The Book of Woe: The DSM and the Unmaking of Psychiatry

by Gary Greenberg

  17. the Midtown Manhattan Study: Srole et al., Mental Health in the Metropolis, vol. 1.

  18. “designed for classifying full-blown pathology”: Ibid., 134.

  19. So rather than ask . . . they asked about: Ibid., 388–91.

  20. a six-point classification: Ibid., 134–38.

  21. “mental illness and mental health [differed]”: Ibid., 135.

  22. the actual number is 81.5 percent: Ibid., 138.

  23. It was more than double the rate of mental illness: Ibid., 141–43.

  24. he cited the 23 percent figure accurately: Regier et al., “The De Facto U.S. Mental Health Services System,” 687.

  25. about 15 percent of Americans were mentally ill: Ibid., 692–93.

  Chapter 4

  1. “the mind is a set of operations”: Kandel, “The New Science of Mind,” 69.

  2. “all mental disorders”: Ibid., 71.

  3. “We can think of mental disorders”: Insel, “Rethinking Mental Illness,” 2011 American Psychiatric Association annual meeting, Honolulu, May 14, 2011.

  4. “neurologizing tautologies”: Meyer, “The Aims and Meaning of Psychiatric Diagnosis,” 165.

  5. “driving the Devil out”: Shorter and Healy, Shock Therapy, 30.

  6. it was hard to argue with the biological psychiatrists: For a history of these discoveries, see Greenberg, Manufacturing Depression, chapters 7, 8; Healy, The Creation of Psychopharmacology, and Shorter, History of Psychiatry.

  7. depression, he announced, must be the result: Schildkraut, “The Catecholamine Hypothesis of Affective Disorders.”

  8. “The gold standard was the DSM criteria”: Steven Hyman e-mail, October 5, 2012.

  9. “to the point that they are considered”: Kupfer, First, and Regier, Research Agenda for DSM-V, xix.

  10. “yet unknown”: Ibid.

  11. “In a way, I was born to do the DSM”: Michael First interview, April 25, 2011.

  12. “I have a patient”: Paul Fink interview, September 2, 2010.

  13. “There is no assumption”: DSM-IV-TR, xxxi.

  14. “The purpose of DSM-III”: DSM-III, 12.

  15. “consensus of current formulations”: DSM-III-R, xxix.

  16. black-box warning: http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM161641.pdf.

  Chapter 5

  1. “When I heard about them”: Allen Frances interview, July 7, 2011.

  2. Biederman thought he detected in these children: Biederman, “Resolved: Mania Is Mistaken for ADHD.”

  3. a small literature reporting a few cases of “hyperactive children”: Ibid., 1091.

  4. “the essential feature of Bipolar Disorder”: DSM-IV-TR, 382.

  5. “a distinct period of abnormally and persistently elevated”: DSM-IV-TR, 362.

  6. Manic episodes have seven Criterion B symptoms: Ibid.

  7. So Biederman set out to prove: Wozniak et al., “Mania-Like Symptoms.” See also Biederman, “Pediatric Bipolar Disorder Coming of Age.”

  8. One in five of those patients: Wozniak et al., “Mania-Like Symptoms,” 873.

  9. Biederman’s announcement provoked: See, for instance, Klein, Pine, and Klein, “Resolved: Mania Is Mistaken for ADHD,” and McClellan, “Commentary: Treatment Guidelines for Child and Adolescent Bipolar Disorder.”

  10. “smallpox vaccine was ridiculed”: Biederman, “Resolved,” 1098.

  11. “disorders with bipolar features”: DSM-IV-TR, 400.

  12. “thoughtful clinical investigators”: Papolos and Papolos, The Bipolar Child, 32.

  13. “latest research findings” would recognize the symptoms: Ibid., 55–59.

  14. “You have bipolar disorder”: Anglada, Brandon and the Bipolar Bear, 16.

  15. “can’t do their job right”: Ibid., 17.

  16. Brandon most likely inherited it: Ibid., 20.

  17. “Young and Bipolar”: “Young and Bipolar,” Time, August 19, 2002.

  18. 6.67 percent of office visits: Moreno et al., “National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth.”

  19. “The label may or may not reflect reality”: Benedict Carey, “Bipolar Disorder Cases Rise Sharply in U.S. Children,” The New York Times, September 3, 2007.

  20. there is “some medicine that could help”: Anglada, Brandon and the Bipolar Bear, 21.

  21. rebranding atypical antipsychotics: The APA had a hand in this effort. See Hales et al., What Your Patients Need to Know About Psychiatric Medications, 183–85.

