The Book of Woe: The DSM and the Unmaking of Psychiatry (41 page)

At
Wired
, where this book got its start (and its title): Bill Wasik and Bess Kalb.

At Blue Rider Press: Aileen Boyle, Anna Jardine, Phoebe Pickering, David Rosenthal, and the inestimable Sarah Hochman.

For crack agentry: Jim Rutman.

For reading and comment on parts of the manuscript: Barney Carroll, Bill Musgrave, and Stuart Vyse.

For reading and comment on the entire manuscript: Rand Cooper, Gideon Lewis-Kraus, and Michelle Orange.

For interviews that no doubt turned out to be more than they bargained for, not to mention all those follow-up e-mails: Bill Bernet, Michael Carley, Gabrielle Carlson, Will Carpenter, Jane Costello, Bruce Cuthbert, Max Fink, Paul Fink, Steve Hyman, Tom Insel, Nomi Kaim, Ronald Kessler, David Kupfer, John Livesley, Catherine Lord, Steve Mirin, Bill Narrow, Roger Peele, Harold Pincus, Darrel Regier, Jay Scully, David Shaffer, Andrew Skodol, Bob Spitzer, Fred Volkmar, Jerry Wakefield, Barbara Wiechmann, Tom Widiger, and Sid Zisook.

For research materials and editorial assistance: Paula Caplan, Beth Card, Bart Laws, Ned Shorter, Steve Silberman, Katherine Sticklor, and Ken Kendler.

For careful proofreading: Ruth Greenberg.

For honesty, patience, and generosity: Michael First.

For honesty, patience, generosity, and hospitality, sometimes against their better judgment: Allen Frances and Donna “Peach” Manning.

And, as always, for bringing out my best and putting up with my worst, and for her blue eyes: Susan Marie Powers.

Chapter 1

1.
“In noticing a disease”:
Cartwright, “Diseases and Peculiarities of the Negro Race,” Part 1, 332.

2.
“the disease causing Negroes”:
Ibid., 331.

3.
Two classes of persons:
Ibid., 332.

4.
“whipping the devil”:
Ibid.

5.
“submissive knee-bender”:
Ibid.

6.
“northern hornbooks in Medicine”:
Cartwright, “Diseases and Peculiarities of the Negro Race,” Part 2, 506.

7.
“demonstrated, by dissection”:
Ibid., 505.

8.
“the membranes, tendons, and aponeuroses”:
Ibid., 506.

9.
dyaesthesia aethiopica:
Cartwright, “Diseases and Peculiarities,” Part 1, 333.

10.
“the learned Dr. Cartwright”:
Olmsted,
Journeys and Explorations
, 122.

11.
“the nervous erythism”:
S. B. Hunt, “Dr. Cartwright on ‘Drapetomania,’” 441–42.

12.
They underwent countless therapies:
For an account of the treatment of homosexuals, see LeVay,
Queer Science
, chapter 4.

13.
11 percent of the U.S. adult population:
Centers for Disease Control, “NCHS Data Brief, October 19, 2011,” http://www.cdc.gov/nchs/data/databriefs/db76.htm.

14.
you got tired of feeling numb:
For side effects of antidepressants, see Glenmullen,
Prozac Backlash
.

15.
placebo effect:
Kirsch,
The Emperor’s New Drugs
.

16.
this chemical imbalance does not, as far as doctors know:
Greenberg,
Manufacturing Depression
.

17.
more than seventy combinations of symptoms:
See DSM-IV-TR, 356. There are nine symptoms of depression, but patients need have only five in any combination to earn the diagnosis.

18.
“another [of] the ten thousand”:
Cartwright, “Diseases and Peculiarities,” Part 1, 336.

19.
“Love is a madness”:
Plato,
Phaedrus
, 265e.

20.
Before John Snow:
The best account of this famous story is probably Steven Johnson’s
The Ghost Map
.

21.
Louis Pasteur and Robert Koch:
Ullmann, “Pasteur–Koch.”

22.
“blessed rage to order”:
Stevens, “The Idea of Order at Key West,”
The Palm at the End of the Mind
.

23.
Adam and Eve:
Genesis 2:19–21.

24.
“loose, baggy monster”:
Henry James,
The Tragic Muse
, 4.

25.
“insomnia, flushing, drowsiness”:
Beard,
American Nervousness
, 7–8.

26.
“As long as I live”:
Gay,
Freud
, 491.

27.
“It burdens [a doctor]”:
Freud,
The Question of Lay Analysis
, 95.

28.
“the mental sciences”:
Ibid., 88–90.

