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

by Gary Greenberg

  16. “committed dimensionalist”: Allen Frances e-mail, May 17, 2012.

  17. “I believe I was chosen”: Thomas Widiger e-mail, May 21, 2012.

  18. “under active investigation”: DSM-IV, 633–34.

  19. a paper, published just before DSM-IV: Frances, “Dimensional Diagnosis of Personality Disorders—Not Whether but When and Which.”

  20. “It might be more consistent”: First et al., “Personality Disorders and Relational Disorders,” 130.

  21. “uniform classification of general personality functioning”: Ibid., 131.

  22. “That is why I pushed”: Michael First e-mail, May 15, 2012.

  23. Regier, he said, had asked him: Thomas Widiger e-mail, May 21, 2012.

  24. According to Widiger’s distillation: See Widiger and Simonsen, “Alternative Dimensional Models of Personality Disorder.”

  25. “basic science research”: Ibid., 123.

  26. “The devil, of course”: Ibid., 126.

  27. “Nobody on the work group”: Thomas Widiger e-mail, May 21, 2012.

  28. “a sense of self-identity”: For the original proposal, see http://web.archive.org/web/20100323205756/http://www.dsm5.org/ProposedRevisions/Pages/PersonalityandPersonalityDisorders.aspx.

  29. insufficient “empirical evidence”: Skodol, “Personality Disorder Types Proposed for DSM-5,” 138.

  30. “We knew we couldn’t incorporate”: Andrew Skodol interview, May 24, 2012.

  31. “embarrassingly bad”: Thomas Widiger e-mail, September 23, 2010.

  32. “lost opportunity” that “negates years of progress”: Livesley, “Confusion and Incoherence in the Classification of Personality Disorder,” 307.

  33. “cumbersome hodgepodge”: Frances, “The DSM-5 Personality Disorders,” DSM-5 in Distress (blog), http://www.psychologytoday.com/blog/dsm5-in-distress/201004/the-dsm5-personality-disorders-great-intentions-unusable-result.

  34. “an unwieldy conglomeration”: Shedler et al., “Personality Disorders in DSM-5,” 1027.

  Chapter 17

  1. “There has been a continual struggle”: Helena Hansen, e-mail, September 27, 2011.

  2. “This is amazing!”: Helena Hansen e-mail, September 28, 2011.

  3. “Approaching endgame”: Allen Frances e-mail, November 14, 2011.

  4. “A random and geographically diverse”: Allen Frances e-mail, October 31, 2011.

  5. “pretty Spockean”: Allen Frances e-mail, September 21, 2010.

  6. an open letter to the APA: Available at http://www.ipetitions.com/petition/dsm5/.

  7. a letter on behalf of his 115,000: Available at http://www.counseling.org/Resources/pdfs/ACA_DSM-5_letter_11-11.pdf.

  8. “bring Darrel to see DSM-5”: Allen Frances e-mail, August 28, 2010.

  9. “trying to negotiate”: Allen Frances e-mail, November 15, 2011.

  10. “Cast of fascinating and colorful characters”: Ibid.

  11. “This will likely be the most important”: Allen Frances e-mail, October 25, 2011.

  12. “Don’t waste your best brains”: Ibid.

  13. “I was in Dubuque”: Allen Frances e-mail, November 4, 2011.

  14. “your brilliant opening”: Allen Frances e-mail, October 16, 2011.

  15. “Paula Caplan in drag”: Allen Frances e-mail, January 5, 2012.

  16. “one-time pillar of the psychiatric establishment”: Rob Waters, “Therapists Revolt Against Psychiatry’s Bible,” http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/.

  17. “Fate has an ironic sense of humor”: Allen Frances e-mail, July 14, 2011.

  18. “Everything I say”: Allen Frances e-mail, October 16, 2011.

  19. “Where you see intelligent conspiracy”: Allen Frances e-mail, September 18, 2011.

  20. “Dereification is just as dumb”: Allen Frances e-mail, January 15, 2012.

