What do you think?
Rate this book
The Book of Woe: The DSM and the Unmaking of Psychiatry
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.
405 pages, Hardcover
First published May 1, 2013
124 people are currently reading
3194 people want to read
About the author
Gary Greenberg
5 books18 followersLibrarian Note: There is more than one author by this name in the goodreads data base.
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 30 of 116 reviews
June 8, 2020
One of my fields of study in college was psychology, so I have always been very interested in knowing what is going on in the fields of psychiatry and psychology. I also have some fairly strong opinions about the validity (or invalidity) of psychiatry. I really enjoyed reading this book, as it touched on a lot of what remains wrong with these fields, along with the development of the DSM 5. However, I found the book a bit tedious in its long descriptions of the internal disagreements, fights, and jabs that took place during the development of the DSM 5. I care not so much about the internal struggles of the APA as I do about the potential consequences to society brought about by yet more mental disorders with little provided evidence as to their validity.
December 4, 2015
This is one of my favorite books of the year. Greenberg does not hold back with his fair, and yet scathing, review of the DSM from its inception to now. During my undergrad as a cog neuro major, one of my favorite classes was one in which we tore apart the various diagnoses in the DSM. I think it is a worthwhile endeavor for all health care professionals. Unquestionably, the DSM, including the new DSMV, has a long list of inherent problems and Greenberg hits on most of them. This is a problem for psychiatry for a few reasons.
1. Critiquing the DSM might result in giving power to fringe groups, such as scientologists. This is the same problem faced by scientists who are trying to revise the modern synthesis of evolution. Any criticism is misunderstood and misused by creationist groups lacking even the most basic scientific education.
2. Despite the above mentioned problem, critiquing the DSM is necessary if psychiatry intends on their treatments being more than a placebo effect.
There is no doubt, in my mind, that people have suffered from various mental issues throughout history. However, it is a tricky business to understand what is more or less objectively harmful (perhaps we would put schizophrenia with paranoid delusions in this category?) and more subjective "illness" like homosexuality, gender identity disorders, which are the result not of illness but of societies and cultures.
Who can we trust to create diagnoses? Have our experts turned into the decemviri? Recall the making of law in 450 BCE Rome. Roman citizens needed to find the most nobel of men, who could be trusted to be above the very law itself. These men could hold even the highest of the lawmakers in the land to their laws. The nobel decemviri ("ten men") were chosen and trusted. They wrote and effected the law of the land. But, when asked to step down, the refused and turned into tyrants who were extremely hard to remove from power. Greenberg describes a similar occurrence happening with the top "experts" mental health has to offer. Without needing to sensationalize his story, Greenberg takes the reader through the many questionable actions for the DSM committees-- who they shut out, what passed for evidence, what was included or excluded and on what grounds, and so much more. The power plays are exposed for all to see. That was perhaps the best aspect of the book, but there were so many great nuggets of info Greenberg treated his reader to, it's hard to say what was the best overall aspect of this book.
This is a tell all of the most delicious fashion. I highly recommend it to anyone interested in any aspect of mental health.
Some interesting questions are raised in this book:
Should insurance companies require a diagnosis?
How can we ensure that individuals get medical coverage (by giving diagnosis) without stigmatizing them?
How should that diagnosis be made?
What proof should be required for the diagnosis ?
How standard should the criteria be?
What sets each diagnosis apart?
Who gets to say what is a disorder?
Are any of these diagnoses even real?
Should we offer treatment and if so, what kind?
Asking questions like these, and others, challenge the world of psychiatry to do better, be better. Yet, it seems we are long way off. In the past Freudian psychiatry was replaced with more empirically sound behaviorism. In the end, that didn't really help. Right now our best bets are treatments like CBT and meds. But are we even using these wisely? It's important to think about.
Greenberg makes a big deal about diagnosing various psychiatric disorders the same way we diagnose cancer or diabetes. However, despite all the advancement in imagining, pharma, and psych research in general, we are far from being able to do that. If we have very little evidence that someone should be diagnosed with a particular disorder and even less evidence that many of the treatments work, are we no better than the snake oil salesmen of the past? If we are mere snake oil salesmen in white coats, should we just ignore the plethora of people who are or believe they are suffering? What is to be done about any of it? This books raises more questions than it answers, and I love that!
One thing I felt Greenberg glossed over was criteria for the various personality disorders. I had the best professor and she walked us through each personality disorder and its accompanying criteria. It was interesting to understand the lives and social status of those doing the diagnosing v those who were the diagnosed. This alone could have filled a book and deserved a few chapters. Greenberg dismisses this major area of study as a passing feminist whim that didn't even deserve much consideration. That was disappointing to say the least. But, the rest of the book was so good, I forgave him that oversight.
If you are interested in how experts make diagnosis, and in many cases false diagnoses, I highly recommend Sybil Exposed by Debbie Nathan. It was even more enjoyable than Greenberg's book. Nathan wrote a real page turner in which she examined every aspect of Mason (the real sybil) Wilbur (Sybil's psychiatrist who created personalities), and found most of the story to have been made up. She visited Mason's hometown and interviewed people, checked medical records, etc. Great read.
1. Critiquing the DSM might result in giving power to fringe groups, such as scientologists. This is the same problem faced by scientists who are trying to revise the modern synthesis of evolution. Any criticism is misunderstood and misused by creationist groups lacking even the most basic scientific education.
2. Despite the above mentioned problem, critiquing the DSM is necessary if psychiatry intends on their treatments being more than a placebo effect.
There is no doubt, in my mind, that people have suffered from various mental issues throughout history. However, it is a tricky business to understand what is more or less objectively harmful (perhaps we would put schizophrenia with paranoid delusions in this category?) and more subjective "illness" like homosexuality, gender identity disorders, which are the result not of illness but of societies and cultures.
Who can we trust to create diagnoses? Have our experts turned into the decemviri? Recall the making of law in 450 BCE Rome. Roman citizens needed to find the most nobel of men, who could be trusted to be above the very law itself. These men could hold even the highest of the lawmakers in the land to their laws. The nobel decemviri ("ten men") were chosen and trusted. They wrote and effected the law of the land. But, when asked to step down, the refused and turned into tyrants who were extremely hard to remove from power. Greenberg describes a similar occurrence happening with the top "experts" mental health has to offer. Without needing to sensationalize his story, Greenberg takes the reader through the many questionable actions for the DSM committees-- who they shut out, what passed for evidence, what was included or excluded and on what grounds, and so much more. The power plays are exposed for all to see. That was perhaps the best aspect of the book, but there were so many great nuggets of info Greenberg treated his reader to, it's hard to say what was the best overall aspect of this book.
This is a tell all of the most delicious fashion. I highly recommend it to anyone interested in any aspect of mental health.
Some interesting questions are raised in this book:
Should insurance companies require a diagnosis?
How can we ensure that individuals get medical coverage (by giving diagnosis) without stigmatizing them?
How should that diagnosis be made?
What proof should be required for the diagnosis ?
How standard should the criteria be?
What sets each diagnosis apart?
Who gets to say what is a disorder?
Are any of these diagnoses even real?
Should we offer treatment and if so, what kind?
Asking questions like these, and others, challenge the world of psychiatry to do better, be better. Yet, it seems we are long way off. In the past Freudian psychiatry was replaced with more empirically sound behaviorism. In the end, that didn't really help. Right now our best bets are treatments like CBT and meds. But are we even using these wisely? It's important to think about.