29.
“the patient’s ambivalent feeling”:
American Psychiatric Association, DSM-I, 34.

30.
a psychologist showed:
Ash, “The Reliability of Psychiatric Diagnoses.”

31.
By 1962, despite various attempts:
Summarized in Beck, “Reliability of Psychiatric Diagnoses.”

32.
doctors in Great Britain:
Sandifer et al., “Psychiatric Diagnosis.” See also Kendell et al., “Diagnostic Criteria of American and British Psychiatrists.”

33.
Erving Goffman and Michel Foucault:
See Goffman,
Asylums
, and Foucault,
Madness and Civilization
.

34.
The DSM instructs users:
American Psychiatric Association, DSM-IV-TR, xxxi–xxxii.

35.
“perhaps the most powerful psychiatrist in America”:
Daniel Goleman, “Scientist at Work,”
The New York Times
, April 19, 1994.

36.
“Here’s the problem”:
Allen Frances interview, August 16, 2010.

37.
the lead of the
Wired
article:
Gary Greenberg, “The Book of Woe: Inside the Battle to Define Mental Illness,”
Wired
, December 2010, 126–36.

38.
“Bullshit is unavoidable”:
Frankfurt,
On Bullshit
, 63.

39.
“neither on the side of the true”:
Ibid., 56.

Chapter 2

1.
“The present classification of mental diseases is chaotic”:
Salmon et al., “Report of the Committee on Statistics,” 256.

2.
“It cannot be supposed”:
Jarvis,
Relation of Education to Insanity
, 4–5.

3.
“Within the last fifty years”:
Ibid., 6.

4. “
In an uneducated community”:
Ibid., 8.

5.
“From all this survey”:
Ibid., 11.

6.
“In the present state of our knowledge”:
Grob, “Origins of DSM-I,” 231. Emphasis in original.

7.
“had become marginal”:
Shorter,
History of Psychiatry
, 144.

8.
“Pathological anatomy”:
Kraepelin,
Lectures
, 27.

9.
“poetic interpretation”:
Kraepelin, “Manifestations of Insanity,” 512.

10.
he took a Kraepelinian approach:
Salmon, “Report of the Committee on Statistics,” 256–59.

11.
the association issued the
Statistical Manual:
Grob, “Origins of DSM-I,” 426.

12.
its last edition ran to seventy-one pages:
American Psychiatric Association,
Statistical Manual for the Use of Hospitals
.

13.
a membership of only 2,295 doctors:
Grob, “Origins of DSM-I,” 427.

14.
“Our experiences with therapy
”
:
Quoted in Grob, “Origins of DSM-I,” 428.

15.
Psychoanalysis proved easy enough to adapt:
For a detailed account of this shift, see Zaretsky,
Secrets of the Soul
, especially chapters 10 and 11.

16.
only 10 percent of their cases:
American Psychiatric Association, DSM-I
,
vi.

17.
“At least three nomenclatures”:
Ibid., vii.

18.
“stepchild of [the] Federal Government”:
DSM-I, x.

19.
Anxiety Reaction:
DSM-I, 32.

20.
Depressive Reaction:
DSM-I, 33.

21.
“disorders of psychogenic origin”:
DSM-I, 24.

22.
“Instead of putting so much emphasis”:
Menninger,
The Vital Balance
, 325.

23.
“Man in transaction with his universe”:
Quoted in Wilson, “DSM-III and the Transformation of American Psychiatry,” 401.

24.
it had become a professional backwater:
Wilson, “DSM-III,” 403.

25.
“compared to other types of services”:
Quoted ibid.

26.
The war over the homosexuality diagnosis:
For a full account, see Bayer,
Homosexuality and American Psychiatry
.

27.
Ego-Dystonic Homosexuality:
DSM-III, 281–82.

28.
“If groups of people march”:
Bayer,
Homosexuality and American Psychiatry
, 141.

29.
“Referenda on matters of science”:
Ibid., 153.

30.
“Psychiatry was regarded as bogus”:
Robert Spitzer interview, August 27, 2010.

31.
“I was uncomfortable with not knowing”:
Spiegel, “The Dictionary of Disorder.”

32.
By 1972, the group had described:
Feighner et al., “Diagnostic Criteria for Use in Psychiatric Research.”

33.
Research Diagnostic Criteria:
Spitzer et al., “Research Diagnostic Criteria: Rationale and Reliability.”

34.
A. One or more distinct periods:
Ibid., 776.

35.
the nosology would inexorably gain substance:
Ibid., 781–82.

36.
“The use of operational criteria”:
Ibid., 781.

