A Case That Tells the Weird Tale of DSM – and Other Recommended Reading

For a single post that shows how weirdly and unevenly psychiatric diagnosis actually works (and fails to work) in this country, and what that means for the new DSM, get over to Maia Svalavitz’s clear-eyed account of her own five diagnoses (and the one she never got):

 Over the course of my life, I have been given no fewer than five different diagnoses for mental illnesses, under the diagnostic system laid out in psychiatry’s “bible,” the DSM.  But it was a sixth diagnosis— one that ironically will no longer appear in the edition being rolled out this week, DSM-5— that probably most accurately describes what is genuinely different about me.  I’m sharing this because my experience is a case study for explaining why the latest revision to the manual is raising such ire.

That’s at  Viewpoint: My Case Shows What’s Right — and Wrong — With Psychiatric Diagnoses | TIME.com. A brave piece of writing, a splendid read.

Other essential reading on the DSM comes from Gary Greenberg, who’s been blogging about it at Elements, the New Yorker’s science channel. The D.S.M. and the Nature of Disease, is his primer on the current flap on the new DSM. Does Psychiatry Need Science? looks at the DSM5’s failure to include what Greenberg argues is a better-documented disorder than many in the manual: melancholia, a sort of less acute but perfectly serious form of depression than the favored official “Major Depressive Disorder.” And he brings some needed historical perspecitve in The Creation of Disease and The Rats of N.I.M.H. which looks at the National Institute of Mental Health’s long-running dissatisfaction with the DSM’s categories.

Greenberg’s other essential reading is his “The Book of Woe,” a romp of an account of the making — rather sausagelike — of the DSM-5, which is to come out next week amid doubtless even more noise. It might or might not be, as many are saying, that the DSM, however flawed, is still the best thing we have to diagnose mental illness. But this book will show you why it’s not only not getting better, but how the APA steadfastly failed to fix even its most obvious problems.

My review of Greenberg’s book at Nature (paywalled; I’ll re-pub the whole thing here in a couple weeks) mostly shares his grim view:

For more than 100 years, psychiatry has been getting by on pseudo-scientific expla- nations and confident nods while it waited for the day, always just around the corner, in which it could be a strictly biological undertaking. Part of the DSM5’s long delay occurred because, a decade ago, APA leaders actually thought that advances in neurosci- ence would allow them write a brain-based DSM. Yet, as former APA front liner Michael First, a psychiatrist at Columbia University in New York, confirms on Greenberg’s last page, the discipline remains in its infancy.

Greenberg shows us vividly that psychiatry’s biggest problem may be a stubborn reluctance to admit its immaturity. And we all know how things go when you won’t admit your problems.

Also sharply critical, though slightly less so than Greenberg, is Allen Frances, who edited the previous edition of the DSM (DSM-IV). His book Saving Normal is also just out, and he’s posting a steady stream of sharp-tongued criticism of the new DSM at Huffington Post, among other places.

I’m dying to get Frances and Greenberg in the same room.

But start and end with Maia Svalavitz’s account of her own history; it grounds the discussion in a way that’s quite needed.

Photo: David Dobbs

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