Greenberg makes a big deal about diagnosing various psychiatric disorders the same way we diagnose cancer or diabetes. However, despite all the advancement in imagining, pharma, and psych research in general, we are far from being able to do that. If we have very little evidence that someone should be diagnosed with a particular disorder and even less evidence that many of the treatments work, are we no better than the snake oil salesmen of the past? If we are mere snake oil salesmen in white coats, should we just ignore the plethora of people who are or believe they are suffering? What is to be done about any of it? This books raises more questions than it answers, and I love that!
One thing I felt Greenberg glossed over was criteria for the various personality disorders. I had the best professor and she walked us through each personality disorder and its accompanying criteria. It was interesting to understand the lives and social status of those doing the diagnosing v those who were the diagnosed. This alone could have filled a book and deserved a few chapters. Greenberg dismisses this major area of study as a passing feminist whim that didn't even deserve much consideration. That was disappointing to say the least. But, the rest of the book was so good, I forgave him that oversight.
If you are interested in how experts make diagnosis, and in many cases false diagnoses, I highly recommend Sybil Exposed by Debbie Nathan. It was even more enjoyable than Greenberg's book. Nathan wrote a real page turner in which she examined every aspect of Mason (the real sybil) Wilbur (Sybil's psychiatrist who created personalities), and found most of the story to have been made up. She visited Mason's hometown and interviewed people, checked medical records, etc. Great read.
December 2, 2013
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.
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.
March 27, 2014
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.
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.
September 9, 2013
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.
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.
October 1, 2013
Having spent some time using mental health services and having heard about the controversy about the DSM, I was interested in the inner workings of the profession. The author, himself a psychiatrist, argues that the attempt to make mental problems fit into a diagnostic model like physical medical problems is premature and in fact impossible. I had never considered the fact that just because I tell the mental health care provider that I have certain mental issues cannot in any real and concrete way lead to a firm "diagnosis" of any sort. There are no blood tests or scans or manipulation so that can prove that I am suffering from any named disorder. How can the person know how badly my life is disturbed, whether it is "moderately" or "severely" or more than five days a week or anything. Maybe in the future there will be diagnostic tests that say I have elevated levels of enzyme X in my blood which proves I have this condition but we aren't there yet. This book is about the American Psychiatric Association and it's battle to create a new diagnostic manual for their members and the wider mental health.community. It's a bureaucratic farce that unfortunately has consequences for anyone needing their help. I was appalled to learn about the arguments over the bereavement exclusion, which allows you three months to grieve without calling you depressed. I am still grieving for the loss of my husband years after he died. Does that make me mentally ill by definition? Be prepared for war by email and lots of profession point scoring. An interesting read especially if you've ever been in therapy.
June 29, 2013
A solid, if frightening, introduction to the failings of modern psychiatry and the sham of the DSM-5. I had to remind myself that the people Greenberg was writing about were not characters, partially because they acted so strangely and partially because the author painted them in such a buffoonish light. The tone was heavy-handed at times as Greenberg portrayed himself as a prophet but the writing was solid and the information was timely.
February 21, 2017
I came to this book for a thoughtful exposé on a manual, and a field of supposed expertise, that's regularly invoked to judge my clients' character after a 2-hour interview, predict their future behavior, and pronounce them fit/unfit for release. I wanted a roadmap for disentangling what's legit from what's arbitrary and made-up.
What I got: (1) a bit of intriguing critique on psychiatric practice and how "mental disorder" is defined; (2) a ton of political play-by-play (who said what, who did what, and gossip/turmoil thereby caused), and (3) nearly constant preaching against overdiagnosis, overmedication, and doctors' ties with Big Pharma. The most valuable bits, to me, were buried somewhere around Chapter 15/16, where the author looks into the social effects of creating, removing, revising, and over-applying diagnoses such as ADHD, bipolar, and Asperger's.
So I did glean some valuable knowledge about the history of psychiatry and its socially constructed bible (the DSM), but I had to endure a lot of ranting and uninteresting narration to get it. If you like politics, preaching, and long sentences with multiple dependent clauses, you may find this book more star-worthy than I did.
What I got: (1) a bit of intriguing critique on psychiatric practice and how "mental disorder" is defined; (2) a ton of political play-by-play (who said what, who did what, and gossip/turmoil thereby caused), and (3) nearly constant preaching against overdiagnosis, overmedication, and doctors' ties with Big Pharma. The most valuable bits, to me, were buried somewhere around Chapter 15/16, where the author looks into the social effects of creating, removing, revising, and over-applying diagnoses such as ADHD, bipolar, and Asperger's.
So I did glean some valuable knowledge about the history of psychiatry and its socially constructed bible (the DSM), but I had to endure a lot of ranting and uninteresting narration to get it. If you like politics, preaching, and long sentences with multiple dependent clauses, you may find this book more star-worthy than I did.
September 1, 2015
The most interesting "boring" book I've ever read.
Disclaimer: interesting only for those who enjoy seeing a bible (not necessarily THE Bible, but that too) shredded systematically. I could see how this would be dull for some people, but for me (as a psychologist) it was utterly fascinating to see the paranthesesed names (in our textbooks, for example, the author of key studies always were mentioned) being humanized.
The book reads almost like a novel, in that it's just a flowing story, with a few time jumps but more or less in order. The chapters are rather arbitrarily divided, and you couldn't look something up. Its the story of the back and forth between the closed group writing the DSM, and the outside world, but this is just a pretext.
The real point of the book is to discredit the DSM as an authority on what ails us, and in my opinion, this book does an excellent job. I started out with the vague idea that there were indeed some diagnoses that were stretching too much into the territory of normality, but this book opened up my eyes to how far this really went, and why.
Psychiatrists, the APA in particular, are trying to walk the fine line of creating labels to things that don't exist. There are many reasons, some for the good of the patients, others for the good of their profession, but ultimately they are creating a Noble Lie. People are ill, yes, but not because of some underlying pathology that can be detected by a select group of symptoms that survived cultural selection to make it into the DSM as diagnoses.
Not convinced? Read the book. Greenberg isn't trying to prove that mental illness can't be carved up into categories, but he is making a point of the entirely arbitrary, unreliable, unscientific process that went behind the current and past DSMs.
Regarding how reliable this book is, you don't need to be a psychologist or anything like that, just science-minded, to understand that it is. A physisist could tell you just as easily that if four diagnoses were discarded based on the assumption that if not enough research had been done, then clearly they didn't really exist (this is assuming that absense of evidence is evidence of absense), or that the number of criteria needed to make the cut for a diagnosis was decided because "it seemed more or less right", you're not doing science.
You really don't have to agree with the author on everything to benefit from the story he tells. You don't necessarily have to reach the conclusion that he (and now I) have that psychiatry is largely founded on air, to at least realize that the DSM is not based on science, and that's really important that people who care understand.
Disclaimer: interesting only for those who enjoy seeing a bible (not necessarily THE Bible, but that too) shredded systematically. I could see how this would be dull for some people, but for me (as a psychologist) it was utterly fascinating to see the paranthesesed names (in our textbooks, for example, the author of key studies always were mentioned) being humanized.