37.
a conclusion he published in the
Archives of Sexual Behavior
:
Spitzer, “Can Some Gay Men and Lesbians Change Their Sexual Orientation?”

38.
a letter to the
Archives
:
Spitzer, “Spitzer Reassesses His 2003 Study of Reparative Therapy
.
”

Chapter 3

1.
“In the morning, everyone would be screaming ideas”:
Allen Frances telephone interview, November 23, 2011.

2.
people who “employ self-sacrificing and self-defeating behavior”:
Siever and Klar, “A Review of DSM-III Criteria for the Personality Disorders,” 304.

3.
“dumb idea”:
Allen Frances e-mail, November 27, 2011.

4.
“The fact that we had a descriptive system only revealed”:
Allen Frances interview, August 16, 2010.

5.
“loving the pet, even if it is a mutt”:
Allen Frances e-mail, September 3, 2010.

6.
“seemed a bit like stamp collecting”:
Hyman, “The Diagnosis of Mental Disorders: The Problem of Reification,” 157.

7.
“The tendency [is] always strong”:
James Mill,
Analysis of the Phenomena of the Human Mind,
5. The quotation is from a footnote appended to a later edition of Mill’s 1829 book by his son John Stuart Mill.

8. “
It became a source of real worry”:
Ibid.

9.
“I realized that it got me nowhere”:
Steven Hyman e-mail, October 5, 2012.

10.
the
Post
had twice come out against parity:
“The Mental Health Amendment,”
The Washington Post
, April 28, 1996; and “‘Parity’ in Health Insurance,”
The Washington Post
, December 4, 2001.

11.
They “asked questions”:
“Changes Put APA on Right Track to Face Future,”
Psychiatric News
, October 4, 2002.

12.
They’d asked twenty thousand people:
The questionnaire is available in Robins and Regier,
Psychiatric Disorders in America
, 401–26.

13.
The ECA’s findings:
Ibid., 333.

14.
And the sick among us were really sick:
Ibid., 357.

15.
only 19 percent:
Ibid., 361.

16.
the paper came out in favor of parity:
“Equity for Mental Illness,”
The Washington Post
, September 9, 2002.

17.
the Midtown Manhattan Study:
Srole et al.,
Mental Health in the Metropolis,
vol. 1.

18.
“designed for classifying full-blown pathology”:
Ibid., 134.

19.
So rather than ask
 . . . they asked about:
Ibid., 388–91.

20.
a six-point classification:
Ibid., 134–38.

21.
“mental illness and mental health [differed]”:
Ibid., 135.

22.
the actual number is 81.5 percent:
Ibid., 138.

23.
It was more than double the rate of mental illness:
Ibid., 141–43.

24.
he cited the 23 percent figure accurately:
Regier et al., “The De Facto U.S. Mental Health Services System,” 687.

25.
about 15 percent of Americans were mentally ill:
Ibid., 692–93.

Chapter 4

1.
“the mind is a set of operations”:
Kandel, “The New Science of Mind,” 69.

2.
“all mental disorders”:
Ibid., 71.

3.
“We can think of mental disorders
”
:
Insel, “Rethinking Mental Illness,” 2011 American Psychiatric Association annual meeting, Honolulu, May 14, 2011.

4.
“neurologizing tautologies”:
Meyer, “The Aims and Meaning of Psychiatric Diagnosis,” 165.

5.
“driving the Devil out”:
Shorter and Healy,
Shock Therapy
, 30.

6.
it was hard to argue with the biological psychiatrists:
For a history of these discoveries, see Greenberg,
Manufacturing Depression
, chapters 7, 8; Healy,
The Creation of Psychopharmacology
, and Shorter,
History of Psychiatry
.

7.
depression, he announced, must be the result:
Schildkraut, “The Catecholamine Hypothesis of Affective Disorders.”

8.
“The gold standard was the DSM criteria”:
Steven Hyman e-mail, October 5, 2012.

9.
“to the point that they are considered”:
Kupfer, First, and Regier,
Research Agenda for DSM-V
, xix.

10.
“yet unknown”:
Ibid.

11.
“In a way, I was born to do the DSM”:
Michael First interview, April 25, 2011.

12.
“I have a patient
”
:
Paul Fink interview, September 2, 2010.

13. “
There is no assumption”:
DSM-IV-TR, xxxi.

14.
“The purpose of DSM-III”:
DSM-III, 12.

15.
“consensus of current formulations”:
DSM-III-R, xxix.

16.
black-box warning:
http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM161641.pdf.

Chapter 5

1.
“When I heard about them”:
Allen Frances interview, July 7, 2011.