, $28.95), the diagnoses in psychiatry have as much to do with politics as science, and even more to do with satisfying insurers who want a clearly named disease before they'll pay for treatment. The DSM IV and now the DSM 5—published May 14—each radically revise their predecessors, but they do so in much the same way that Reagan revised Carter.
Psychiatrists Allen Frances and Bob Spitzer—editors of DSM IV and III, respectively—have become the most vocal opponents of the new DSM 5, whose draft versions have abolished Asperger's syndrome and gender dysmorphic disorder and instated a psychosis risk syndrome that basically implies someone might go crazy someday.
And just as in politics, the results of psychiatric infighting redound into the real world. Frances warns that the new DSM 5, in proliferating the number of mental illnesses and making it easier to diagnose them, will cause "diagnosis epidemics" such as the sudden rush to medicate people for bipolar disorder in the early 2000s that led to a near-doubling of the number of children treated with antipsychotic drugs known to cause weight gain, diabetes and shortened lifespans. Mental illnesses are real, Frances says, but the demarcations are arbitrary "bullshit."
Greenberg isn't shy about his own feelings, either; a practicing psychologist, Greenberg says he won't use insurance companies because they require diagnoses that are neither true nor false. The simple naming of a disorder, he writes, can affect not only how patients are understood by others but how they understand themselves. But the naming doesn't always describe a real thing, he writes, and people trying earnestly to relieve suffering have been turned into bullshit artists by insurance forms.
Greenberg's book is shy on the actual details of the DSM 5—it wasn't out when he wrote The Book of Woe, and the committee behind it is oddly secretive—focusing instead on the politics of its making. So there's a bit of sleight-of-hand here, warning us about something he knows not of. But as a polemic book grounded in gonzo journalism, it's effective in one thing: It gives pause to anyone whose doctor hands them a little red pill and a name for their suffering.