  21. “I like to think the best of you”: Allen Frances e-mail, January 5, 2012.

  22. “What’s the ending mean?”: Allen Frances telephone interview, November 23, 2011.

  23. I received this message: Eve Herold e-mail, November 7, 2011.

  24. “We realize how challenging it is”: Lisa Countis e-mail, November 7, 2011.

  25. “This behavior pattern”: DSM-I, 35.

  26. “The journey into the future”: The newsletter is available at http://api.ning.com/files/AbciMXSvxet4NaqPJajU41T2kvOhgvc3JLSZdblrTDlfSyH4b2tKRiorseSDWZFCrifi7jgzHZyn7S5TvwzCpddFjQN—kLt/DSM5.fieldtrials.pdf.

  27. the treasurer delivered grim news: http://www.ncpsychiatry.org/APA/APA%20Assembly%20ReportNov2011.pdf.

  28. running a blog called Dsm5watch: It can now be found at dxrevisionwatch.com.

  29. “It has come to our attention”: Cecilia Stoute e-mail to Suzy Chapman, December 22, 2011.

  30. “I thought it was a hoax”: Suzy Chapman e-mail, June 11, 2012.

  31. “I could not finance a legal wrangle”: Suzy Chapman e-mail, February 27, 2012.

  Chapter 18

  1. “The idea of medicalizing normality”: Elizabeth Lopatto, “Psychiatric Group Push to Redefine Mental Illness Sparks Revolt,” Bloomberg Businessweek, January 27, 2012.

  2. “I wasn’t exactly hiding it”: Fred Volkmar e-mail, June 26, 2012.

  3. “It was one thing to make a change”: Michael Carley e-mail, June 28, 2012.

  4. “damage control”: http://grasp.org/profiles/blogs/very-important-dsm-5-update.

  5. “We have to make sure”: Amy Harmon, “A Specialists’ Debate on Autism Has Many Worried Observers,” The New York Times, January 20, 2012.

  6. “There has never been an agenda”: Debra Brauser, “Concern over Changes to Autism Criteria Unfounded,” Medscape Medical News, January 25, 2012.

  7. “10,000 plus e-mails”: This exchange, not reported in the press, is available at http://grasp.org/profiles/blogs/dsm-5-update-a-poor-poor-descent-into-pettiness.

  8. a Carey-penned DSM piece: Benedict Carey, “Grief Could Join List of Disorders,” The New York Times, January 24, 2012.

  9. a World Psychiatry article by Jerry Wakefield and Michael First: Wakefield and First, “Validity of the Bereavement Exclusion to Major Depression: Does the Empirical Evidence Support the Proposal to Eliminate the Exclusion in DSM-5?”

  10. “set out realistic expectations”: Kraemer et al., “DSM-5: How Reliable Is Reliable Enough?,” 13.

  11. a pair of op-ed columns: Paul Steinberg, “Asperger’s History of Overdiagnosis,” and Benjamin Nugent, “I Had Asperger Syndrome, Briefly,” The New York Times, January 31, 2012.

  12. “The proposals in DSM-5”: See “Psychologists Fear US Manual Will Widen Mental Illness Diagnosis,” The Guardian, February 9, 2012.

  13. The Lancet . . . in a single issue, a report: See http://www.thelancet.com/journals/lancet/issue/vol379no9816/PIIS0140-6736%2812%29X6007-0.

  14. “I still feel sadness”: Kleinman, “Culture, Bereavement, and Psychiatry,” 608.

  15. “even if,” as the Illinois version put it: Public Act 097-0972 available at http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=097-0972.

  16. “the door is still very much open”: John Gever, “DSM-5 Critics Pump Up the Volume,” MedPage Today, February 29, 2012.

  17. “You’ve got to feel sorry”: Gary Greenberg, “Not Diseases, but Categories of Suffering,” The New York Times, January 29, 2012.

