Book review: The Book of Woe, by Gary Greenberg
A new edition of the Diagnostic and Statistical Manual of Mental Disorders, the so-called bible of psychiatry, is always an awkward moment for psychiatry. It's a rewriting of the rules of engagement with the human mind and a tacit admission of past errors, errors that have caused irreparable harm. Homosexuality was listed as a mental disorder, for example, until 1973.
Gary Greenberg argues that the manual and its authors at the American Psychiatric Association wield their power arbitrarily and often unwisely, encouraging the diagnosis of too many bogus mental illnesses in patients and too much medication to treat them.
For bodily diseases, there are actual tests. For mental diseases, not so much. Psychiatrists are forced to deal with symptoms, which are often misleading. "A doctor who diagnosed strep entirely on the basis of symptoms was practising bad medicine," Greenberg writes, "while a doctor who diagnosed depression only on the basis of symptoms was practising standard psychiatry." He argues that psychiatry needs to become more humble, not more certain and aggressive.
Greenberg has three essential targets. The first is diagnostic inflation - the way we are turning normal people, especially normal children, into mental patients. The second is the American Psychiatric Association, which he doesn't trust to possess naming rights to psychological pain, in part because of its financial stake in new editions of the manual.
Finally, there is the fifth manual itself. Greenberg was among the lower-level therapists - "collaborative investigators", in the association's terminology - who supplied data in field trials to help undergird the book's conclusions. He saw the disarray up close.
A central argument against the last edition of the manual was that it gave clinicians too much discretion and led to a diagnostic epidemic.
Greenberg says the manual, in its every iteration, is nothing more than "a compendium of expert opinions masquerading as scientific truths, a book whose credibility surpasses its integrity, whose usefulness is primarily commercial".
The New York Times