Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders

by Stuart A. Kirk, Herb Kutchins

A persuasive and passionate plea from two mental health professionals to ease use of the Diagnostic Statistical Manual of Mental Disorders under their belief that it is leading to an over-diagnosed society.

For many health professionals, the Diagnostic Statistical Manual of Mental Disorders (DSM) is an indispensable resource. As the standard reference book for psychiatrists and psychotherapist everywhere, the DSM has had an inestimable influence on the way medical professionals diagnosis mental disorders in their patients.

But with a push to label clients with pathological disorders in order to get reimbursed by insurance companies, the purpose of the DSM is no longer serving as a reference book. Instead, it is acting as a list of things that can qualify a patient’s diagnosis.

In Making Us Crazy, Stuart Kirk and Herb Kutchins evaluate how the DSM has become the influence behind diagnoses that assassinate character and slander the opposition, often for political or monetary gain. By examining how the reference book serves as a source to label every phobia and quirk that arises in a patient, Kirk and Kutchins question the overuse of the DSM by today’s mental health professionals.

Genres: Psychology, Nonfiction, History, Mental Illness

304 pages, Paperback

First published January 1, 1997

Reviews

[Rick · Rating 4 out of 5]

I read this in between my first and second year of grad school (getting a degree in clinical social work), and I am SO glad I did. It still weighs heavily on my perception of the people I come into contact with on a daily basis. It is a big reminder for me to always understand the person as a person, not as an illness. Anyone who has a job that requires them to utilize the DSM (Diagnostics and Statistics Manual) would benefit from reading this book. Why it isn't 5 stars: the authors are not exactly objective and have a clearly liberal agenda. While not bad in and of itself, it sometimes colors their commentary too much, imho.

[Kelly · Rating 5 out of 5]

Used this book as a main text for a MSW course on mental health perspectives. Presents excellent critiques of the DSM & helps the reader to learn about the social and political context within which the DSM has been created and recreated. The authors are both clinicians, which was helpful for our purposes; they are clear from the opening paragraph about their agenda and criticality of the DSM. This book is a little dated at this point, and really centers on the DSM IV TR, but as it presents and critics the history and formation of the DSM, I found it useful and will use it again for this course.

If you are unfamiliar with the sordid history of psychiatry in the US, this book will be infuriating, upsetting, inspiring, and devastating.

[Dfordoom · Rating 5 out of 5]

A frightening look at the creation of psychiatry’s Holy Book, the DSM-IV. Like all holy books, the DSM-IV is a mixture of hearsay, rumour, fantasy, superstition, prejudice, politics and sheer silliness. It’s the heart and soul of modern psychiatry, and it’s what makes psychiatry a less scientific version of voodoo. The authors also document the extent to which the DSM-IV was the product of the financial demands of the insurance industry, and the extent to which it is a product of political bigotry.

[Maggie · Rating 4 out of 5]

Sharp, clear and unflinching.

The authors do a phenomenal job in critically and systematically detailing the interrelationships between politics, self-interested power and careerism, braggadocio, bigotry and capitalism with the construction (and seemingly endless expansion) of mental disorders in the DSM.

They also raise really good questions about the medicalization of everyday life, the expansion of medical/state surveillance that is partially facilitated through the institutionalization of the DSM etc etc etc.

Read it :)

[Kevin Bass · Rating 3 out of 5]

An interesting discussion and introduction of the political uses of psychiatry. Not sufficiently scholarly, but it is in my view an adequate starting point.

[Steven H · Rating 5 out of 5]

HOW IS THE DSM ACTUALLY PRODUCED? HERE'S THE BACKGROUND

Herb Kutchins is a professor at CSU Sacramento. Stuart A. Kirk is a former psychiatric social worker, who holds the Marjorie Crump Chair in Social Welfare at UCLA.

They wrote in the Preface to this 1997 book, "It is precisely because issues of psychiatric diagnosis, commentary by psychiatrists on all manner of social issues, and the use of medical authority are so ubiquitous in our lives and because we are so vulnerable to the misuse of psychiatric diagnosis and authority that we wrote this book. There is a growing tendency in our society to medicalize problems that are not medical, to find psychopathology where there is only pathos, and to pretend to understand phenomena by merely giving them a label and a code number... in this book we question the legitimacy of this tendency and describe its risks.

"To pursue this goal, we take the reader into the world of the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM)... As the authoritative manual of the American Psychiatric Association (APA), DSM defines, classifies, and describes what the association says are mental illnesses." (Pg. x) They add, "In this book we examine critically how the APA creates categories of mental disorders.... we trace how the psychiatric profession struggles with various political constituencies to create categories of mental disorder and to garner support for their official acceptance." (Pg. 15-16)

They note, "The psychiatrists had to fight with the psychologists' association over professional turf. The dispute arose when Robert Spitzer... attempted to develop a general definition of mental disorder... When he presented his ideas ... he made the assertion that 'mental disorders are a subset of medical disorders.' This statement... attempted to establish that mental disorders are fully within the province of medicine, a notion that caused a storm of protest from the American Psychological Association... when DSM-III was released in 1980, the disputed passage had been dropped. What was learned, however, was that defining mental disorders is not only conceptually difficult but also politically controversial." (Pg. 30)

They say, "Most of these changes passed without controversy, until feminist psychotherapists confronted the APA about the proposed inclusion of three new psychiatric disorders, which they viewed as having serious negative consequences for women---Paraphilic Rapism, Premenstrual Dysphoric Disorder, and Masochistic Personality Disorder." (Pg. 47)

They record, "Spitzer ... was dissatisfied with the definition of mental disorder he had used to justify replacing the psychiatric diagnosis of homosexuality with Sexual Orientation Disorder in DSM-II... it finally appeared... as Ego-dystonic Homosexuality (EDH)... The adoption of EDH proves that not every change in DSM was the result of outside political pressure or new scientific evidence... There was some opposition to EDH... Gay activists decided against another public battle, one they feared they might lose... The wisdom of the gay activists' decision was confirmed in 1987, when Ego-dystonic Homosexuality was quietly eliminated from ... DSM-III-R." (Pg. 78)

They observe, "Throughout the entire struggle over the inclusion or exclusion of homosexuality from DSM, the minor role played by scientific research has been striking... it was a political debate, not a scientific one." (Pg. 99)

This is an excellent, very informative book, that will be of great interest to a wide variety of readers interested in issues relating to psychiatry and psychology.

[Jonathan · Rating 4 out of 5]

I read a lot of this stuff, so a lot of the arguments were familiar. But they are well-made.

[Jeffrey Acorn]

I read this in graduate school many years ago so the information is not that fresh. To keep it brief, I consider this a must read for all professions which use the Diagnostic and Statistical Manual of Mental Disorders. It provides a decent beginning to under nosological aspects of the DSM and how they are not always based on science but rather political motives, etc.

[Tamilyn White · Rating 5 out of 5]

SO looking forward to the day when insurance companies don't require a Diagnosable Problem to support their insured in seeking support for difficulties.