The Bible of Psychiatry is a Book of Woe
This post is based on an Jeff Schectman’s interview on his podcast, Specific Gravity. Find more from Specific Gravity here.
Since 1952, the American Psychiatric Association has created and maintained a guide to diagnosing and identifying psychiatric conditions. There have been five total issues of the guide, with the latest update, the first since 1994, having just been released.
The Diagnostic and Statistical Manual of Mental Disorders is so important to the practice of psychology and psychiatry that it is often unironically referred to as “The Bible of Psychiatry”. Inclusion in the DSM means that a disorder or psychiatric condition formally exists (and can be recognized by courts, insurance companies, the FDA, etc.), and exclusion means that it formally does not.
In his new book, The Book of Woe: The DSM and the Unmaking of Psychiatry, which he discussed with Jeff Schechtman on Specific Gravity, author and psychotherapist Gary Greenberg discusses the pitfalls of this system, in which the meeting of bland and often unscientific criteria is the sole qualification for pathology.
Greenberg says that the DSM is ultimately a very fragile document, and that the power it is given, which power is basically complete and unquestionable authority on all matters psychological, is undue. He notes that its appeal as an inerrant text (notes of biblical stature once again) is largely as a money maker for the American Psychiatric Association and as a fundamentally lazy (to the point of being inaccurate) way to understand, diagnose, and treat psychiatric pathologies.
He notes the Catch-22 absurdity of having to act as though definitions and categories decided upon by human committee are as real as scientific laws. This has deleterious effects on both practitioners and patients of psychiatry. It also, Greenberg notes, hurts research psychiatry: “They have to research categories that they know aren’t real!”
The most important changes in the update from 1994 are of formalizing the belief in a single “autism sprectrum” (rather than a combination of the distinct conditions of autism and Asperber’s), and the de-pathologizing of certain conditions like being transgender.