An excellent, playful takedown of the DSM5 in The Book of Woe

From The Week of May 27, 2013 Compared to the talents and the weapons claimed by the great diversity of life on Earth, humans are an unremarkable species. We cannot hide ourselves in plain sight nor poison our enemies with venom. We cannot glide through the skies nor survive at the bottom of the oceans. But what we lack in tusks and gills, wings and exoskeletons we make up for with the power to think, an ability that has given rise not just to dreams and language, science and culture, but the only advanced civilization to have ever graced our planet. Our minds are remarkable machines that evolution has shaped into tools that we will use to rise beyond our base genetics, our root circumstances, and take to the stars. But for all its glory and its plasticity, the human mind is not without its flaws. For while it has enabled some to make discoveries that have re-imagined our world and our universe, it has also steered some into the pits of hell, condemning them to lives of madness and confusion, obsession and disassociation from which it is difficult to recover. And it has encouraged yet others to study these malformed minds to both glean knowledge of their illnesses and to aid in their healing. But just how successful has that effort been to catalogue and heal the array of human mental afflictions? Gary Greenberg explains in his fascinating polemic. The diagnostic and Statistical Manual (DSM) is the psychiatrist's handbook. An oft-revised classification of mental illnesses, it is an encyclopedia of disorders that range from the disassociative to the obsessive. Though largely confined to the psychiatric community, the alphabet soup of its terminology, BP, OCD, BPD, has spilled over into mainstream culture, causing some to prematurely diagnose themselves with its theatre of mental horrors while motivating others to rebel against its labels, rejecting them as nonsense. Between, it has given rise to an eruption of proscriptive drug use unimaginable fifty years ago, a result that none of its authors could have predicted. The DSM has undoubtedly been beneficial to some. Its classifications, assembled from thousands of studies, have helped clinicians accurately recognize and properly treat mental illness in their patients. However, the DSM is simultaneously, and unavoidably, the work of men and women who cannot escape the biases of their culture. Thus, over the years, "afflictions" such as homosexuality have been included in its pages, proscriptions offered for its curation. These incidents damage the Manual's credibility. For if illnesses can so easily slip in and out of its pages, then what truly is mental illness? Can we ever know? The result of both a career as a clinician and the most recent and controversial revision of the DSM, The Book of Woe is an excellent and utterly unforgiving examination of the DSM: its history, its implementation and its architects. Though Mr. Greenberg pays particular interest to the pointed criticisms of the DSM5 by Allen Frances, the author of the previous version, this exercise in mud-slinging is merely an entertaining and clarifying lens through which to view the ways in which the DSM has impacted psychiatrists, their patients and the wider culture. In this, Mr. Greenberg is clinical in his ruthlessness, raising awareness of the numerous ways in which the DSM's various revisions have been exploited by doctors and pharmaceutical firms to create highly profitable drugs of dubious effectiveness at the expense of patients and their concerned families. This work is hardly the first to raise such concerns, but they are handled here with both care and passion. Though much of The Book of Woe's critiques of the DSM5 will be of little interest to non-psychiatrists, Mr. Greenberg is effective in taking the reader into the anatomy of a diagnosis, not only revealing how thin the line is between mental health and mental illness, as defined by the DSM, but the ways in which such diagnoses offer hope to bewildered families seeking answers. The author poignantly captures just how desperate some people are to get help, help that, at times, the DSM actually hinders instead of aids. The Book of Woe only re-enforces the critical importance of being one's own best advocate, of questioning everything as a means to getting the proper diagnosis, a task made all the more difficult when one's mind is clouded by illness. The Book of Woe is certainly not without its flaws. Mr. Greenberg barely even attempts to be objective about the DSM5, featuring here its critics far more than its promoters. Moreover, he has chosen to prominently focus on the bumps in the road to the DSM5's publication, making it seem as though the book is a nonsensical result of bureaucratic bumbling. His desire to emphasize these flaws gives what would appear to be a distorted view of the DSM5's quality. However, even in this, Mr. Greenberg's work serves a purpose, chiefly, to reveal the degree to which the APA has deployed all the typical and despicable tools of a bureaucracy on the defensive to fend off criticisms and discredit its criticizers, a reality that leaves the APA looking both disorganized and greedy. For those interested in the history of the DSM, The Book of Woe is a wonderful read, full of colorful characters and powerful minds. But for those looking for a good catfight between deeply interested parties, looking to preserve both fame and fortune, look no further. (4/5 Stars)