  22. devastating side effects: See, for example, Üçok and Gaebel, “Side Effects of Atypical Antipsychotics: A Brief Overview.”

  23. twelve-to-twenty-year decrease in life expectancy: See Whitaker, Anatomy of an Epidemic, 175–77.

  24. studies indicating that children’s symptoms improved: For a summary, see Kowatch et al., “Treatment Guidelines for Children and Adolescents with Bipolar Disorder.”

  25. prevalence of BD among children: Moreno et al., “National Trends.”

  26. antipsychotic use in children and adolescents: “Antipsychotic Drug Use Among Kids Soars,” Associated Press, May 3, 2006.

  27. Gardiner Harris reported: Gardiner Harris, “Proof Is Scant on Psychiatric Drug Mix for Young,” The New York Times, November 23, 2006.

  28. stories such as that of Rebecca Riley: David Abel, “Hull Parents Arrested in Girl’s Poisoning Death,” The Boston Globe, February 6, 2007.

  29. “In psychiatry Mr. Grassley has found”: Benedict Carey and Gardiner Harris, “Psychiatric Group Faces Scrutiny over Drug Industry Ties,” The New York Times, July 12, 2008.

  30. what Grassley found when he investigated Joseph Biederman: Gardiner Harris and Benedict Carey, “Researchers Fail to Reveal Full Drug Pay,” The New York Times, June 8, 2008.

  31. “move forward the commercial goals”: Gardiner Harris, “Research Center Tied to Drug Company,” The New York Times, November 25, 2008.

  32. “will support the safety and effectiveness of risperidone”: Gardiner Harris, “Drug Maker Told Studies Would Aid It,” The New York Times, March 20, 2009.

  33. this exchange, which followed his testimony: Ibid.

  34. “I have never seen someone so angry”: Harris, “Research Center Tied to Drug Company.”

  35. “violated certain requirements”: Liz Kowalczyk, “Harvard Doctors Punished Over Pay,” The Boston Globe, July 2, 2011.

  36. Grassley wasn’t stopping with Biederman: Gardiner Harris, “Top Psychiatrist Didn’t Report Drug Makers’ Pay,” The New York Times, October 3, 2008.

  37. He revealed that Frederick Goodwin: Gardiner Harris, “Radio Host Has Drug Company Ties,” The New York Times, November 21, 2008.

  38. a drug that has been “generic for decades”: Statement of Frederick K. Goodwin, M.D., http://drgoodwin.com/index.php?page=nyt.

  39. Alan Schatzberg owned nearly $5 million in stock: Harris, “Top Psychiatrist.”

  40. “I have come to understand”: Senator Grassley’s letter is available at http://www.finance.senate.gov/newsroom/ranking/release/?id=56860a96-5fba-4fb9-9207-849e796998ad.

  41. nearly one-third of the organization’s $62.5 million annual revenue: Carey and Harris, “Psychiatric Group Faces Scrutiny over Drug Industry Ties.”

  42. As the Times had reported earlier: Benedict Carey, “Study Finds a Link of Drug Makers to Psychiatrists,” The New York Times, April 20, 2006.

  43. the report of a team led by psychologist Lisa Cosgrove: Cosgrove et al., “Financial Ties Between DSM-IV Panel Members and the Pharmaceutical Industry,” 154–60.

  44. “Pharmaceutical companies have a vested interest”: Ibid., 159.

  45. Restless legs syndrome: GlaxoSmithKline, press release, June 10, 2003, www.gsk.com/press_archive/press2003/press_06102003.htm.


  46. “With every new revelation”: Carey and Harris, “Psychiatric Group Faces Scrutiny.”

  47. the $4 million or so the industry kicked down every year: See APA Treasurer’s Report, May 2012. Available at https://docs.google.com/file/d/0BzWdENl1wkVSYk5aXzRZelFYUjA/edit?pli=1. This report contains APA financial reports from 2005 to 2011.

  48. “my board thought that through”: James Scully interview, September 13, 2010.

  49. it took nearly two years: Regier et al., The Conceptual Evolution of DSM-5, xxv.

  50. “All the people at the top”: Michael First interview, April 25, 2011.

  51. “a new diagnostic paradigm must be developed”: Kenneth S. Kendler et al., “Guidelines for Making Changes to DSM-V,” http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf.

  Chapter 6

  1. “I was bored stiff”: Allen Frances e-mail, October 7, 2011.

  2. “Psychiatric classification”: Allen Frances e-mail, October 11, 2011.

  3. “Perhaps not surprisingly, the diagnosis”: Allen Frances e-mail, October 7, 2011.

