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

by Gary Greenberg

  8. “The development process has been so public”: Alan Schatzberg, “Some Thoughts on DSM-V,” Psychiatric News, August 21, 2009.

  9. “I’m too small a fish”: Jane Costello e-mail, August 1, 2010.

  10. “I cannot in good conscience”: Jane Costello resignation letter, available at http://www.scribd.com/doc/17162466/Jane-Costello-Resignation-Letter-from-DSMV-Task-Force-to-Danny-Pine-March-27-2009.

  11. the response came from Darrel Regier: Regier supplied me with the letter via e-mail, November 11, 2010.

  12. “Since we considered”: Darrel Regier e-mail, November 11, 2010.

  13. “When there is smoke”: Carolyn Robinowitz interview, October 4, 2010.

  14. the APA issued a press release: American Psychiatric Association, “DSM-5 Publication Date Moved to May 2013,” news release, December 10, 2009, http://www.dsm5.org/Newsroom/Documents/09-65%20DSM%20Timeline.pdf.

  15. “long vetting process”: Beth Casteel e-mail, November 11, 2010.

  16. “I’m going to be quite critical”: Allen Frances, “DSM-V in Severe Distress: Is a Happy Ending Possible?” January 15, 2010, http://columbiapsychiatry.org/videos/dsm-v-severe-distress-happy-ending-still-possible.

  17. The APA posted a full draft: Although it has since been taken down, the draft is available at http://web.archive.org/web/20100402094501/http://www.dsm5.org/ProposedRevisions/Pages/Default.aspx.

  18. “Anything you put in that book”: Benedict Carey, “Revising Book on Disorders of the Mind,” The New York Times, February 10, 2010.

  19. “The 19 Worst Suggestions for DSM5”: Allen Frances, “Opening Pandora’s Box: The 19 Worst Suggestions for DSM5,” Psychiatric Times, February 11, 2010, www.psychiatrictimes.com/print/article/10168/1522341?printable=true.

  Chapter 10

  1. another letter to the trustees: Frances, “To the Membership of the APA,” Psychiatric Times, June 2, 2010, http://www.psychiatrictimes.com/dsm-5/content/article/10168/1565491.

  2. “I was of age in the ’60s”: Allen Frances e-mail, January 23, 2012.

  3. “I never yell”: Ibid.

  4. “nice irony”: Ibid.

  5. “This was the stupidest idea in the world”: Allen Frances telephone interview, November 23, 2011.

  6. “After the third or fourth”: Herb Peyser interview, January 23, 2012.

  7. Freud once said: See Freud, The Joke and Its Relation to the Unconscious.

  8. “orderly and democratic process”: David Shaffer interview, December 8, 2011.

  9. “David probably misinterpreted”: Allen Frances e-mail, January 23, 2012.

  10. “that children with the broad phenotype”: Leibenluft et al., “Defining Clinical Phenotypes of Juvenile Mania,” 436.

  11. “claim to define a new diagnosis”: Leibenluft, “Severe Mood Dysregulation,” 131.

  12. “Justification for Temper Dysregulation Disorder with Dysphoria”: “Justification for Temper Dysregulation Disorder,” http://www.dsm5.org/Proposed%20Revision%20Attachments/Justification%20for%20Temper%20Dysregulation%20Disorder%20with%20Dysphoria.pdf.

  13. it announced a new “naming convention”: American Psychiatric Association, “APA Modifies DSM Naming Convention to Reflect Publication Changes,” news release, March 9, 2010.

  14. “distinctly unmedical”: Schatzberg, “Presidential Address,” 1163.

  15. “Some of the attacks”: Ibid.

  16. New Orleans had “risen as the Phoenix”: Ibid., 1162.

  17. “the negative attacks on industry”: Ibid., 1164.

  18. “There are a number of new drugs”: Ibid.

  Chapter 11

  1. “Turning bereavement into major depression”: Allen Frances, “Good Grief,” The New York Times, August 14, 2010.

  2. “Sure, there’s a reality out there”: Allen Frances interview, August 16, 2010.

  3. “The full truth”: Allen Frances e-mail, February 2, 2012.

  4. “Like most medical specialties”: Allen Frances interview, July 7, 2011.

  5. “stigmatization [and] inappropriate care”: Wakefield et al., “Extending the Bereavement Exclusion,” 433.

  6. “ignore the many other kinds”: Ibid., 434.

  7. “define every undesirable consequence”: Horwitz and Wakefield, The Loss of Sadness, 220–21.

  8. “Psychiatry has made immense strides”: Ibid., 225.

  9. “There are few signs”: Ibid., 212.