The book reads almost like a novel, in that it's just a flowing story, with a few time jumps but more or less in order. The chapters are rather arbitrarily divided, and you couldn't look something up. Its the story of the back and forth between the closed group writing the DSM, and the outside world, but this is just a pretext.
The real point of the book is to discredit the DSM as an authority on what ails us, and in my opinion, this book does an excellent job. I started out with the vague idea that there were indeed some diagnoses that were stretching too much into the territory of normality, but this book opened up my eyes to how far this really went, and why.
Psychiatrists, the APA in particular, are trying to walk the fine line of creating labels to things that don't exist. There are many reasons, some for the good of the patients, others for the good of their profession, but ultimately they are creating a Noble Lie. People are ill, yes, but not because of some underlying pathology that can be detected by a select group of symptoms that survived cultural selection to make it into the DSM as diagnoses.
Not convinced? Read the book. Greenberg isn't trying to prove that mental illness can't be carved up into categories, but he is making a point of the entirely arbitrary, unreliable, unscientific process that went behind the current and past DSMs.
Regarding how reliable this book is, you don't need to be a psychologist or anything like that, just science-minded, to understand that it is. A physisist could tell you just as easily that if four diagnoses were discarded based on the assumption that if not enough research had been done, then clearly they didn't really exist (this is assuming that absense of evidence is evidence of absense), or that the number of criteria needed to make the cut for a diagnosis was decided because "it seemed more or less right", you're not doing science.
You really don't have to agree with the author on everything to benefit from the story he tells. You don't necessarily have to reach the conclusion that he (and now I) have that psychiatry is largely founded on air, to at least realize that the DSM is not based on science, and that's really important that people who care understand.
September 27, 2013
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.
April 24, 2017
From the book
Here’s the problem, Frances said, there is no definition of a mental disorder.
I mentioned that that hadn’t stopped him from putting one into the DSM-IV or the people who were then making the DSM-5 from fiddling with it.
psychiatrists were once known as alienists
The DSM didn’t help doctors prove that patient’s were suffering from medical diseases rather than the human condition
Robert Spitzer (Columbia Psy) laid out a compromise that the DSM would no longer list homosexuality as a disease
How insurance companies decide coverage and how patients may or may not get cheated over coverage
…that psychiatry, much more than other medical specialties, is still deeply in the debt of ancient medicine
The Book of Woe demonstrated how some illnesses labeled as diseases are not diseases or illnesses at all but allowed raciest medical professionals to excuse oppression and practice racism like the so called disease Drapetomania a disease that causes Negros to run away as listed in Diagnostic and Statically Manual of Mental Disorders (DSM). Unbelievable!
My conclusion is that we, as intelligent human beings, stop placing all our trust in the medical profession because the labels they place on us can be detrimental to our future, e.g., ADHD, FAS, etc.
Here’s the problem, Frances said, there is no definition of a mental disorder.
I mentioned that that hadn’t stopped him from putting one into the DSM-IV or the people who were then making the DSM-5 from fiddling with it.
psychiatrists were once known as alienists
The DSM didn’t help doctors prove that patient’s were suffering from medical diseases rather than the human condition
Robert Spitzer (Columbia Psy) laid out a compromise that the DSM would no longer list homosexuality as a disease
How insurance companies decide coverage and how patients may or may not get cheated over coverage
…that psychiatry, much more than other medical specialties, is still deeply in the debt of ancient medicine
The Book of Woe demonstrated how some illnesses labeled as diseases are not diseases or illnesses at all but allowed raciest medical professionals to excuse oppression and practice racism like the so called disease Drapetomania a disease that causes Negros to run away as listed in Diagnostic and Statically Manual of Mental Disorders (DSM). Unbelievable!
My conclusion is that we, as intelligent human beings, stop placing all our trust in the medical profession because the labels they place on us can be detrimental to our future, e.g., ADHD, FAS, etc.
April 10, 2016
I simply couldn't finish this. Greenberg's ax-grinding and bitterness cast a shadow over even the interesting parts of the history. Psychiatry as a field has its multitude of issues, but the fact that science and medicine are subject to our biases, assumptions, and prejudices is just as true in other other branch of science or medicine. (And if Greenberg wants to bring up Drapetomania, I could meet him with the Tuskegee Syphilis Study or raise him with the entire field of eugenics.) What's more, not being clear why or exactly how a disease manifests, or being able to only treat symptoms isn't unique to psychiatry either.
But people will want to believe this book. They want to believe that psychiatry is BS, and that allows them to think that mentally ill people don't really need their medication, that they just need to try to be happy, or what have you. Yay.
What a waste of time.
But people will want to believe this book. They want to believe that psychiatry is BS, and that allows them to think that mentally ill people don't really need their medication, that they just need to try to be happy, or what have you. Yay.
What a waste of time.
July 1, 2013
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.
August 31, 2013
A great book & a fascinating read. Despite all the interesting characters Greenberg introduces us to, this is a book about IDEAS. His critique of the DSM is blistering, and the politics & foibles he shows us are beautifully horrifying.
The issues raised range from mental illness as identity, categories existing strictly for insurance purposes, the law & mental illness categories, psych testing for things you already know you've found, and more.
While Greenberg can be a little dry -- "the careful reader will by now have detected the odor of a certain barnyard effluent suffusing this book" -- he does have a sense of humour that adds a lot to the text.
Possibly the highest form of praise I can offer: I am in the process of tracking down his two other books.
The issues raised range from mental illness as identity, categories existing strictly for insurance purposes, the law & mental illness categories, psych testing for things you already know you've found, and more.
While Greenberg can be a little dry -- "the careful reader will by now have detected the odor of a certain barnyard effluent suffusing this book" -- he does have a sense of humour that adds a lot to the text.
Possibly the highest form of praise I can offer: I am in the process of tracking down his two other books.
March 18, 2014
This was a book that weighed heavy on me as I read it. The examples in this book demonstrates the problems associated with making everyone have a label to get insurance to cover their visits to get help. What happens when those labels catch on in society is also problematic as individuals begin to think of themselves as broken. Labels once applied are almost never removed from a person and this does them no favors. This was a great read to understand the system of therapy and how the DSM was established, as well as how it is used today. Be prepared to be have an emotional read with this book as it will make you angry in parts.
Mr. Joe
Mr. Joe
October 16, 2014
An engaging journalistic narrative about how the psychiatric regime perpetuates its harmful nonsense and gets away with it. Well worth a read. Validating and insightful for psychiatric survivors.
November 6, 2014
This book is an insider's report of the process behind the American Psychology Association's publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The author accuses the APA of ignoring scientific evidence to maximize profit from its ownership of the DSM-5 copyright. According to the author, the APA needs the revenue from the sale or licensing of its intellectual property due to falling revenue from membership and drug company sponsorship.
There is a market for the diagnoses of mental illnesses, because health plans generally only reimburse mental health care providers to treat diagnosed mental illnesses. Thus, the typical clinical psychologist in a small practice, such as the author's, must play the game of Diagnosing for Dollars.
