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The Book of Woe: The DSM and the Unmaking of Psychiatry
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The Book of Woe: The DSM and the Unmaking of Psychiatry [Format Kindle]

Gary Greenberg

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Chapter 1

Shortly after New Orleans physician Samuel Cartwright discovered a new disease in 1850, he realized that like all medical pioneers he faced a special burden. “In noticing a disease not heretofore classed among the long list of maladies that man is subject to,” he told a gathering of the Medical Association of Louisiana, “it was necessary to have a new term to express it.” Cartwright could have followed the example of many of his peers and named the malady for himself, but he decided instead to exercise the ancient Greek he’d learned while being educated in Philadelphia. He took two words—drapetes, meaning “runaway slave,” and the more familiar mania—and fashioned drapetomania, “the disease causing Negroes to run away.” The new disease, Cartwright reported in The New Orleans Medical and Surgical Journal, had one diagnostic symptom—“absconding from service”—and a few secondary ones, including a sulkiness and dissatisfaction that appeared just prior to the slaves’ flight. Through careful observations made when he practiced in Maryland, he developed a crude epidemiology and concluded that environmental factors could play a role in the onset of drapetomania.

Two classes of persons were apt to lose their Negroes: those who made themselves too familiar with them, treating them as equals; and on the other hand those who treated them cruelly, denied them the common necessaries of life, neglected to protect them, or frightened them by a blustering manner of approach.

But the most evenhanded treatment would not prevent all cases, and for those whose illness was “without cause,” Cartwright had a prescription: “whipping the devil out of them.”

Lest anyone doubt that drapetomania was a real disease—and, evidently, some Northern doctors did—Cartwright offered proof. First of all, he said, we know that Negroes are descended from the people of Canaan, a name that means “submissive knee-bender,” so it’s clear what God had in mind for the race. And in case a reader subscribed to the notion, taught in the “northern hornbooks in Medicine,” that “the Negro is only a lampblacked white man . . . requiring nothing but liberty and equality—social and political—to wash him white,” Cartwright called as witnesses the prominent European doctors who had “demonstrated, by dissection, so great a difference between the Negro and the white man as to induce the majority of naturalists to refer him to a different species.” Africans’ blood was darker, he said, and “the membranes, tendons, and aponeuroses, so brilliantly white in the Caucasian race, have a livid cloudiness in the African.” This historical and biological evidence, Cartwright concluded, proved that running away is neither willfulness nor the normal human striving for freedom, but illness plain and simple.

Drapetomania was never considered for the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s compendium of mental illnesses, but that may be only because there was no such book in 1850. (Indeed, the Association of Superintendents of American Institutions for the Insane, the organization that eventually became the APA, was only six years old at the time, and the word psychiatry had just come into use.) Certainly it met many of the criteria for inclusion. It was a condition that caused distress for a certain group of people. It had a known and predictable onset, course, and outcome.

Its diagnostic criteria could be listed in clear language that a doctor could use, for instance, to distinguish normal stubbornness from pathological dissatisfaction, or to determine whether a slave was running away because he was sick or just evil. Many people besides Cartwright had observed it. Its discovery was announced in a respected professional journal. Its definition was precise enough to allow other doctors to develop tests that distinguished normal (or, as the DSM puts it, expectable) from disordered dissatisfaction, and to conduct research that confirmed (or didn’t) that most runaway slaves had been sulky prior to absconding, or that slaves treated too familiarly or too cruelly were more likely to contract drapetomania, or that whipping prevented the disease from running its full course. Still other doctors might have recommended potions that would relieve its symptoms. As the years wore on, some doctors might have objected that the disease pathologized a normal response to atrocious conditions, while others might have fought bitterly and publicly over smaller issues: whether or not defiance also belonged on the list of criteria; whether to add Dr. Cartwright’s other discovery, dyaesthesia aethiopica, the malady causing slaves to “slight their work,” to the diagnostic manual; which gene predisposed slaves to drapetomania and dyaesthesia; where the thirst for freedom could be found in the brain; and, perhaps, whether or not these were real illnesses or only constructs useful to understanding what Dr. Cartwright called the “diseases and physical peculiarities of the Negro race.”

Dr. Cartwright’s disease, in short, and the promise it held out—that a widely observed form of suffering with significant impact on individuals and society could be brought under the light of science, named and identified, understood and controlled, and certain thorny moral questions about the nature of slavery sidestepped in the bargain—might have spawned an entire industry. A small one, perhaps, but one that would have no doubt been profitable to slave owners, to doctors, maybe even to slaves grateful for their emancipation from their unnatural lust for freedom—and, above all, to the corporation that owned the right to name and define our psychological troubles, and to sell the book to anyone with the money to buy it and the power to wield its names.