  10. “It just doesn’t make any sense to me whatsoever”: Sidney Zisook interview, September 10, 2010.

  11. Zisook did some data mining of his own: Zisook and Kendler, “Is Bereavement-Related Depression Different Than Non-Bereavement-Related Depression?”

  12. “provides some support”: Ibid., 791.

  13. “Because work toward the DSM-V”: Zisook et al., “Validity of the Bereavement Exclusion,” 102.

  14. “validity of the bereavement exclusion”: Ibid., 104.

  15. “Why should bereavement be singled out”: Ibid., 105.

  16. “Idiotic”: Jerome Wakefield e-mail, January 31, 2012.

  17. a study showing that GSK’s Wellbutrin: Zisook et al., “Buproprion Sustained Relief for Bereavement.”

  18. “The DSM-IV position is not logically defensible”: Kendler, “Grief Exclusion,” http://www.dsm5.org/about/Documents/grief%20exclusion_Kendler.pdf.

  19. “that sadness in response to loss”: Wakefield et al., “Extending the Bereavement Exclusion,” 439.

  Chapter 12

  1. “the best we can do”: See Allen Frances, “The Most Important Psychiatrist of Our Time,” Psychiatric Times, December 22, 2010.

  2. “Moving forward”: Regier, “Diagnostic Threshold Considerations for DSM-5,” 293.

  3. “the clinical judgment of a psychiatrist”: Ibid., 285.

  4. the National Comorbidity Survey: Kessler et al., “Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States.”

  5. “We had much greater confidence”: Ibid., 286.

  6. Regier’s team began to dig them out: Narrow et al., “Revised Prevalence Estimates of Mental Disorders in the United States.”

  7. “To put it mildly”: Regier, “Diagnostic Threshold Considerations,” 288.

  8. Wakefield and Spitzer pointed out: Wakefield and Spitzer, “Lowered Estimates—but of What?”

  9. “What is striking about this debate”: Regier, “Diagnostic Threshold Considerations,” 289.

  10. “to define the problem out of existence”: Kessler et al., “Mild Disorders Should Not Be Eliminated from the DSM-V,” 1.121.

  11. “In response to this scientific critique”: Regier, “Diagnostic Threshold Considerations,” 289.

  12. “I wasn’t aware that he had interpreted”: Ronald Kessler e-mail, February 9, 2012.

  13. “Certainly some of the loudest concerns”: Regier, “Diagnostic Threshold Considerations,” 290.

  14. Just look at the history of “progress”: Ibid.

  15. “It may be of interest”: Ibid., 292–93.

  16. “Since the broad definition”: Ibid., 293.

  17. “DSM-IV has a label for everyone you might want to treat”: Roger Peele interview, November 4, 2011.

  18. his $600,000-per-year salary: That is as of 2010, according to the APA’s tax return, available at http://www.guidestar.org/FinDocuments/2010/130/433/2010-130433740-077883c7-9.pdf.

  19. “The spirit of moderation”: Montesquieu, The Spirit of Laws, 49.

  20. “They [the dimensional measures] will continue to evolve”: Darrel Regier e-mail, September 29, 2010.

  Chapter 13

  1. more than eight thousand comments: Joan Arehart-Treichel, “DSM-5 Work Groups Assess Thousands of Comments,” Psychiatric News, August 20, 2010.

  2. “developed a strong sense of uniqueness an
d belonging”: Bernstein, “DSM-5: Year Ahead and Year in Review,” Psychiatric News, August 20, 2010.

  3. “I fought to get myself comfortable in high school”: Nomi Kaim interview, June 16, 2011.

  4. “It was a total add-on”: Fred Volkmar interview, March 1, 2012.

  5. The disorder was first described by an Austrian pediatrician: See Wing, “Asperger’s Syndrome: A Clinical Account,” and Lyons and Fitzgerald, “Asperger and Kanner, the Two Pioneers.”

  6. “an especially intimate relationship”: Wing, “Asperger’s Syndrome,” 117–18.

  7. “pervasive lack of responsiveness”: DSM-III, 89.

  8. “the syndromes are more alike than unalike”: Wing, “Asperger’s Syndrome,” 121.

  9. “the term is helpful”: Ibid., 124.

  10. Of the nearly one thousand subjects: Volkmar et al., “Field Trial for Autistic Disorder in DSM-IV.”

  11. “The Little Professor Syndrome”: Lawrence Osborne, “The Little Professor Syndrome,” The New York Times Magazine, June 18, 2000.

  12. “Some things made sense”: Michael Carley and CC interview, October 13, 2011.

  13. “I . . . have yet to stand successfully”: Carley, Asperger’s from the Inside Out, 4.