Unlike a physical ailment such as cancer, most mental illnesses cannot be diagnosed with clinical laboratory tests with clear-cut positive or negative results. Rather, a patient meets the criteria for a diagnosis by exhibiting feelings or behavior indicating symptoms of a mental disorder, as defined by the DSM-5. The cost of treatment for a diagnosis is submitted in a health care claim for reimbursement to an insurance company using ICD (International Classification of Diseases) codes. The central premise of this book is that a clinical psychologist does not generally treat a patient for a discrete "illness" the way an oncologist treats a patient for cancer. But in order to get insurance to pay, the therapist pretends to do so -- for example by diagnosing the patient with "Adjustment Disorder" -- and claiming to be treating the patient for this "mental illness." Or the practitioner gives the parents of a school-aged patient a diagnosis that qualifies as a disability under the federal Individuals with Disabilities Act so the child can get additional services in school under an individualized education plan (aka "special ed").
Thus, the nosology is not driven by scientific evidence of brain disease. It is just meeting the demands of the marketplace for mental health diagnoses. The DSM begs the question whether it helps the treatment of patients to classify their suffering as being symptomatic of a particular "illness" or "disorder."
The "field tests" of the draft DSM-5 were carried out incompetently and failed to validate the diagnoses, so the lion's share of the taxonomy just amounts to scientifically meaningless pigeonholes. The author attended a conference where the APA attempted to demonstrate how to use the DSM-5 to diagnose a woman who hoards stuff with "Hoarding Disorder." The author was able to simulate the APA's rigmarole to diagnose a patient who came to him because she was a depressed insomniac who drank too much. But the DSM was not very helpful for a patient who acted more like one of the characters from the HBO show "Girls."
I thought it was interesting to get an insider's view of some of the controversies about specific changes to the DSM: for example, dropping the "bereavement exception" to the diagnosis of depression, folding Asperger's Syndrome into the definition of autism spectrum disorder and determining whether sexual attraction to young, teenage girls is a mental disorder known as "Hebephilia" (Kevin Spacey in American Beauty?).
The fact that the diagnoses are defined by the symptoms makes the line between immorality and mental illness nearly impossible to draw for certain diagnoses that manifest themselves with criminal or just selfish behavior. It is quite possible that a narcissist could benefit from therapy, but does the patient really have the medical illness known as Narcissistic Personality Disorder, or just serious character flaws?
It's interesting to consider the diagnosis of autism spectrum disorder in light of this book. A person diagnosed with Asperger's Syndrome under the DSM-IV would probably meet the criteria for autism spectrum disorder. It may be that an extra copy of a particular segment of chromosome 7 greatly increases the risk of autism (as reported recently in the New York Times), but no clinical laboratory tests are used in practice to diagnosis people with autism spectrum disorder, nor is there any medication to treat it. So why are people with certain traits considered to have a "mental disorder"? If you took two people with the same traits, it is quite possible that one is "impaired" and the other is not simply because they live in different environments. Or a person might have the traits, but he has learned to and in fact does act like a "normal" person. Even those who successfully "pretend" to be "normal," may be "impaired." The DSM-5 notes: "Adults who have developed compensation strategies . . . suffer from the effort and anxiety of consciously calculating what is socially intuitive for most individuals."
Does the adult in question really have some type of illness? Or does he just need to find a way to get himself and others to accept him the way he is? Doesn't nearly everyone suffer from the effort and anxiety of consciously calculating what is socially acceptable? Or is social interaction in our complex world really "intuitive" for "normal" people?
There is a market for the diagnoses of mental illnesses, because health plans generally only reimburse mental health care providers to treat diagnosed mental illnesses. Thus, the typical clinical psychologist in a small practice, such as the author's, must play the game of Diagnosing for Dollars.
Unlike a physical ailment such as cancer, most mental illnesses cannot be diagnosed with clinical laboratory tests with clear-cut positive or negative results. Rather, a patient meets the criteria for a diagnosis by exhibiting feelings or behavior indicating symptoms of a mental disorder, as defined by the DSM-5. The cost of treatment for a diagnosis is submitted in a health care claim for reimbursement to an insurance company using ICD (International Classification of Diseases) codes. The central premise of this book is that a clinical psychologist does not generally treat a patient for a discrete "illness" the way an oncologist treats a patient for cancer. But in order to get insurance to pay, the therapist pretends to do so -- for example by diagnosing the patient with "Adjustment Disorder" -- and claiming to be treating the patient for this "mental illness." Or the practitioner gives the parents of a school-aged patient a diagnosis that qualifies as a disability under the federal Individuals with Disabilities Act so the child can get additional services in school under an individualized education plan (aka "special ed").
Thus, the nosology is not driven by scientific evidence of brain disease. It is just meeting the demands of the marketplace for mental health diagnoses. The DSM begs the question whether it helps the treatment of patients to classify their suffering as being symptomatic of a particular "illness" or "disorder."
The "field tests" of the draft DSM-5 were carried out incompetently and failed to validate the diagnoses, so the lion's share of the taxonomy just amounts to scientifically meaningless pigeonholes. The author attended a conference where the APA attempted to demonstrate how to use the DSM-5 to diagnose a woman who hoards stuff with "Hoarding Disorder." The author was able to simulate the APA's rigmarole to diagnose a patient who came to him because she was a depressed insomniac who drank too much. But the DSM was not very helpful for a patient who acted more like one of the characters from the HBO show "Girls."
I thought it was interesting to get an insider's view of some of the controversies about specific changes to the DSM: for example, dropping the "bereavement exception" to the diagnosis of depression, folding Asperger's Syndrome into the definition of autism spectrum disorder and determining whether sexual attraction to young, teenage girls is a mental disorder known as "Hebephilia" (Kevin Spacey in American Beauty?).
The fact that the diagnoses are defined by the symptoms makes the line between immorality and mental illness nearly impossible to draw for certain diagnoses that manifest themselves with criminal or just selfish behavior. It is quite possible that a narcissist could benefit from therapy, but does the patient really have the medical illness known as Narcissistic Personality Disorder, or just serious character flaws?
It's interesting to consider the diagnosis of autism spectrum disorder in light of this book. A person diagnosed with Asperger's Syndrome under the DSM-IV would probably meet the criteria for autism spectrum disorder. It may be that an extra copy of a particular segment of chromosome 7 greatly increases the risk of autism (as reported recently in the New York Times), but no clinical laboratory tests are used in practice to diagnosis people with autism spectrum disorder, nor is there any medication to treat it. So why are people with certain traits considered to have a "mental disorder"? If you took two people with the same traits, it is quite possible that one is "impaired" and the other is not simply because they live in different environments. Or a person might have the traits, but he has learned to and in fact does act like a "normal" person. Even those who successfully "pretend" to be "normal," may be "impaired." The DSM-5 notes: "Adults who have developed compensation strategies . . . suffer from the effort and anxiety of consciously calculating what is socially intuitive for most individuals."
Does the adult in question really have some type of illness? Or does he just need to find a way to get himself and others to accept him the way he is? Doesn't nearly everyone suffer from the effort and anxiety of consciously calculating what is socially acceptable? Or is social interaction in our complex world really "intuitive" for "normal" people?
Read
November 28, 2022Read it for school, pretty interesting info on the DSM
Read
March 3, 2014The Book of Woe: the DSM And the Unmaking of Psychiatry, by Gary Greenberg, Narrated by David Drummond, Produced by Tantor Audio, downloaded from audible.com.
The publisher’s note explains this book as thoroughly as I ever could.
