Sep 11

Book Review: The Book of Woe: The DSM and the Unmaking of Psychiatry

The Book of Woe: The DSM and the Unmaking of PsychiatryThe Book of Woe: The DSM and the Unmaking of Psychiatry by Gary Greenberg
I saw this in a bookstore and only had to read the cover to know it was a book I’d be interested in. Psychology? Personality descriptors? Behind-the-scenes drama? I’m there! I adore psychology, love reading about it, but am skeptical about medical authorities, so I figured I’d rip through this book in a day or two.

It starts out promisingly enough; Greenberg describes a 19th century mental affliction common to slaves in which they curiously desire to escape their masters. Perhaps he’s taking a cheap shot, Greenberg asks rhetorically, and then replies that perhaps to gay people who remember when homosexuality was a mental disease will think his point is valid after all. This sets the tone of the book: anger and frustration at the entire American psychiatry industry.

The Scientologists are going to love this book, if they can get through the dull prose and meandering structure. They might find the same problem that I did: this book (despite my love of its potentially juicy subject matter) bored me. I’ve been puzzling over why it did so, and came up with a few possible reasons.

First of all, the book feels deeply personal. It reminds me of a celebrity tell-all about people on a TV show I’ve never seen. It’s hard to keep all the people straight, and it’s off-putting to hear what feel like veiled ad-hominem attacks when you don’t know the subject.

I didn’t much care for the structure either. Large chunks of the book consisted of dull “and then they had another meeting, and then they talked about the meeting, and then someone sent an email” which made me want to skim pages. The authors writing style feels like that of an academic, (which is to say, dull, obtuse and unnecessarily complex)and while some sections feel refreshingly readable, the prose inevitably slipped back into academese as if the editor couldn’t fully rein in a lifetime of habit. It’s loose chronological structure left many pages of dull exposition without any case studies or anecdotes to wake the reader up again. After a chapter or two of this, I’d get ready to close it and put it on the shelf, but then there’d be something interesting, like a case study or anecdote of someone who was directly affected by the change in diagnosis. I’d perk up, excited at the concrete livening up the abstract, but then the author would go back to the he-said, she-said.

I don’t think there was enough good material here for a book. I should clarify: too much of the wrong kind of material (descriptions of meetings between people you don’t know) and not enough of the right kind of material (concrete examples to solidify his points). Here’s my synopsis: “They started writing a book called the DSM a long time ago to make psychiatray feel more like medicine to describe mental illnesses. Then it sold really well, so they revised it a few more times. But then the guy who helped write the fourth version wasn’t consulted about the fifth version, and he got really mad, and they all started bickering about it.” It makes them all sound so petty and shallow. I’m not so high and mighty that I don’t like gossip, but if you’re going to slander your colleagues and debase the public view of your profession, you should at least titillate us in the process.

I’m not sure how I feel about the thrust of this book. On one hand, I think some people give diagnoses too much credit, like the people who blame all of their asshole-tendencies on their self-diagnosed Aspbergers. Also, not enough people are aware of how the drug companies influence the creation of diseases to fit whatever cure they’re shilling. So that’s valuable. On the other hand, he makes the APA sound like a bunch of ninnies, and I am pretty sure that most of these people are intelligent, educated, and caring professionals doing the best they can.

Everyone is touched, at least at some level, by psychiatry in this culture. People watch talk show docs diagnose callers, people read pop-science books about personality disorders, and everyone has either gone to a therapist or known someone who has. So this is relevant to a lot of people, even if they aren’t involved with psychiatry as a profession. The subject matter could have made this a winner of a bestseller, which is why I tried to finish it despite the many sections which bored me.

I hesitantly recommend this to people who are deeply interested in psychiatry and aren’t put off by weak writing.

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