The sardonic title does not do justice to “The Book of Woe,” one of three books being recently published which censure the so–called bible of psychiatry, the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). The writing sometimes degenerates from logic to empty rhetoric, yet his treatise is comprised of both a well–written philosophical critique and a stunning behind–the–scenes exposé of the history of the American Psychiatric Association (APA) and of its bible.
Greenberg is a Connecticut psychotherapist, book author, and journalist. In the book, he never aligns himself with antipsychiatry. In much of the book, Greenberg informally debates with Allen Frances, the powerful psychiatrist who was chair of the DSM–IV task force in 1994, but who later turned coat against the fifth edition, DSM–5. While these two intellectual mental health professionals agree that the DSM is fatally flawed, they disagree about the extent to which psychiatry itself is faulty. On page 346, Frances tells Greenberg, “Your bias is showing.” Greenberg responds, “It isn’t bias to be skeptical. And it’s not antipsychiatry to question psychiatry. […]” (347).
One thing that needs to be distinguished here, though, is that there are various definitions of antipsychiatry. Even Greenberg fails to note that. (For instance, the Collins English Dictionary on Dictionary.com gives this lovely definition.) In “The Book of Woe,” notable psychiatrists use the term antipsychiatry as an invective and their only definition of the term seems to be literal: a complete opposition to psychiatry and to “mental health” treatment. On page 278, Allen Frances laments, “Everything I say is seized by the antipsychiatry fanatics and misused for their own unfortunate purposes.”
I am someone who identifies as an antipsychiatrist. I have engaged in antipsychiatric activism and I have been following antipsychiatry and Mad Pride news for a few years now. (You can read the story of how I was drawn to antipsychiatry here.) So when I borrowed “The Book of Woe” from the library, I had two expectations. One: I would agree with the book. Two: The arguments would be redundant to me, because I’ve heard it all before.
On the first expectation, I was correct. Greenberg shattered my second expectation.
Greenberg elegantly expounds many of the points with which we antipsychiatrists are already familiar—such as why the serotonin hypothesis about depression is so flawed (even if SSRIs are sometimes effectual). However, he has new revelations about the history of the DSM.
Those who have never seriously questioned psychiatry may assume that the DSM, especially the recent DSM–5, is the culmination of scientific consensus about the nature of mental illness and how to treat it. They couldn’t be more wrong.
Instead, the DSM is the culmination of years and years of infighting between psychiatrists and other mental health professionals, who have clashed bitterly about the nature of mental disorders, where to draw the line between mental health and mental illness, what conditions are disorders, and how to diagnose and treat them. Even the DSM–5 is the result of this internecine strife and many unsteady compromises. It’s not just obvious flip–flops like the former diagnoses of homosexuality and Asperger syndrome (both covered in detail in Greenberg’s book). Just about every diagnosis in the manual has undergone some private controversy. Only insiders and journalists have been privy to this.
You might think that the infighting is mostly personal and rather meaningless. Actually, each conflict is the embodiment of deep philosophical problems and scientific weaknesses.
You will read about:
• How pediatric psychiatrist Joseph Biederman, the “discoverer” of childhood bipolar disorder in kids previously diagnosed with ADHD, was investigated by senator Charles Grassley and what was found about the drug money of Biederman and the APA.
• How the International Classification of Diseases (ICD), published by the World Health Organization (WHO), provides a current alternative to the DSM. One is a huge moneymaker and the other is free.
• Why a professional working on the DSM publicly resigned (133).
• How Gary Greenberg was allowed to contribute to the research for the DSM–5. What he experienced as a Collaborating Investigator. The message from the APA director of communications, refusing to provide him any more information due to his “deeply negative and biased” article in “Wired” (282). How the DSM oversight was so disordered that he continued being a Collaborating Investigator (283). The abysmal performance of the field trials.
• How the National Institute of Mental Health (NIMH) is researching its own means of scientific classification of mental disorders (339).
Someday psychiatry could be replaced by clinical psychology and clinical neuroscience. On page 61, Thomas Insel, Director of NIMH, hints at the latter possibility. (However, Insel recently defended the DSM.)
My next read will be the treatise of Allen Frances on the DSM–5, entitled “Saving Normal.”
Author: Gary Greenberg. Book: The Book of Woe: The DSM and the Unmaking of Psychiatry. Place of publication: New York, New York. Publisher: Penguin Group (USA). Imprint: Blue Rider Press. Date: 2013.