The Book of Woe: The DSM and the Unmaking of Psychiatryby Published 02 May 2013
|The Book of Woe: The DSM and the Unmaking of Psychiatry.pdf|
|Publisher||Blue Rider Press|
An exposé of the psychiatric profession’s bible from a leading psychotherapist, The Book of Woe reveals the deeply flawed process by which mental disorders are invented and uninvented—and why increasing numbers of therapy patients are being declared mentally ill.
The Book of Woe: The DSM and the Unmaking of Psychiatry Reviews
I saw this in a bookstore and only had to read the cover to know it was a book I'd be interested in. Psychology? Personality descriptors? Behind-the-scenes drama? I'm there! I adore psychology, love reading about it, but am skeptical about medical authorities, so I figured I'd rip through this book in a day or two.
It starts out promisingly enough; Greenberg describes a 19th century mental affliction common to slaves in which they curiously desire to escape their masters. Perhaps he's taking a cheap shot, Greenberg asks rhetorically, and then replies that perhaps to gay people who remember when homosexuality was a mental disease will think his point is valid after all. This sets the tone of the book: anger and frustration at the entire American psychiatry industry.
The Scientologists are going to love this book, if they can get through the dull prose and meandering structure. They might find the same problem that I did: this book (despite my love of its potentially juicy subject matter) bored me. I've been puzzling over why it did so, and came up with a few possible reasons.
First of all, the book feels deeply personal. It reminds me of a celebrity tell-all about people on a TV show I've never seen. It's hard to keep all the people straight, and it's off-putting to hear what feel like veiled ad-hominem attacks when you don't know the subject.
I didn't much care for the structure either. Large chunks of the book consisted of dull "and then they had another meeting, and then they talked about the meeting, and then someone sent an email" which made me want to skim pages. The authors writing style feels like that of an academic, (which is to say, dull, obtuse and unnecessarily complex)and while some sections feel refreshingly readable, the prose inevitably slipped back into academese as if the editor couldn't fully rein in a lifetime of habit. It's loose chronological structure left many pages of dull exposition without any case studies or anecdotes to wake the reader up again. After a chapter or two of this, I'd get ready to close it and put it on the shelf, but then there'd be something interesting, like a case study or anecdote of someone who was directly affected by the change in diagnosis. I'd perk up, excited at the concrete livening up the abstract, but then the author would go back to the he-said, she-said.
I don't think there was enough good material here for a book. I should clarify: too much of the wrong kind of material (descriptions of meetings between people you don't know) and not enough of the right kind of material (concrete examples to solidify his points). Here's my synopsis: "They started writing a book called the DSM a long time ago to make psychiatray feel more like medicine to describe mental illnesses. Then it sold really well, so they revised it a few more times. But then the guy who helped write the fourth version wasn't consulted about the fifth version, and he got really mad, and they all started bickering about it." It makes them all sound so petty and shallow. I'm not so high and mighty that I don't like gossip, but if you're going to slander your colleagues and debase the public view of your profession, you should at least titillate us in the process.
I'm not sure how I feel about the thrust of this book. On one hand, I think some people give diagnoses too much credit, like the people who blame all of their asshole-tendencies on their self-diagnosed Aspbergers. Also, not enough people are aware of how the drug companies influence the creation of diseases to fit whatever cure they're shilling. So that's valuable. On the other hand, he makes the APA sound like a bunch of ninnies, and I am pretty sure that most of these people are intelligent, educated, and caring professionals doing the best they can.
Everyone is touched, at least at some level, by psychiatry in this culture. People watch talk show docs diagnose callers, people read pop-science books about personality disorders, and everyone has either gone to a therapist or known someone who has. So this is relevant to a lot of people, even if they aren't involved with psychiatry as a profession. The subject matter could have made this a winner of a bestseller, which is why I tried to finish it despite the many sections which bored me.
I hesitantly recommend this to people who are deeply interested in psychiatry and aren't put off by weak writing.
A scathing criticism of the new DSM-5, The Book of Woe chronicles the development of the newest edition of psychiatry's Diagnostic and Statistical Manual--the book listing mental disorders and illnesses. Gary Greenberg, a psychologist clinician who participated in the field trials during the development of DSM-5, shines the spotlight on egregious problems, including harmful diagnoses of the past (such as children's bipolar disorder), potentially disastrous changes to current disorders (such as removing the bereavement exclusion from Major Depressive Disorder and doing away with the Asperger's Syndrome diagnosis), and the creation of new disorders that describe criminal behavior in terms of illness (such as hebephilia). While all of this data is fascinating, the most interesting aspect of this book is Greenberg's assertion that psychiatry isn't dealing with reality at all. There is no physical indication that such a thing as depression or ADHD or bipolar disorder actually exist. That's not to say the symptoms such patients experience aren't real. It's just that we cannot act with certainty that disorders present themselves the same way and should be treated the same way in every person. They don't. Greenberg does not claim to be antipsychiatry. Instead, he calls for an honest psychiatry in which doctors admit that we can't really define what causes a particular disorder. We can only describe the symptoms we see, and we can make a guess as to what treatments might help. By medicalizing human suffering, Greenberg says, psychiatry has erected a scientific facade that has no basis in fact, has caused more harm than good and has overstepped its bounds in determining where normal human suffering ends and illness begins. This is an in-depth look at the problems with the current psychiatric system. It also highlights the fact (although unintentionally) that any human attempt to understand and treat suffering apart from the grace of God will always fall short.