Even if you’re one of the many people who are suspicious of psychiatry and skeptical of its claims to have identified the varieties of our suffering and collected them in a single volume, you might be thinking that I’m not being entirely fair here, that even if the Civil War hadn’t come along ten years later and rendered Cartwright’s outrageous invention moot, doctors would have quickly consigned drapetomania to the dust-bin of medical history. You might point out that even at the time sensible people objected—Frederick Law Olmsted, for instance, whose Journeys and Explorations in the Cotton Kingdom includes a mordant account of “the learned Dr. Cartwright” and his diseases, and the unnamed doctor who satirized Cartwright in the Buffalo Medical Journal by suggesting that drapetomania occurs when “the nervous erythism of the human body is thrown into relations with the magnetic pole . . . thus directing [the slave’s] footsteps northward.” You might say that in introducing a book about the DSM with an anecdote about a diagnosis that is so obviously specious, and in implying that this is somehow emblematic of the diagnostic enterprise, I am taking a cheap shot.

And you may be right.

On the other hand, especially if you are a gay person, you might not be so quick to think that drapetomania is merely a low-hanging cherry that I’ve picked to flavor my tale. Because you might be old enough to remember back forty or fifty years, to a time when homosexuality was still listed in the DSM. Which meant that doctors could get paid to treat it, scientists could search for its causes and cures, employers could shun its victims, and families could urge them to seek help, even as gay people conducted their intimacies in furtive encounters, lived in fear and shame, lost jobs, forwent careers, and chained themselves to marriages they didn’t want. They underwent countless therapies—shocks to the brain and years on the couch, behavior modification and surrogate sex, porn sessions that switched from homo to hetero at the crucial moment—in desperate attempts to become who they could not be and to love whom they could not love, to get free of their own deepest desires, all in the name of getting well. And all this, at least in part, because a society’s revulsion had found expression in the official diagnostic manual of a medical profession, where it gained the imprimatur not of a church or a state, but of science. When doctors said homosexuality was a disease, that was not an opinion, let alone bigotry. It was a fact. When they wrote that fact down in the DSM, it was not a denunciation. It was a diagnosis.

Or maybe you’re among the 11 percent of the U.S. adult population whose daily regimen includes taking a dose or two of Lexapro or Paxil or some other antidepressant, and you’ve been doing that for years, ever since a doctor told you that you had Major Depressive Disorder (or maybe she just said you had clinical depression), meaning that your sulkiness and dissatisfaction were symptoms of a mental disorder, and that this was a chemical imbalance that those drugs would fix. And maybe they did, because at least for a little while you felt better; but then you got tired of feeling numb, of gaining weight, of not wanting sex and not being able to have an orgasm even if you did; and then you tried to get off the drugs only to find that your brain off drugs is an unruly thing, that your old difficulties returned or new ones arose when you stopped taking them. Which might mean, you told yourself, that you indeed have that disease, but every once in a while—when you read about the placebo effect, or you hear that this chemical imbalance does not, as far as doctors know, really exist, or when you look at the DSM and realize that there are more than seventy combinations of symptoms that can result in this one diagnosis and that any two people with...

Revue de presse

“[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,

“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)[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,

“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,

“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

“[E]ngaging, radical and generally delectable...Greenberg is a practicing psychotherapist who writes with the insight of a professional and the panache of a literary journalist....[a] brilliant take-down of the psychiatric profession...The Book of Woe offers a lucid and useful history.”
—Julia M. Klein, The Chicago Tribune

“This is a landmark book about a landmark book....Greenberg paints a picture so compelling and bleak that it could easily send the vulnerable reader into therapy....takes the reader deep inside the secretive world of the panels and personalities that have spent years arguing about which disorders and symptoms they would keep and which they would discard in the new DSM.
—Robert Epstein, Scientific American