For more than two years, author and psychotherapist Gary Greenberg has embedded himself in the war that broke out over the fifth edition of the Diagnostic
and Statistical Manual of Mental Disorders (the DSM) - the American Psychiatric Association's (APA) compendium of mental illnesses and what Greenberg calls
"the book of woe". Since its debut in 1952, the book has been frequently revised, and with each revision, the "official" view on which psychological problems
constitute mental illness has changed. Homosexuality, for instance, was a mental illness until 1973, and Asperger's gained recognition in 1994 only to
see its status challenged nearly 20 years later. Each revision has created controversy, but the DSM-5, the newest iteration, has shaken psychiatry to its
foundations. The APA has taken fire from patients, mental health practitioners, and former members for extending the reach of psychiatry into daily life
by encouraging doctors to diagnose more illnesses and prescribe more therapies - often medications whose efficacy is unknown and whose side effects are
severe. Critics - including Greenberg - argue that the APA should not have the naming rights to psychological pain or to the hundreds of millions of dollars
the organization earns, especially when even the DSM's staunchest defenders acknowledge that the disorders listed in the book are not real illnesses. Greenberg's
account of the history behind the DSM, which has grown from pamphlet-sized to encyclopedic since it was first published, and his behind-the-scenes reporting
of the deeply flawed process by which the DSM-5 has been revised is both riveting and disturbing. Anyone who has received a diagnosis of mental disorder,
filed a claim with an insurer, or just wondered whether daily troubles qualify as true illness should know how the DSM turns suffering into a commodity
and the APA into its own biggest beneficiary.
The publisher’s note explains this book as thoroughly as I ever could.
For more than two years, author and psychotherapist Gary Greenberg has embedded himself in the war that broke out over the fifth edition of the Diagnostic
and Statistical Manual of Mental Disorders (the DSM) - the American Psychiatric Association's (APA) compendium of mental illnesses and what Greenberg calls
"the book of woe". Since its debut in 1952, the book has been frequently revised, and with each revision, the "official" view on which psychological problems
constitute mental illness has changed. Homosexuality, for instance, was a mental illness until 1973, and Asperger's gained recognition in 1994 only to
see its status challenged nearly 20 years later. Each revision has created controversy, but the DSM-5, the newest iteration, has shaken psychiatry to its
foundations. The APA has taken fire from patients, mental health practitioners, and former members for extending the reach of psychiatry into daily life
by encouraging doctors to diagnose more illnesses and prescribe more therapies - often medications whose efficacy is unknown and whose side effects are
severe. Critics - including Greenberg - argue that the APA should not have the naming rights to psychological pain or to the hundreds of millions of dollars
the organization earns, especially when even the DSM's staunchest defenders acknowledge that the disorders listed in the book are not real illnesses. Greenberg's
account of the history behind the DSM, which has grown from pamphlet-sized to encyclopedic since it was first published, and his behind-the-scenes reporting
of the deeply flawed process by which the DSM-5 has been revised is both riveting and disturbing. Anyone who has received a diagnosis of mental disorder,
filed a claim with an insurer, or just wondered whether daily troubles qualify as true illness should know how the DSM turns suffering into a commodity
and the APA into its own biggest beneficiary.
November 22, 2014
As a book, "The Book of Woe" is sobering, startling and intimately written. Greenberg's language has a way sidling up to you and elbowing you in the ribs as you both take in the hypocrisy, inconsistency, and illusion that is psychiatric diagnosis. He holds the constructs of diagnosis up to the sunlight and allows you to see the holes for yourself without the condescension and spin that some of his subjects are guilty of. Anyone who is remotely interested in mental health treatment needs to read this.
As a relatively seasoned social worker and as someone who engages with diagnostic labels daily, it's a disturbing read and one that gives a vocabulary to my previously inarticulate critiques of the field. It's also the first time some of these concepts have been made clear to me despite my relationship with experts in the field and in university - take from that what you will. It's a great instance of the tension within the field between the comfort that the "noble lie" can give and the stigma and limits on healing it can enforce. This is without doubt one of the most relevant books I've read in my career to date.
As a relatively seasoned social worker and as someone who engages with diagnostic labels daily, it's a disturbing read and one that gives a vocabulary to my previously inarticulate critiques of the field. It's also the first time some of these concepts have been made clear to me despite my relationship with experts in the field and in university - take from that what you will. It's a great instance of the tension within the field between the comfort that the "noble lie" can give and the stigma and limits on healing it can enforce. This is without doubt one of the most relevant books I've read in my career to date.
January 8, 2014
A good read with a well researched outline of the combination of history, people, professional and market forces that have led to the DSM being what it is - and the inner contradictions and limitations of the medical model of psychiatry.
A bit snarkier in places than it needs to be, and a bit longer than it needed to be. Also makes a few bald assertions that could do with either being qualified or backed up more fully (although perhaps if I'd read the author's earlier work Manufacturing Depression, some of the things that bothered me a bit in this regard might be covered more fully).
None the less, thought-provoking, evidence based and raises very valid concerns.
Anyone with an interest in mental health issues should have a look at it, parrticularly if you have direct experience as a consumer/patient/etc
A bit snarkier in places than it needs to be, and a bit longer than it needed to be. Also makes a few bald assertions that could do with either being qualified or backed up more fully (although perhaps if I'd read the author's earlier work Manufacturing Depression, some of the things that bothered me a bit in this regard might be covered more fully).
None the less, thought-provoking, evidence based and raises very valid concerns.
Anyone with an interest in mental health issues should have a look at it, parrticularly if you have direct experience as a consumer/patient/etc
December 4, 2020
This is a must-read for anyone who is (or knows someone who is) involved with the profession/practice of psychiatry. First, and note well: It’s not intended as a take-down of the profession or an anti-psychiatry screed. The author is a practicing psychologist/psychotherapist who is involved in and deeply sympathetic with the work of all professionals who engage in helping people who ask for and need assistance with troubling emotions, behaviors, and thinking patterns. And in most instances, he along with all other treatment providers must formally diagnose a patient/client in order to be reimbursed by insurance companies.
The problem he addresses is this: as physicians, psychiatrists are deeply invested in the world of disease, diagnosis, and cure, but — to their ongoing embarrassment — the problems that they treat are not “diseases” in the same way that, for example, pneumonia or cancer or seizure disorders are diseases. There are no firmly established, reliable, and objective correlates or markers or evidence of the presence of a psychiatric “illness.” The presence of a psychiatric disorder is found or displayed only by way of self- or other-reported thoughts, feelings, or behaviors that cannot be observed/confirmed by objective findings, tests, or measures within the person’s body. The “diseases” are not found; they are inferred, and the inferences becomes diagnoses which then can be treated, often with prescription medication, something that may or may not help — or harm.
This difficulties come to a head in every new edition of the very influential and profitable (to the American Psychiatric Association) manual of diagnosis called the Diagnostic and Statistical Manual. Dr. Greenberg’s book was written in the midst of the huge project of creating a new edition of the DSM (DSM-5). He became a journalist for the purpose of following the twists and turns of the process of revising something that arguably has no good basis for its very existence. His close working relationships in this project with the very biggest names in psychiatric diagnosis and disorders gave him an inside look at the politics and the opinions of those who endeavored to create a new, improved, medically and philosophically credible diagnostic manual. As a (now retired) psychologist who engaged in psychiatric diagnosis for a living, and who taught this process and the philosophy behind it to graduate students, I was delighted with this book. Greenberg is a first-class writer and thinker.