  14. “At GRASP we envision a world”: http://grasp.org/page/mission-statement.

  15. She ballparked it: Wing, “Asperger’s Syndrome,” 119–20.

  16. Eric Fombonne, an epidemiologist working in England, reviewed: Fombonne, “The Epidemiology of Autism: A Review.”

  17. “secular increase”: Ibid., 777.

  18. a rate of 34 per 10,000: Yeargin-Alsopp, “Prevalence of Autism in a U.S. Metropolitan Area,” 53.

  19. these results were “an underestimate”: Ibid., 81.

  20. As of 2002, the CDC reported: All CDC figures can be found in Autism and Developmental Disabilities Monitoring Network, “Prevalence of Autism Spectrum Disorders,” available at http://www.cdc.gov/ncbddd/autism/documents/ADDM-2012-Community-Report.pdf.

  21. “opening Pandora’s Box”: Wing, “Reflections on Opening Pandora’s Box.”

  22. a prevalence rate in a city in Korea: Kim et al., “Prevalence of Autism Spectrum Disorders,” 907.

  23. blitzed the media: “New Study Reveals Autism Prevalence in South Korea,” Autism Speaks, news release, May 9, 2011.

  24. “the need for improved and wider autism screening”: “Top Ten Autism Research Achievements of 2011,” Autism Speaks, news release, December 20, 2011, http://www.autismspeaks.org/about-us/press-releases/top-10-autism-research-achievements-2011.

  25. “a stigmatizing hereditary disorder”: Kim et al., “Prevalence of Autism,” 910.

  26. “Lower rates in 9- and 10-year-olds”: Yeargin-Alsopp, “Prevalence of Autism in a U.S. Metropolitan Area,” 53.

  27. “Diagnosis of ASDs”: Charman, “The Highs and Lows of Counting Autism,” 874.

  28. “canaries [who] sensed before anyone else”: Lethem, The Ecstasy of Influence, 73.

  29. “premature to add Asperger’s”: Michael First e-mail, March 20, 2012.

  30. “We probably were premature”: Allen Frances e-mail, February 20, 2012.

  31. “It involves a use of treatment resources”: Amy Harmon, “A Specialists’ Debate on Autism Has Many Worried Observers,” The New York Times, January 20. 2012.

  32. “The goal was not to change prevalence”: Catherine Lord interview, March 29, 2012.

  33. most important factor in determining which diagnosis: Lord et al., “A Multisite Study of the Clinical Diagnosis of Different Autism Spectrum Disorders,” 309–11.

  Chapter 14

  1. “People say, ‘What’s in a name?’”: Dilip Jeste, “State of Classification of Neurocognitive Disorders,” American Psychiatric Association annual meeting, May 17, 2011.

  2. “Attire is ‘aloha business/casual’”: http://web.archive.org/web/20110523195007/http://www.psych.org/annualmeeting.

  3. “invent[ing] out of thin air”: Thomas Widiger, “The DSM-5 Personality Disorder Dimensional Model,” American Psychiatric Association annual meeting, May 15, 2011.

  4. “I do sense a reactionary element”: David Shaffer, “State of the Science on Diagnostic Classification: Implications for DSM-5,” American Psychiatric Association annual meeting, May 17, 2011.

  5. “Allen and I have a big disagreement”: Michael First interview, March 2, 2012.

  6. First stuck to small ball: Michael First, “The Future of Psychiatric Nosology,” Association for the Advancement of Philosophy and Psychiatry annual meeting, May 15, 2011.

  7. Kupfer and Regier demonstrate: David J. Kupfer and Darrel A. Regier, “Diagnostic Assessment in DSM-5: Approaches and Examples,” American Psychiatric Association annual meeting, May 16, 2011.

  8. “That’s why we are doing a field test”: Darrel Regier interview, September 14, 2010.

  9. “two rigorous study designs”: American Psychiatric Association, “APA Announces Start of Field Trials for DSM-5,” press release, October 5, 2010.

  10. “I’m surprised”: Darrel Regier e-mail, October 6, 2010.

  11. “People’s expectations of what reliability should be”: Kraemer, “DSM-5 Field Trials,” American Psychiatric Association annual meeting, May 17, 2011.

  12. Spitzer “could have employed”: Kirk and Kutchins, The Selling of DSM, 61–62.

  13. “We’d better get smart about measuring”: Lawson Wulsin, “DSM-5 Research and Development,” American Psychiatric Association annual meeting, May 16, 2011.

  Chapter 15

  1. “You have to understand”: Allen Frances interview, July 9, 2011.