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  • Nombre de pages de l'édition imprimée : 417 pages
  • Pagination - ISBN de l'édition imprimée de référence : 0399158537
  • Editeur : Blue Rider Press; Édition : 1 (2 mai 2013)
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Commentaires client les plus utiles sur (beta) 4.1 étoiles sur 5  51 commentaires
33 internautes sur 35 ont trouvé ce commentaire utile 
5.0 étoiles sur 5 A full frontal assault on reductionism 23 juin 2013
Par Nancy Fair - Publié sur
Format:Relié|Achat vérifié
For anyone (therapists and laypersons alike) who has ever read parts of the DSM (any version) and come away suspecting that they themselves could readily receive a large number of the diagnoses described, depending upon the day, Gary Greenberg has addressed these concerns eloquently. As a therapist working in the field for more than 17 years, I have felt my anger rise steadily at the reductionist hubris presented as fact by proponents of the medical model of human distress. Greenberg's expose links the history of psychiatry, with its relentless pursuit of theoretical and financial legitimacy through medicalization, to the reductionism inherent in this paradigm. Although the topic of Big Pharma's contributions to the medicalization of psychiatry is mentioned in the book, it is not Greensberg's focus and should be expanded upon, given the market-driven nature of nearly all aspects of our current culture. At times, the seemingly endless debates among those involved in the DSM5 project was heavy reading, and I was tempted to skim several chapters in the book. But for the most part, it reads like a spy novel - complete with secrets, conspiracy theories, and betrayals- leaving the reader wondering just whose side people are on, or indeed, what exactly those sides represent, particularly for people seeking help for what is termed, "mental illness." Overall, Greenberg is successful in his efforts to invite the reader to share his critical look at psychiatry and its attempts to reduce human suffering to quantifiable and reimbursable categories. He reminds us that, so far, the human mind remains a mystery,and more than the sum of its biological parts.
18 internautes sur 18 ont trouvé ce commentaire utile 
5.0 étoiles sur 5 Who would believe there would be so many laugh out loud moments in "The Book of Woe"? Well, done Sir Author 7 juillet 2013
Par Nancy Drew - Publié sur
Format:Format Kindle|Achat vérifié
Gary Greenberg gets it right and dishes it out on a sumptuous platter of history with a whole lotta gentle direct humor woven through his very exposing/disclosing book. In a down to earth readable style (not psychedelic, psychiatric, psycho, academic bureaucratic mumble jumble jargon) he's drawn the curtain back and exposed the Wizard of Id? Or maybe the Wizard of Ego? The Wizard of War? The DSM-5; a book written by committee; members who sit around a table every so many years and make up stuff, a book that has no scientific basis.

We had to study the Diagnostic and Statistical Manual (DSM) when I was in graduate school (and who didn't like looking up what was wrong with their family members and self-diagnosing themselves?). It's merely a checklist of symptoms, not causation, not a mental health diagnosis, not a scientific diagnosis, not a medical diagnosis. "Check, check, check, check." "OK now this is who you are." Then a few years down the line: "Check, check, oh?" "OK now you're not that anymore".

And it's very political. "Combat fatigue" was taken out at the height of the Vietnam War. It was veterans who studied then lobbied to get "post traumatic stress" in not only for themselves but also for children who were horribly abused. That is a label that at least speaks to causation. Then homosexuals lobbied to get "homosexuality" out, now "transgendered" want to be kept in.

Greenberg lays out the history of the DSM, it's pioneering characters including its subsequent characters who now say "oops", but to his credit the author exposes the story and the behind the scenes of the story, treats the history in a respectful but direct way using humor; making them into people, not gurus who have the holy seeing as to who you are based on a checklist.

I didn't know until reading Greenberg's book that out of the history of slavery came one of the first sort of DSM labels. That slaves running away was a mental disorder. If that doesn't say it all about so-called mental illness. If you don't accept the horrible conditions of your life you are mentally ill! "Now take these drugs!" In the new DSM book, in the DSM-5 if you grieve longer than two weeks for a loved one's death you are officially mentally ill.

Greenberg lays out the money issue as to why now? Why now revamp the DSM? Why now? Because the American Psychiatric Association (APA) is in need of money. With all the criticism they were getting for drug money flowing into their coffers as well as the drug companies doing trainings for the APA, for drugging the hell out of our kids, the APA greatly reduced the drug money connection. The DSM is their best selling book. They need the money but as the reviews on the DSM-5 show anyone can get the "diagnosis" and "code numbers" on line, free from which to do their insurance billing. DSM-5 not needed.

Greenberg's description of the "committee work" I found hilarious and sad for it is exactly the same process I witnessed of the government re-writing the health, safety and well-being of children in day care regulations. It went on forever and the main folks advocating for no safety rules were some of the day care providers with the poor histories of providing care to children. Then like the DSM committee work it all went on line for public comment. The committee work Greenberg watched in action and the committee I watched in action were the similar dynamic although because a couple of us die hard advocates were on the committee the government did at least on paper a better job of keeping safety regulations. And yes, like Greenberg witnessed with his committee, the day care regulation committee also tried to keep their meetings secret and attempted to take away the first amendment rights of us advocates who spoke to the media.

Where did this phenomenon start coalescing from in history? Once again it looks like from the Germans and a guy named Emil Kraepelin in the mid 1800s (which is where and when the whole public education system started) and by the end of the 1800s started the classification system, his "neat categories of mental illness".

But it was really war that jumped the gun into providing a warm petri dish in which psychiatrists were grown and thrust out into the world to try to stop soldiers returning from war from having emotional reactions about their experiences, well maybe not stop the emotional reactions but to deny they had anything to do with war. 1952 the year the DSM first got published was the year that Dr. Ewan Cameron was the president of the APA. Working out of Canada for the C.I.A. he headed up the MKULTRA program up there Where they experimented on children (see "The Franklin Cover Up"). 1952 was the year the USA got schizophrenia. Out of war sprang our modern mental health (cover up) systems.