The problem he addresses is this: as physicians, psychiatrists are deeply invested in the world of disease, diagnosis, and cure, but — to their ongoing embarrassment — the problems that they treat are not “diseases” in the same way that, for example, pneumonia or cancer or seizure disorders are diseases. There are no firmly established, reliable, and objective correlates or markers or evidence of the presence of a psychiatric “illness.” The presence of a psychiatric disorder is found or displayed only by way of self- or other-reported thoughts, feelings, or behaviors that cannot be observed/confirmed by objective findings, tests, or measures within the person’s body. The “diseases” are not found; they are inferred, and the inferences becomes diagnoses which then can be treated, often with prescription medication, something that may or may not help — or harm.
This difficulties come to a head in every new edition of the very influential and profitable (to the American Psychiatric Association) manual of diagnosis called the Diagnostic and Statistical Manual. Dr. Greenberg’s book was written in the midst of the huge project of creating a new edition of the DSM (DSM-5). He became a journalist for the purpose of following the twists and turns of the process of revising something that arguably has no good basis for its very existence. His close working relationships in this project with the very biggest names in psychiatric diagnosis and disorders gave him an inside look at the politics and the opinions of those who endeavored to create a new, improved, medically and philosophically credible diagnostic manual. As a (now retired) psychologist who engaged in psychiatric diagnosis for a living, and who taught this process and the philosophy behind it to graduate students, I was delighted with this book. Greenberg is a first-class writer and thinker.
May 20, 2022
Anyone using the DSM or working with people with DSM diagnoses should read this
October 13, 2020
Reads like an ivory tower gossip column.
Im sure if you're a member of this tiny inward looking club it might be fascinating but as for learning anything, this book is somehow more useless than any DSM edition.
Im sure if you're a member of this tiny inward looking club it might be fascinating but as for learning anything, this book is somehow more useless than any DSM edition.
March 10, 2015
[I've finished reading this now - final thoughts at the bottom] I'm still reading this so I'll update my review when I finish. But one thing I've noticed so far:
I learned a good lesson moving from academia to the real word - it's not clever or a sign of great knowledge to write 168-word sentences. (Unless you're Cormac McCarthy, but he does the whole lack of grammar thing all the way through and doesn't expect you to remember 10 different people at once, their history with psychiatry, which addition of the DSM they worked on and their attitude to the new DMS-5).
Quote from p.166:
There was another one on the same page at 114 words.
[Notes since finishing the book:]
This was a bit of a lesson in horse gaits - trot, gallop, walk, canter. I went from totally engrossed for a few pages to drifting off and realising I hadn't taken in any of the last page I'd just read. I was fascinated in the subject matter, of which it gave some interesting history. It was, of course, very one-sided so I can imagine psychiatry has dismissed it to some degree. Although I do agree with the idea that we shouldn't over-subscribe everyday problems and behaviours to mental disorders, and how insurance companies use the DSM to decide who gets funding and who doesn't, and that psychiatrists and psychologists change someone's diagnosis to make sure they do get funding.
I found some good passages that I'll keep for future reference. I won't repeat them here as they may only be of interest to me.
Also reify - how many times in one book can you use that word. A lot as it turns out.
I learned a good lesson moving from academia to the real word - it's not clever or a sign of great knowledge to write 168-word sentences. (Unless you're Cormac McCarthy, but he does the whole lack of grammar thing all the way through and doesn't expect you to remember 10 different people at once, their history with psychiatry, which addition of the DSM they worked on and their attitude to the new DMS-5).
Quote from p.166:
Because if a man of integrity like Sid Zisook, who is as affable and humane and charming a guy as you might like to meet, and surely the kind of psychiatrist - emphatic, articulate, knowledgeable - whom, if you needed one, you'd want to see, if such a man finds himself, in the space of two minutes, totally contradicting himself, talking out of both sides of his mouth, and unwittingly becoming the best evidence of the incoherence of his own position [of course, you'll remember his exact history with the DSM and his current position on the DSM-5] merely by acknowledging that he pays attention to his patients, when smart and compassionate doctors spill buckets of ink over the question of whether or not they should consider what we are going through before they tell us what we are suffering from and what we should do about it, [bored yet?] and when the proposal to do so moves Bob Spitzer [remember him, his history with psychiatry and stand on the DSM-5?] to say to me, "If we did that, then the whole system falls apart," then you know [still following?] that you are knee-deep in a setting of psychological adversity.
There was another one on the same page at 114 words.
[Notes since finishing the book:]
This was a bit of a lesson in horse gaits - trot, gallop, walk, canter. I went from totally engrossed for a few pages to drifting off and realising I hadn't taken in any of the last page I'd just read. I was fascinated in the subject matter, of which it gave some interesting history. It was, of course, very one-sided so I can imagine psychiatry has dismissed it to some degree. Although I do agree with the idea that we shouldn't over-subscribe everyday problems and behaviours to mental disorders, and how insurance companies use the DSM to decide who gets funding and who doesn't, and that psychiatrists and psychologists change someone's diagnosis to make sure they do get funding.
I found some good passages that I'll keep for future reference. I won't repeat them here as they may only be of interest to me.
Also reify - how many times in one book can you use that word. A lot as it turns out.
June 11, 2015
This book is a critique on the psychiatry business APA (American Psychiatric Association) and its partner, the DSM (Diagnostic and Statistical Manual of Mental Disorders) the compendium of mental illness in its fifth edition since its birth. Although extremely interesting, be prepared for a lot of repetition. Hence the 4 stars. But I did find much of the content interesting.
It covers the history behind how mental illness has over the years been diagnosed and treated. It shows, clearly, that the DSM has made mental illness and suffering into a commodity.
I became inquisitive about psychology in my early teens. Even then, when reading on the subject, I was clearly aware that psychology was able to diagnose and label mental conditions, but offered little in the way of moving forward, or cures. It seemed to keep people in their past, asking questions that entrenched them in their problems further. The language used and the mindset, for me, was and is wrong for problem solving.
I see examples of this in TV shows today, with so called psychology PhDs insisting that someone (who is ready to move on, a hoarder) should in fact process the problem further, keeping them locked inside the problem even more than necessary, when all they want to do is throw everything away.
Some even use hypnosis, in the most terrible way. Poor skill in this field can have extremely negative outcomes. Never underestimate the power of suggestion.
Realistically, people need to learn the ability to be independent and make good decisions. I have often felt that psychology binds many individuals to the psychologist. Not in all cases, but certainly many. I don't know how often I hear something like: "My psychologist is brilliant. I've been going to him/her for ten years." TEN YEARS!!!!!
I am not saying that there aren't good psychologists out there, because there are, such as, Virginia Satir who worked on change management and taught people strategies on how to cope with a problem. The truth is, we need to ask the correct question to gain necessary outcomes that move us forward in life.
However, from this book, my understanding is that the DSM is a drug peddler and works in such a way, that it makes people into addicts, rather than solving their problems. I have known many people that prove this. Drugs are rarely the answer. In extreme case, yes. But they are too easily available and it is a massive market which is cornered and enforced by governments. Nobody has a say. They came in at the right time.
Fortunately, people are becoming aware and doing something about it.
