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. ( )

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.
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I'm trying to figure out what to make of this book. The author goes into great detail about how the DSM is largely fabricated from politics and incomplete science. Which is true, to a point. There is some good information here about how over-diagnosis can be a bad thing for many people. However, for many others, being diagnosed with a mental illness and being able to receive the appropriate treatment (including, in some cases, medication) is extraordinarily important.

I can't help but think that the author cherry picked quotes and information to make his case against the DSM stronger. Also, based on the anecdotes about his own diagnosis as a young man and one of his patient's diagnoses, I would say he's biased against psychiatry in general. Just because a few people get misdiagnosed, or start off on the wrong medication(s), doesn't mean that all of psychiatry is wrong or inaccurate. Additionally, psychiatric medications can and do save lives.

Honestly, I wish he had given some sort of alternative. How can people with mental illnesses be treated without an agreement (however questionable that agreement may be) upon what defines mental illnesses? Without labels such as major depressive disorder and bipolar disorder, people with those illnesses will not receive the appropriate (and, in many cases life-saving) treatment. ( )

I registered a book at BookCrossing.com!
http://www.BookCrossing.com/journal/14219271