Lloyd de Mause and Alice Miller probably had the most direct diagnosis for our modern era in that "all war is about child abuse" but I don't think the author reviewed that aspect of our modern mental illness. Maybe his next book?

A great read, a fun read, many laughing out loud moments. Laughing takes power and control away from those insisting that their way makes sense, only makes sense, it's the only way if you will only obey them. Please read and enjoy this book.
9 internautes sur 9 ont trouvé ce commentaire utile 
5.0 étoiles sur 5 A must read for those giving or being given diagnoses 19 juin 2013
Par Dr. Nan - Publié sur
Greenberg does a superb job of explaining the nature and origin of diagnosis and the DSMs. I am a psychologist and am well trained in making diagnoses. Many of my clients believe that the diagnosis(es) they have been given define them in some way. They think they are "chemically imbalanced" or possessed of "broken" or "mis-wired" brains. Further, they often come to believe that their diagnoses (depression, anxiety, PTSD, etc.) mean they will be permanently compromised or disabled. This is no surprise as many have been told that these diagnoses refer to physical illness, that their symptoms are produced by illness that is located in the brain/body. At this time, there simply isn't evidence to support such a theory. The theory may be true, but it behooves scientists to provide solid empirical support in order to make such a claim. As yet, they have not.

Without question, the experiences that DSM diagnoses attempt to categorize are real -- humans suffer tremendously and that suffering requires attention and treatment. But the labels that the DSM slaps on those experiences transforms them from human pain and suffering into disease (and, thus, big money-makers for folks in several industries). Greenberg reminds us that psychiatry does not speak the gospel truth. Not even the scientific truth, in this case. As a therapist, I am always glad to be reminded of this.
36 internautes sur 45 ont trouvé ce commentaire utile 
3.0 étoiles sur 5 Has some truth worth reading, but the presentation needed more work 11 mai 2013
Par John Carl - Publié sur
Format:Relié|Achat vérifié
There is an important message in this book. Psychiatry could use some more humility in terms of diagnosis, claims of underlying mechanism and ultimately its use of authority to set the threshold for what is normal and what should be treated in a clinical setting. Its not that psychiatry forgot about these things entirely, but that it should dedicate to make these things a higher priority. That's the truth as I see it and this book does offer some interesting examples and discourse on the topic. There is much to think about as we move forward in clinical practice and research.

I really wish this message had been brought out without the occasional diatribes, and in a more positive manner. As it stands, the truth that is in the book is very easy to dismiss as simply anti-psychiatry or at least so close to anti-psychiatry that it just cannot be taken seriously. I wish the author had a bit more restraint in that way the message was crafted, to truly be a home run, but it appears to lose the required nuance as the book went on. It could have been 100 pages shorter and had more of an impact with right tone and some editing.

What I will say about the narrative is that I did enjoy it for the most part. Dr. Greenberg has humor and sarcasm in many places that do work well. His overall style was nice and light. I do doubt that anyone not in the know would find the personal drama aspect very compelling. I think if you're in the field you can imagine very well how these things happened, and may get a voyeuristic thrill out of some parts, but its not a good story from the human interactions point of view.

So I give it a middle of the road 3 stars since the truth and a lot of the writing are balanced by the poor way the truth was presented, almost begging to be dismissed entirely, and by the lack of narrative tension that seems should surround a controversy.
44 internautes sur 56 ont trouvé ce commentaire utile 
4.0 étoiles sur 5 Important, despite faults 8 mai 2013
Par A - Publié sur
The editorial reviews describe pretty well the gist of the book, so I will just consider here a couple of faults that unfortunately detract from the message. First, it could have done with some editing. The message is often obscured by not quite coherent ramblings that go on too long and are tedious to slog through. Second, while the author rightly attacks the APA for making up diagnoses not validated by research, he then unaccountably turns around and heaps scorn on people who are trying to do exactly what I had thought he was advocating, namely finding a scientific basis for certain diagnoses. A particularly grating example is his criticism of researchers using brain imaging to understand craving and addiction, where he sets up some unbelievably gratuitous straw men for the purpose of bringing down people. Another glaring inconsistency is his criticism of the medicalization of normality while defending diagnoses like Asperger's for people who clearly have nothing wrong with them, except for suffering from what one might call "I want to be a special snowflake too" syndrome. I found myself wondering many times - does he actually have a thesis besides just liking to criticize everybody out of some sort of spite?

I think the main message to be taken from the book is simply that the DSM-5 and the mainly political machinations behind it are a shambles and a joke. This is important enough for 4 stars, and the book certainly contains more than sufficient evidence to prove this. The stars are neither for the writer nor the editor, though.
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