  4. “confidentiality in the development”: See Hannah Decker, “A Moment of Crisis in American Psychiatry,” h-madness (blog), April 27, 2010, http://historypsychiatry.com/2010/04/27/a-moment-of-crisis-in-the-history-of-american-psychiatry/.

  5. the APA had insisted: On its acceptance form, available at http://www.dsm5.org/about/Documents/DSM%20Member%20Acceptance%20Form.pdf.

  6. “We are rethinking”: “DSM-V Development Will Be Complex and Open Process,” Psychiatric News, June 6, 2008.

  7. “I was dumbfounded”: Robert Spitzer e-mail, September 24, 2010.

  8. “I found out how transparent” . . . “I didn’t know whether”: Robert Spitzer, “DSM-V: Open and Transparent?” Psychiatric News, July 18, 2008.

  9. “I told him I completely agreed”: Allen Frances interview, August 15, 2010.

  10. new diagnosis to be called Psychosis Risk Syndrome: For a full description, see Carpenter, “Anticipating DSM-V: Should Psychosis Risk Become a Diagnostic Class?” and Woods et al., “Validity of the Prodromal Risk Syndrome for First Psychosis.”

  11. a conversion rate of 25 to 30 percent: See Cornblatt and Correll, “A New Diagnostic Entity in DSM-5?”

  12. “I had not been closely following”: Allen Frances interview, August 16, 2010.

  13. Carpenter explained to Pincus: William Carpenter interview, September 10, 2010.

  14. “I still think it’s a crazy idea”: Harold Pincus interview, December 9, 2011.

  15. pseudoneurotic schizophrenia: Allen Frances telephone interview, November 23, 2011.

  16. “more kids getting unneeded antipsychotics”: Allen Frances interview, August 16, 2010.

  Chapter 7

  1. “People are going to write dissertations”: James Scully interview, September 13, 2010.

  2. Zucker was known for research: See Zucker and Bradley, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents.

  3. a fetish Blanchard called autogynephilia: Blanchard, “The Concept of Autogynephilia and the Typology of Male Gender Dysphoria.”

  4. “out of step”: National Gay and Lesbian Task Force, “Task Force Questions Critical Appointments to APA’s Committee on Sexual and Gender Identity Disorders,” news release, May 18, 2008. http://www.thetaskforce.org/press/releases/PR_052808.

  5. “thorough and balanced”: American Psychiatric Association, “APA Statement on GID and the DSM-V,” news release, May 23, 2008, http://www.dsm5.org/Newsroom/Documents/APAStatementonGIDandTheDSMV.pdf.

  6. “the DSM is a diagnostic manual”: Ibid.

  7. an immediate rejoinder: Nada Stotland et al., “DSM-V: Open and Transparent? A Response,” Psychiatric News, July 18, 2008.

  8. Regier wanted to know: Darrel Regier, William Narrow, and David Kupfer interview, September 14, 2010.

  9. “I’m not on the task force”: Sidney Zisook interview, September 10, 2010.

  10. “We have enemies”: Stotland, “Presidential Address,” 1102.

  11. “psychiatry is a pseudoscience”: Tom Cruise, interview by Matt Lauer, Today, June 25, 2005, http://msnbc.msn.com/id/8343367/site/todayshow/ns/today-entertainment/t/im-passionate-about-life/.

  12. “Michael First shamed me into it”: Allen Frances e-mail, December 18, 2011.

  13. “Setting the Record Straight”: Alan Schatzberg et al., “Setting the Record Straight,” Psychiatric Times, July 1, 2008.

  14. “Soaring ambition is another matter”: William Carpenter, “Criticism vs Fact,” Psychiatric Times, July 7, 2008.

  15. “letting nostalgia and passion”: Alarcon, “DSM-5—The We Know Better/Holier Than Thou Crusade,” Psychiatric Times, July 14, 2008.

  16. “You must understand”: Allen Frances, letter to APA board of trustees, July 6, 2009. http://www.scribd.com/doc/17172432/Letter-to-APA-Board-of-Trustees-July-7-2009-From-Allen-Frances-and-Robert-Spitzer.

  17. The APA’s financial picture: APA’s Treasurer Report, 2012.

  18. “In reality, clinicians in the United States”: Michael First interview, August 24, 2010.

  19. the ICD, created by a public agency, is available for download: You can browse it yourself at http://apps.who.int/classifications/icd10/browse/2010/en.

  20. an unsettling if unsurprising discovery: Clayton et al., “The Bereavement of the Widowed.”

  21. “a full depressive syndrome”: DSM-III, 333.

  22. The bereavement exclusion: DSM-III-R, 223.

  23. he tried to define disease: Spitzer and Endicott, “Medical and Mental Disorder: Proposed Definition and Criteria,” in Critical Issues in Psychiatric Diagnosis.