  2. “If it seems like this is coming”: Allen Frances interview, August 16, 2010.

  3. “My narcissism couldn’t survive the teenage insight”: Allen Frances e-mail, April 22, 2010.

  4. “over a period of at least 6 months” . . . “The fantasies, sexual urges”: DSM-IV, 528.

  5. “the symptom criteria alone”: First and Frances, “Issues for DSM-V,” 1240.

  6. “While we have been preoccupied”: Linda Bowles, “Kinder Gentler Pedophilia,” WorldNetDaily, http://www.wnd.com/1999/05/228/.

  7. “acknowledge the ‘APA’s clear opposition’”: Linda Bowles, “Pedophilia: Good News Bad News,” WorldNetDaily, http://www.wnd.com/1999/06/231/.

  8. if someone “has acted on these urges”: DSM-IV-TR, 572.

  9. “Fewer than half of child molesters”: Michael First e-mail, April 22, 2012.

  10. “too polemical”: Kutchins and Kirk, Making Us Crazy, 164–65.

  11. “a tendency to feel inordinately threatened”: Pantony and Caplan, “Delusional Dominating Personality Disorder,” 127–30.

  12. “I really wasn’t sure”: Kutchins and Kirk, Making Us Crazy, 171.

  13. “It is disruptive to constantly tinker”: Ibid., 172.

  14. Caplan did give Frances a shout-out: Paula Caplan, “DSM-5 Heads’ Comments Reveal Lack of Compassion and of Respect for Science,” When Johnny and Jane Come Marching Home (blog), http://whenjohnnyandjanecomemarching.weebly.com/1/post/2011/05/dsm-5-heads-new-comments-reveal-lack-of-compassion-and-of-respect-for-science.html.

  15. On the appointed day: This account is from Caplan, “Letter from DSM-5 Task Force Head Leaves Major Concerns Unanswered,” Science Isn’t Golden (blog), http://www.psychologytoday.com/blog/science-isnt-golden/201106/letter-dsm-5-task-force-head-leaves-major-concerns-unanswered-part-1. The public relations firm that arranged the conference call declined to comment.

  16. “the continued and continuous medicalisation”: British Psychological Society, “Response to the American Psychiatric Association: DSM-5 Development,” http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf.

  17. Regier made clear in his official response: See “Society’s
Critical Response to DSM-5,” The Psychologist News, July 13, 2011, http://www.thepsychologist.org.uk/blog/blogpost.cfm?threadid=2102&catid=48.

  18. “previous failures”: Melville, The Confidence-Man, 77.

  19. “stranger entering”: Ibid.

  20. “general resistance or indifference”: Blanchard et al., “Pedophilia, Hebephilia, and the DSM-V,” 336.

  21. “discriminable erotic age-preference”: Ibid., 335.

  22. “Your neighbors’ 7-year-old girl”: Blanchard et al., “IQ, Handedness, and Pedophilia in Adult Male Patients,” 292.

  23. “to minimize his embarrassment”: Blanchard et al., “Pedophilia, Hebephilia, and the DSM-V,” 339.

  24. “hebephilia exists”: Ibid., 347–48.

  Chapter 16

  1. “We are . . . test piloting”: APA Research e-mail, July 8, 2011.

  2. “The most common reason”: Now found at http://www.findthatpdf.com/search-80840213-hPDF/download-documents-ft-20note-20for-20web-20site.pdf.htm.

  3. “We have learned”: Eve Moscicki e-mail, September 9, 2011.

  4. “Thanks for your candid note”: Ibid.

  5. another note from Kupfer and Regier: APA Research e-mail, September 20, 2011.

  6. DSM-5 proposal for Generalized Anxiety Disorder: This once appeared at www.dsm5.org/ProposedRevisions1.2011/Pages/proposedrevision5478.html?rid=167.

  7. the old one: DSM-IV-TR, 476.

  8. “A Personality Disorder is an enduring pattern”: DSM-IV-TR, 685.

  9. “ensures that consideration will be given”: DSM-IV-TR, 28.

  10. “I think this is the best way”: Allen Frances e-mail, May 1, 2012.

  11. “I have never really been a doctor”: Gay, Freud, 681.

  12. “They have the lowest reliability”: Allen Frances e-mail, May 12, 2012. See Frances, “The DSM-III Personality Disorders Section: A Commentary.”

  13. The kappas were .56 to .65: Spitzer et al., “DSM-III Field Trials: I. Initial Interrater Diagnostic Reliability.”

  14. “the personality disorders are not at all clearly distinct”: Frances, “The DSM-III Personality Disorders Section,” 1050.

  15. “Rather than being diagnosed”: Ibid., 1051.