I enjoyed reading something that further cemented something I have always believed about this industry.
Sergiu Pobereznic (author)
amazon.com/author/sergiupobereznic
It covers the history behind how mental illness has over the years been diagnosed and treated. It shows, clearly, that the DSM has made mental illness and suffering into a commodity.
I became inquisitive about psychology in my early teens. Even then, when reading on the subject, I was clearly aware that psychology was able to diagnose and label mental conditions, but offered little in the way of moving forward, or cures. It seemed to keep people in their past, asking questions that entrenched them in their problems further. The language used and the mindset, for me, was and is wrong for problem solving.
I see examples of this in TV shows today, with so called psychology PhDs insisting that someone (who is ready to move on, a hoarder) should in fact process the problem further, keeping them locked inside the problem even more than necessary, when all they want to do is throw everything away.
Some even use hypnosis, in the most terrible way. Poor skill in this field can have extremely negative outcomes. Never underestimate the power of suggestion.
Realistically, people need to learn the ability to be independent and make good decisions. I have often felt that psychology binds many individuals to the psychologist. Not in all cases, but certainly many. I don't know how often I hear something like: "My psychologist is brilliant. I've been going to him/her for ten years." TEN YEARS!!!!!
I am not saying that there aren't good psychologists out there, because there are, such as, Virginia Satir who worked on change management and taught people strategies on how to cope with a problem. The truth is, we need to ask the correct question to gain necessary outcomes that move us forward in life.
However, from this book, my understanding is that the DSM is a drug peddler and works in such a way, that it makes people into addicts, rather than solving their problems. I have known many people that prove this. Drugs are rarely the answer. In extreme case, yes. But they are too easily available and it is a massive market which is cornered and enforced by governments. Nobody has a say. They came in at the right time.
Fortunately, people are becoming aware and doing something about it.
I enjoyed reading something that further cemented something I have always believed about this industry.
Sergiu Pobereznic (author)
amazon.com/author/sergiupobereznic
July 7, 2013
It was good though a bit draggy especially once you got half way through.
The history of the DSM was interesting.
The DSM is a tool, an imperfect tool yeah and perhaps more subjective then other medical diagnostic texts because so little is known about the mind/brain and its functions and because what ails us mentally and emotionally is more then just genes and the physical components of our brain.
Like physical ailments some are temporary, due to life events or circumstances that for a time overwhelm an individual. Some are chronic, just how their brain functions due to various reasons or underpinnings.
Like any tool it is only as good as the one yielding it. Some use the DSM and it numbers to aide a patient in payment for treatment. Some use it to help a patient understand that what ails them is real and that they are not alone in having that condition, those difficulties. Some use it to deny culpability, to justify criminal or other harmful behaviors.
Even with more scientific evidence of how the brain functions, what parts of the mind handle what, blood flows and chemical actions and interactions, there is still what cannot be measured that greatly influences behavior and function, the environment a person is in and their individual experiences. Not everyone will respond to the same situations in the same way, or incurr the same wounds from the same traumas. You can formulate general ideas and perhaps that is the function of the DSM, that generality, a laying out of basic symptoms, behaviors, difficulties. But being highly subjective and from gathered observations or just speculation it makes the DSM perhaps too fluid, to general. Why it needs to be seen as a tool and that is all.
We live in a society where those who have been labeled mentally ill are treated as abnormal, as unnatural, as dysfunctional, though those with other types of ailments temporary or chronic are not. The DSM and its labels are often used to support prejudicial views and treatments. It is used by pharma companies to push its products, taking advantage of those generalities and ambiguity of our understanding of the mind. We have a society that is highly overmedicated as a result.
Psychiatry is an area of medicine unlike any other area because it deals with things that go beyond the mere physical. Though the mind and body are connected and interconnected there is still so much that is unknown and not understood especially since teh brain and mind its function is more then the sum of its component parts.
The history of the DSM was interesting.
The DSM is a tool, an imperfect tool yeah and perhaps more subjective then other medical diagnostic texts because so little is known about the mind/brain and its functions and because what ails us mentally and emotionally is more then just genes and the physical components of our brain.
Like physical ailments some are temporary, due to life events or circumstances that for a time overwhelm an individual. Some are chronic, just how their brain functions due to various reasons or underpinnings.
Like any tool it is only as good as the one yielding it. Some use the DSM and it numbers to aide a patient in payment for treatment. Some use it to help a patient understand that what ails them is real and that they are not alone in having that condition, those difficulties. Some use it to deny culpability, to justify criminal or other harmful behaviors.
Even with more scientific evidence of how the brain functions, what parts of the mind handle what, blood flows and chemical actions and interactions, there is still what cannot be measured that greatly influences behavior and function, the environment a person is in and their individual experiences. Not everyone will respond to the same situations in the same way, or incurr the same wounds from the same traumas. You can formulate general ideas and perhaps that is the function of the DSM, that generality, a laying out of basic symptoms, behaviors, difficulties. But being highly subjective and from gathered observations or just speculation it makes the DSM perhaps too fluid, to general. Why it needs to be seen as a tool and that is all.
We live in a society where those who have been labeled mentally ill are treated as abnormal, as unnatural, as dysfunctional, though those with other types of ailments temporary or chronic are not. The DSM and its labels are often used to support prejudicial views and treatments. It is used by pharma companies to push its products, taking advantage of those generalities and ambiguity of our understanding of the mind. We have a society that is highly overmedicated as a result.
Psychiatry is an area of medicine unlike any other area because it deals with things that go beyond the mere physical. Though the mind and body are connected and interconnected there is still so much that is unknown and not understood especially since teh brain and mind its function is more then the sum of its component parts.
December 11, 2013
a cathartic read for me. it’s always nice to discover that others out there think some of the thoughts you do especially when they are against mainstream knowledge and belief. it feels a bit like finding a home.
Greenberg reports on the process of creating the new DSM-5: the 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. He is, himself, a psychotherapist rather than a psychiatrist and isn’t outright antipsychiatric as Allen Frances, one of the main players in his tale, believes him to be but, nevertheless, understands that the “illnesses” in the DSM do not represent medical diseases in any scientific sense.
the story he tells is one of intrigue, hubris, and self-deluded bumbling. the APA struggles to “fix” the problem of the previous DSMs by bringing in hard, neurological evidence and criteria for diagnosis. it doesn’t work but, despite this, the new DSM hurtles towards publication and dissemination.
mostly, you hear a black and white story where either people believe in mental illness and psychiatry’s role in helping people or you don’t believe in mential illness and think that the paradigm promulgated by psychiatrists is a kind of new priesthood, making up sins for modern, secular times. Greenberg’s book, however, brings nuance to this picture in various ways but mostly by outlining Allen Frances’s point of view that he’s against what they’re doing to create the DSM-5 because of the lack of empirical evidence for any of the “illnesses” listed in the book but yet isn’t antipsychiatric because the profession does lots of good by providing ways for people to think about their suffering. the placebo effect is central to psychiatry’s efficacy. and he wants it to stay that way. he doesn’t want it revealed that these “illnesses” are nothing more than socially defined problems.
it’s a great book to read whether you are for or against the APA and its ilk because it elucidates the process by which one of the most powerful book in history is revised. names and dates and quotes from those intimately involved are given openly. it reveals details on a mostly closed society and how it operates in the face of criticism. it brings questions to bear on the whole paradigm of mental illness apart from Thomas Szasz and his devotees’ well-known rants. an intimate look at an industry that has come to define us in very fundamental ways.
