“The Book of Woe” Takes On the Upcoming DSM-5

Gary Greenberg, The Book of Woe: You could think of the DSM as a handbook designed to help doctors recognize the varieties of psychological travail, not unlike the way Audubon’s field guides help ornithologists recognize birds. You could think of it, as some people (especially its critics) do, as the Bible of psychiatry, providing a scriptural basis for the profession. You could think of it—and this is what the APA would like you to do with the DSM-5—as a living document, akin to the U.S. Constitution, a set of generalizations about the present, flexible and yet lasting enough to see an institution into the future. Or you could think of the DSM as a collection of short stories about our psychological distress, an anthology of suffering. You could think of it as the book of our woes. 

I have to admit I’ve never felt comfortable with any past version of the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Some of this is personal, as in growing up in the era when homosexuality was deemed a mental disorder. But most of it is professional, as in not feeling able to fit most people’s symptoms and issues neatly into medicalized categories—but having to, mostly for insurance purposes.

I’m hardly the only one with discomfort, though. If this wasn’t already clear to me, it’s been made much more so by the various public protests against the soon-to-come long-in-the-making revision, the DSM-5.

One particularly vocal critic is Gary Greenberg, a therapist who participated in field trials that contributed to the foundation of the DSM-5. His own new treatise is called The Book of Woe: The DSM and the Unmaking of Psychiatry. Or, as journalist Gene Weingarten remarks, “This could be titled The Book of … Whoa!” As in, stop the madness (of DSM-ness) already!

In 40 years, the psychiatrists behind developing the DSM in all its incarnations still haven’t been able to get it right, Greenberg essentially states in The Book of Woe: “Psychiatrists have gotten better at agreeing on which scattered particulars they will gather under a single disease label, but they haven’t gotten any closer to determining whether those labels carve nature at its joints, or even how to answer that question. They have yet to figure out just exactly what a mental illness is, or how to decide if a particular kind of suffering qualifies.”

Not only does the DSM lead to the probable over-diagnosis of common life issues, says Greenberg (and other critics), but it also enables the American Psychiatric Association (APA) to make tons of money off concepts that lack provability.

There are no biological tests, for example, no proven courses of treatment for major DSM disorders, no way to know if one clinician’s diagnosis of an individual’s condition is better than the next clinician’s, not enough elimination of cultural bias.

Martha Stout, herself an author of books about psychiatric issues, concludes (New Republic) that it’s worth reading The Book of Woe for at least three reasons:

  • For increasing our understanding of DSM‘s reach. It “profoundly influences nothing less than humankind’s beliefs about itself. The DSM tells people all over the world how to figure out who is normal and who is not, and there are few questions by which human beings are quite so universally intrigued.”
  • To be reminded or informed of the continual view-changing regarding diagnoses, including the effects of evolving “cultural beliefs and bigotry.”
  • Realizing the extent of the business side of all this. The DSM-IV, for example, brought the APA a hundred million dollars. Each clinician who buys the DSM-5 will shell out $199.

Personal disclosure: I’ve never bought a DSM in its fullness. But the smaller “Desk Reference” edition, which I have gotten, will go for close to $70.

Publishers Weekly: “Deploying wised-up, droll reportage from the trenches of psychiatric policy-making and caustic profiles of the discipline’s luminaries, Greenberg subjects the practices of the mental health industry—his own included—to a withering critique. The result is a compelling insider’s challenge to psychiatry’s scientific pretensions—and a plea to return it to its humanistic roots.”

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