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

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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 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. Homosexuality, for instance, was a mental illness until 1973, and Asperger’s gained recognition in 1994 only to see its status challenged nearly twenty 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. Invaluable and informative, The Book of Woe is bound to spark intense debate among expert and casual readers alike.Review“[I]ndustrious and perfervid... Mr. Greenberg [argues] that the [DSM] and its authors, the American Psychiatric Association, wield their power arbitrarily and often unwisely, encouraging the diagnosis of too many bogus mental illnesses in patients (binge eating disorder, for example) and too much medication to treat them....Mr. Greenberg argues that psychiatry needs to become more humble, not more certain and aggressive....Greenberg is a fresher, funnier writer. He paces the psychiatric stage as if he were part George Carlin, part Gregory House.”—Dwight Garner, *The New York Times“Greenberg’s documentation of the DSM-5 revision process is an essential read for practicing and in-training psychotherapists and psychiatrists and is an important contribution to the history of psychiatry.”—*Library Journal“The rewriting of the bible of psychiatry shakes the field to its foundations in this savvy, searching exposé.  Deploying wised-up, droll reportage from the trenches of psychiatric policy-making and caustic profiles of the discipline’s luminaries, Greenberg subjects the practices of the mental health industry—his own included—to a withering critique. The result is a compelling insider’s challenge to psychiatry’s scientific pretensions—and a plea to return it to its humanistic roots.”—Publisher’s Weekly, starred review“Greenberg is an entertaining guide through the treacheries and valuable instances of the DSM, interviewing members on both sides of the divide and keeping the proceedings conversational even when discussing the manual’s pretensions toward epistemic iteration. He also brings his own practice into [The Book of Woe], with examples of the DSM falling woefully short in capturing the complexity of personality. Bright, humorous and seriously thoroughgoing, Greenberg takes all the DSMs for a spin as revealing as the emperor’s new clothes.”—*Kirkus Reviews*“[A] brilliant look at the making of DSM-5...entertaining, biting and essential...Greenberg builds a splendid and horrifying read....[he] shows us vividly that psychiatry’s biggest problem may be a stubborn reluctance to admit its immaturity.”—David Dobbs, Nature.com“Gary Greenberg is a thoughtful comedian and a cranky philosopher and a humble pest of a reporter, equal parts Woody Allen, Kierkegaard, and Columbo. The Book of Woe is a profound, and profoundly entertaining, riff on malady, power, and truth. This book is for those of us (i.e., all of us) who've ever wondered what it means, and what's at stake, when we try to distinguish the suffering of the ill from the suffering of the human.”—Gideon Lewis-Kraus, author of *A Sense of Direction*“This could be titled The Book of ... Whoa! An eye-popping look at the unnerving, often tawdry politics of psychiatry.”—Gene Weingarten, two-time Pulitzer Prize winning author of *The Fiddler in the Subway*“Bringing the full force of his wit, warmth, and tenacity to this accessible inside account of the latest revision of psychiatry’s diagnostic bible, Gary Greenberg has written a book to rival the importance of its subject. Keenly researched and vividly reported, The Book of Woe is frank, impassioned, on fire for the truth—and best of all, vigorously, beautifully alive to its story’s human stakes.”—Michelle Orange, author of This Is Running for Your Life“Gary Greenberg has become the Dante of our psychiatric age, and the DSM-5 is his Inferno. He guides us through the not-so-divine comedy that results when psychiatrists attempt to reduce our hopelessly complex inner worlds to an arbitrary taxonomy that provides a disorder for everybody. Greenberg leads us into depths that Dante never dreamed of. The Book of Woe is a mad chronicle of so-called madness.”—Errol Morris, Academy Award–winning director, and author of *A Wilderness of Error“In this gripping, devastating account of psychiatric hubris, Gary Greenberg shows that the process of revising the DSM remains as haphazard and chaotic as ever. His meticulous research into the many failures of DSM-5 will spark concern, even alarm, but in doing so will rule out complacency. The Book of Woe *deserves a very wide readership.”—Christopher Lane, author of Shyness: How Normal Behavior Became a Sickness“Gary Greenberg’s The Book of Woe is about the DSM in the way that Moby-Dick is about a whale—big-time, but only in part. An engaging history of a profession’s virtual bible, The Book of Woe is also a probing consideration of those psychic depths we cannot know and those social realities we pretend not to know, memorably rendered by a seasoned journalist who parses the complexities with a pickpocket’s eye and a mensch’s heart.  If I wanted a therapist, and especially if I wanted to clear my mind of cant, I’d make an appointment with Dr. Greenberg as soon as he could fit me in.”—Garret Keizer, author of Privacy and *The Unwanted Sound of Everything We Want“The Book of Woe* is a brilliant, ballsy excursion into the minefield of modern psychiatry. Greenberg has wit, energy, and a wonderfully skeptical mind. If you want to understand how we think of mental suffering today—and why, and to what effect—read this book.”—Daniel Smith, author of Monkey Mind “[Greenberg’s] fascinating history of the Diagnostic and Statistical Manual of Mental Disorders (the DSM)...show[s] just how muddled the boundaries of mental health truly are.”—Chloë Schama, *Smithsonian*“Greenberg argues persuasively that the current DSM encourages psychiatrists to reach beyond their competence....I’m impressed by Greenberg’s reporting, his subtlety of thought, his dedication to honesty, and his literacy....a very good book.”—Benjamin Nugent, Slate.com“The process of assembling [DSM-5] has been anything but smooth, as The Book of Woe relates....Greenberg argues—persuasively—that this fifth edition of the DSM arises not out of any new scientific understanding but from one of the periodic crises of psychiatry....invaluable.”—Laura Miller, Salon.com“In The Book of Woe, Greenberg takes the lay reader through a history of the DSM, which is really a history of psychiatry....[a] fascinating and well-researched account.”—Suzanne Koven, *The Boston Globe*About the AuthorGary Greenberg is a practicing psychotherapist and author of Manufacturing Depression and The Noble Lie. He has written about the intersection of science, politics, and ethics for many publications, including The New Yorker, Wired, Discover, and Rolling Stone. He is a contributor at Mother Jones, and a contributing editor at Harper's. Dr. Greenberg lives with his family in Connecticut.