Greenberg reports on the process of creating the new DSM-5: the 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. He is, himself, a psychotherapist rather than a psychiatrist and isn’t outright antipsychiatric as Allen Frances, one of the main players in his tale, believes him to be but, nevertheless, understands that the “illnesses” in the DSM do not represent medical diseases in any scientific sense.
the story he tells is one of intrigue, hubris, and self-deluded bumbling. the APA struggles to “fix” the problem of the previous DSMs by bringing in hard, neurological evidence and criteria for diagnosis. it doesn’t work but, despite this, the new DSM hurtles towards publication and dissemination.
mostly, you hear a black and white story where either people believe in mental illness and psychiatry’s role in helping people or you don’t believe in mential illness and think that the paradigm promulgated by psychiatrists is a kind of new priesthood, making up sins for modern, secular times. Greenberg’s book, however, brings nuance to this picture in various ways but mostly by outlining Allen Frances’s point of view that he’s against what they’re doing to create the DSM-5 because of the lack of empirical evidence for any of the “illnesses” listed in the book but yet isn’t antipsychiatric because the profession does lots of good by providing ways for people to think about their suffering. the placebo effect is central to psychiatry’s efficacy. and he wants it to stay that way. he doesn’t want it revealed that these “illnesses” are nothing more than socially defined problems.
it’s a great book to read whether you are for or against the APA and its ilk because it elucidates the process by which one of the most powerful book in history is revised. names and dates and quotes from those intimately involved are given openly. it reveals details on a mostly closed society and how it operates in the face of criticism. it brings questions to bear on the whole paradigm of mental illness apart from Thomas Szasz and his devotees’ well-known rants. an intimate look at an industry that has come to define us in very fundamental ways.
October 21, 2013
As someone with both an educational and personal stake in the idea of professional mental health, I found this book to be very interesting, disturbing and entertaining by turns. Chronicling the in-fighting, politics, and general craziness of the development of the DSM-5, this book gives a snapshot of just how fuzzy the "science" of mental health still remains. On one hand, I absolutely sympathize with the need to regulate, label and therefore reimburse for mental health issues as too many of those in need of care would never get it without insurance help. At the same time, the difficulty in drawing the lines between normal and ill when it comes to mental health only underscores how gut-based so much of the profession is.
The book felt a little long and repetitive in sections, but I found some of the deeper questions and issues raised to be very interesting. While psychiatry is all well and good, most people will get help from counselors or psychologists and these professionals also rely on the DSM, being forced to slap labels on folks so they can get a course of sessions to help with specific problems they are facing. This part of the larger mental health family largely get shut out of discussions and development of manuals like the DSM because they aren't "real" practitioners doing research and doing WAY too much "talk" therapy, but really – they are the ones doing the heavy lifting. While much of the population will have mental health challenges at one point or another, very few are going to have full blown schizophrenia. One issue raised here that I am interested in exploring further is the bereavement exception for depression diagnoses. While removed in the DSM-5, the idea that even normal, healthy emotional states can, at some unspecified point, become problematic is an interesting one to me. What forms of grieving are healthy? How long should normal grieving persist? What on earth is "normal" grieving anyway? Are individuals who believe in an afterlife and have shortened grieving cycles outside of normal too? Actually, the more I think about it, I wish there had been more about this in the book. Alas, it is what it is – and that's a fun, but at times dry, romp through a bunch of very specialized academics arguing vociferously about minutia, albeit minutia I happen to find interesting.
The book felt a little long and repetitive in sections, but I found some of the deeper questions and issues raised to be very interesting. While psychiatry is all well and good, most people will get help from counselors or psychologists and these professionals also rely on the DSM, being forced to slap labels on folks so they can get a course of sessions to help with specific problems they are facing. This part of the larger mental health family largely get shut out of discussions and development of manuals like the DSM because they aren't "real" practitioners doing research and doing WAY too much "talk" therapy, but really – they are the ones doing the heavy lifting. While much of the population will have mental health challenges at one point or another, very few are going to have full blown schizophrenia. One issue raised here that I am interested in exploring further is the bereavement exception for depression diagnoses. While removed in the DSM-5, the idea that even normal, healthy emotional states can, at some unspecified point, become problematic is an interesting one to me. What forms of grieving are healthy? How long should normal grieving persist? What on earth is "normal" grieving anyway? Are individuals who believe in an afterlife and have shortened grieving cycles outside of normal too? Actually, the more I think about it, I wish there had been more about this in the book. Alas, it is what it is – and that's a fun, but at times dry, romp through a bunch of very specialized academics arguing vociferously about minutia, albeit minutia I happen to find interesting.
March 12, 2014
What does it mean to be clinically depressed? Or bipolar? Or have a personality disorder? The DSM, now in its fifth edition, tries to answer that question. If we want to help the mentally ill, we have to decide who they are--and make a stab at deciding what they have.
Without clear biological markers, however, we're left with subjective criteria, and the process for determining those criteria isn't clear.
Greenberg is a strong critic of the APA and the process that has led to the DSM-5. As he argues, by naming a disorder and its symptoms, we make it real. In 1994, we created kids with Asperger Syndrome; in 2013, we took it away from them. The book is strongest when discussing the processes within the APA and the defects of certain diagnoses that were added or subtracted due to the feelings of advocates, be they patients or doctors.
The weak link of the book is that, as Greenberg himself acknowledges, we don't have a better alternative than the DSM. While neuroscience holds some promise, it will likely not explain all forms of mental suffering. As he is a psychotherapist, I expected (and got) some bias against the psychopharmacological model that's grown amongst psychiatrists, and his distaste for the DSM in his everyday work is also apparent (though this is far from unique in my experience).
The book made me think critically about the process of diagnosis and the way we seek labels to explain or define our behavior, even when they have little practical meaning. In daily life, sometimes a Potter Stewart definition is all you need. But it left me wondering about what should come next. Greenberg doesn't have a better answer than the people he criticizes--and maybe that's not all bad.
Without clear biological markers, however, we're left with subjective criteria, and the process for determining those criteria isn't clear.
Greenberg is a strong critic of the APA and the process that has led to the DSM-5. As he argues, by naming a disorder and its symptoms, we make it real. In 1994, we created kids with Asperger Syndrome; in 2013, we took it away from them. The book is strongest when discussing the processes within the APA and the defects of certain diagnoses that were added or subtracted due to the feelings of advocates, be they patients or doctors.
The weak link of the book is that, as Greenberg himself acknowledges, we don't have a better alternative than the DSM. While neuroscience holds some promise, it will likely not explain all forms of mental suffering. As he is a psychotherapist, I expected (and got) some bias against the psychopharmacological model that's grown amongst psychiatrists, and his distaste for the DSM in his everyday work is also apparent (though this is far from unique in my experience).
The book made me think critically about the process of diagnosis and the way we seek labels to explain or define our behavior, even when they have little practical meaning. In daily life, sometimes a Potter Stewart definition is all you need. But it left me wondering about what should come next. Greenberg doesn't have a better answer than the people he criticizes--and maybe that's not all bad.
Displaying 1 - 30 of 116 reviews