Submitted by Charles Knighton
The storm brewing over the latest edition of psychiatry’s so-called bible is not merely a matter for “eggheads”. The Diagnostic and Statistical Manual of Mental Disorders, or DSM 5 in shorthand, holds vast sway over human lives. It separates the sick from the well. It determines what kind of drugs and other treatment millions of people receive—and whether insurance and government aid programs will support those treatments. Yet the latest DSM in 19 years has arrived amid spreading doubts about whether the manual’s vast authority is merited.
Psychiatry’s great problem has been that science has been unable to identify the biochemical causes of mental disorders, leaving the American Psychiatric Association (APA)—which produces the DSM and profits greatly from its sales—free to codify disorders based merely on clusters of symptoms, all the while persuading themselves that they are proceeding scientifically on a project that is instead built on fictions, seemingly assembled primarily to justify the prescribing of tablets of dubious value.
We are all, to some extent, crazy. If you come to know any human being well enough, you eventually gain access to the basement where the traumas and wounds and deprivations are stored; rummage in there for a while, and you begin to understand the neuroses and fixations that shape his or her personality. The successful, reasonably happy people I’ve known are nuts in a way that works for them. Those who struggle and suffer fail to sublimate their preoccupations to some meaningful use.
About 50 percent of the population, the APA admits, will have one of its listed disorders at some point in their lives. Shy, like Emily Dickinson? You have “avoidant personality disorder”. Obsessed with abstractions and numbers? You have “autistic spectrum disorder,” like Isaac Newton. Suffer from “narcissistic personality disorder,” with some hyper-sexuality thrown in? You must be a politician. To be skeptical of these neat categories isn’t to deny that minds get broken, stuck, or lost, and need help finding their way out of misery. But psychotherapy, despite all the obscurantist jargon its adherents prefer, remains an art, not a science; there really is no bright line between nuts and not. If you’re an old lady who lives amid piles of newspapers and personal treasures, you have “hoarding disorder”. If you’re a CEO who exploits sweatshop labor to pile up countless billions, you’re on the cover of Forbes.
For those who are interested, and all should be, I recommend “The Book of Woe: The DSM and the Unmaking of Psychiatry” by Gary Greenberg.