  24. “present concepts that have influenced the decision”: DSM-III, 6.

  25. Mental disorder, he argued: Spitzer and Endicott, “Medical and Mental Disorder,” 30.

  26. “These guys have some chutzpah”: Kirk and Kutchins, The Selling of DSM, 113.

  27. “In DSM-III each of the mental disorders”: DSM-III, 5–6.

  28. “The syndrome or pattern”: DSM-III-R, xxii.

  29. DSM-IV devoted seven of its 886 pages: DSM-IV, 843–49.

  Chapter 8

  1. “psychiatric classification is necessarily”: Frances, “DSM in Philosophyland: Curiouser and Curiouser.”

  2. “recurrent and persistent thoughts”: DSM-IV-TR, 462–63.

  3. “A diagnosis is a call to action”: Frances, “DSM in Philosophyland.”

  4. “I just wanted them to learn”: Allen Frances e-mail, January 6, 2012.

  5. “One of the reasons”: Robins and Guze, “Establishment of Diagnostic Validity in Psychiatric Illness,” 983.

  6. They concluded that T. pallidum: For a comprehensive history of the discovery of syphilis and its significance to modern medicine, see Quétel, History of Syphilis. See also Greenberg, Manufacturing Depression, 52–60.

  7. a five-step process toward validity: Robins and Guze, “Establishment of Diagnostic Validity,” 983–84.

  8. “validity tests . . . have not lived up”: “Time for a Change?” Psychiatric News, August 21, 2009.

  9. Kenneth Kendler added another validator: Kendler, “The Nosologic Validity of Paranoia.”

  10. “the [diagnostic] categories”: Kendler, “An Historical Framework for Psychiatric Nosology,” 1939.

  11. “to consider our major diagnostic categories”: Ibid.

  12. “critics of psychiatric diagnoses”: Ibid.

  13. “A historic and scientific process”: Ibid.

  14. “It sounded about right”: Kendler et al., “The Development of the Feighner Criteria,” 136.

  15. “wonderful property of iteration”: Kendler, “An Historical Framework,” 1940.

  16. “assure ourselves”: Ibid.

 
17. “wobbly iterations”: Ibid. Emphasis in original.

  18. “asymptotes to a stable and accurate”: Ibid., 1939.

  19. paleontologist Stephen Jay Gould: See Gould, Wonderful Life.

  20. “We follow the tape forward”: Kendler, “An Historical Framework,” 1938.

  21. “The ‘disastrous result’”: “APA Disputes Critics of DSM-V,” Psychiatric News, August 21, 2009.

  22. “attempt to address” . . . “The single most important precondition”: Regier et al., “Conceptual Development of DSM-V,” 649.

  23. “establish better syndrome boundaries”: Darrel Regier e-mail, October 5, 2010.

  24. Some diagnoses, such as depression: DSM-IV-TR, 413.

  25. Global Assessment of Functioning: DSM-IV-TR, 32–34.

  26. National Institutes of Health had created PROMIS: See www.nihpromis.org.

  27. “bottoms-up approach”: Regier et al., “Conceptual Development,” 648.

  28. “If they really want to do dimensional assessment”: Michael First interview, September 28, 2010.

  29. “We don’t expect the DSM-5”: Darrel Regier e-mail, October 11, 2010.

  30. Diagnostic criteria “are intended”: Regier et al., “Conceptual Development,” 648–49.

  Chapter 9

  1. “Advice to DSM V”: Allen Frances, “Advice to DSM V . . . Change Deadlines and Text, Keep Criteria Stable,” Psychiatric Times (blog), August 26, 2009, www.psychiatrictimes.com/display/article/10168/1444663.

  2. in the field trials the new criteria identified 15 percent more: Lahey et al., “DSM-IV Field Trials for ADHD,” 1682.

  3. the actual increase was 28 percent: Akinbami et al., “Attention Deficit Hyperactivity Disorder Among Children,” 2.

  4. “everything was on the table”: Allen Frances, “Alert to the Research Community,” Psychiatric Times, January 7, 2010.

  5. “over the cliff”: Frances, “Advice to DSM-V.”

  6. “I take more blame for DSM-IV”: Allen Frances interview, August 16, 2010.

  7. “some of us have gotten”: Shirley Wang, “Psychiatrists Bash Back at Critics of Diagnostic Manual Revision,” Wall Street Journal Health Blog, January 8, 2009, blogs.wsj.com/health/2009//01/08/psychiatrists-bash-back-at-critics-of-diagnostic-manual-revision.