I gave this book a 3 because it has some important ideas about psychiatry, labels (their benefits and the harm they can do), the use of pills for treatment and the significance of the DSM. Unfortunately, the good stuff is sandwiched within a lot of sarcastic and mean spirited prose. I hope some meaningful discussions about the DSM and psychiatry are sparked by this book but I fear its vitriolic tone will hamper civil discourse.
This is not an easy read for anyone but those who might have an interest in Psychiatry or the medicalisation of life; it is however very enlightening. Written by a psychaitrist, though no doubt he is now systematically shunned by his colleagues, this study shows up the DSM, the Bible of psychiatry to be one of the greatest hoaxes of all times, but one with tragic consequences.
The main purpose of its inception was the decline, during the 60's and 70's in the perceived status of psychiatry to almost the same level as voodoo. This group of Doctors suffering from the terrible insecurities produced by having almost no scientific basis for either their diagnosis or treatment of patients, needed a legitimising touchstone, the DSM. Needlless to say the creation of a "book" where, arbitrary and scientifically baseless they maybe, classifications of mental conditions could be made, given a name and a number which not only served the profession's purpose of legitimising their specialty but also kept insurance companies, lawyers and governements happy by providing something to fill in or boxes to tick so that the money could flow....and flow it did; largely into the pockets of psychaitrists, drug companies and of course research establishemnts that housed and served who? The very people who authored the DSM itself.
The recounbting of the history of the Manual's development together with all the turf wars, ego battles and infighting among the vested interests may be a bit dry in the reading but it is also deeply disturbing. As one who has been at one time swept up by this particular cabal orientated around the DSM I have not only seen the damage but have been sucked into its very vortex myself. I count myself truly lucky that in a moment of rare insight and in complete contradiction to the advice of professionals I was able to defy the odds, refuse their bullshit diagnoses wrapped up in fancy, though official sounding terms and make my own way without the aid of the soul destroying, mind numbing drugs the psychiatrists in my life were only too happy to dispense. Such dispensation much to the pleasure of the drug companies who reap huge financial benefits.
My escape derived from desperation; the bastards nearly killed me over a period of several decades, but I was an adult with at least some life experience and a sense of self preservation which often expressed itself as defiance, though this latter was of course regarded by my psychiatrists as pathalogical. I could decide to give them the flick and I did, the demise they threatened would result could not have been any worse tha the place they put me. There are chidren on the other hand who are classified by psychiatrists based on the DSM as having ADD, ODD and Bi polar disorder. They do not have that choice, and now thousands of kids are having heavy duty drugs thrust down their throats daily, drugs that were once called antipsychotics but have been conveniently renames mood stabilsers by the pharmceutical industry as a marketing expediency. This appalling instance of professional abuse (so much for the Hippocratic Oath)is but a single instance, a tragic tip of the iceberg
The reification of the DSM in the main, serves only the purposes of psychiatrists (access to payments and research funds) drug companies (profits) and of course finally and significantly the APA (Americam Psychiatric Association) which produces the DSM reaping millions from every edition ($6 million from DSMIV)and of course perceived legitimacy for its members.
This is not to say that all psychiatrists are driven by self interest and are schysters, though many are, but if one were to do a cost benefit analysis it is my view that the 19th Century model of sanitoria, large beautiful old houses set in bucloic natural surrounds could do more good at a fraction of the cost now demanded by a profession rampantly craving respectibility, legitimcy and the fruits that flow from both in the form of cash.
It has been quite a conjuring act, they have largely pulled it off and now at whim anyone who displays behaviour that may be eminently human but that draws the attention of an ambitious heavy hitter in the American Psychiatric Association can quickly find themselves classified as mentally ill, drugged out of their mind and contributing liberally through their medical insurance to the lifestyle of a substantial segment of the nouveau riche and infamous.
My five stars are tentative, a reaction to the first few pages of this book. I can already tell it's going to be interesting, intelligent, and insightful. I like a writer who can write a good sentence and make a good point. If this book is as good as Greenberg's "Manufacturing Depression," it will deserve four or five stars for sure.
In fact, I was on vacation in New Orleans, shacked up in the center of the French Quarter, where I spent way too much time sitting in the hotel lobby, reading The Book of Woe. this is significant because even though the topic is of little interest to me, I was gripped. Maybe I was also looking for the diagnosis of someone who catches up on reading while on vacation in New Orleans. There's got to be a word for a disorder like that.