  18. “Wonderful news”: “Wonderful News: DSM 5 Finally Begins Its Belated and Necessary Retreat,” Psychology Today (blog), May 2, 2012. http://www.psychologytoday.com/blog/dsm5-in-distress/201205/wonderful-news-dsm-5-finally-begins-its-belated-and-necessary-retreat.

  19. “stain on psychiatry” . . . “Cassandra”: Allen Frances e-mail, April 29, 2012.

  20. “We encourage the wide dissemination”: Roger Peele provid
ed the memo via e-mail, April 29, 2012.

  21. “What possible copyright excuse”: Allen Frances e-mail, April 23, 2012.

  22. “It is just too nutty” . . . “I used to compare”: Allen Frances e-mail, April 30, 2012.

  Chapter 19

  1. a DSM-5-related 60 percent increase: Mewton et al., “An Evaluation of the Proposed DSM-5 Alcohol Use Disorder Criteria Using Australian National Data,” 947.

  2. “I wanted to avoid a repeat of Axis V”: Roger Peele interview, August 2, 2012.

  3. “Conceptual questions are not minor ‘side issues’”: Kendler et al., “Issues for DSM-V,” 175.

  4. “Yes,” he said, “but I do like a challenge”: Michael First e-mail, May 12, 2012.

  5. “I felt if I just addressed”: Swedo, “Making National Headlines,” American Psychiatric Association annual meeting, May 6, 2012.

  6. “Newsflash from APA Meeting”: See http://www.huffingtonpost.com/allen-frances/dsm-5-reliability-tests_b_1490857.html.

  7. “The controversy stirred by my critique”: Allen Frances e-mail, June 29, 2012.

  Chapter 20

  1. “Melancholia,” they wrote: Parker et al., “Issues for DSM-5: Whither Melancholia?,” 745.

  2. “distinct, identifiable, and specifically treatable”: Ibid., 747.

  3. “I believe the inclusion of a biological measure”: William Coryell e-mail to Max Fink, October 16, 2008.

  4. “I [am] flabbergasted”: Max Fink e-mail to William Coryell, April 9, 2010.

  5. “I believe you and your colleagues”: William Coryell e-mail to Max Fink, April 12, 2010.

  6. “The APA owns all products”: http://www.dsm5.org/Pages/PermissionsPolicy.aspx.

  7. “arrogance, secretiveness” . . . “is no longer capable”: Allen Frances, “Diagnosing the DSM,” The New York Times, May 11, 2012.

  8. “Our resources are more likely”: Thomas Insel e-mail, October 13, 2010.

  9. What Insel heard “over and over again”: Thomas Insel and Bruce Cuthbert interview, December 12, 2011.

  10. “So many of our disorders”: Ibid.

  11. “We call this attention deficit/hyperactivity disorder”: Thomas Insel, “Rethinking Mental Illness,” American Psychiatric Association annual meeting, May 14, 2011.

  12. “Why do you hate psychiatrists”: Allen Frances e-mail, October 20, 2012.

  13. “DSM-IV-TR attempts to describe”: Sadock and Sadock, Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry, 33.

  14. “difficulty of distinguishing a manic episode”: Ibid., 218.

  15. “depressive symptoms are present”: Ibid.

  16. “every sign or symptom seen in schizophrenia”: Ibid., 167.

  17. “Once a diagnosis has been established”: Ibid., 222.

  18. “no one drug is predictably effective”: Ibid., 224.

  19. “Often,” advise Sadock and Sadock, “it is necessary”: Ibid.

  20. “the objective of pharmacologic treatment”: Ibid.

  21. “Not everyone needs to see”: Allen Frances e-mail, October 20, 2012.

  22. “Whatever we’ve been doing for five decades”: Thomas Insel and Bruce Cuthbert interview, December 12, 2011.

  23. Seventy-two percent: Mojtabai and Olfson, “Proportion of Antidepressants Prescribed Without a Psychiatric Diagnosis Is Growing,” 1436.

  24. “abnormal sensations” and “nonspecific pain”: Ibid., 1437.

  25. “The future belongs to illness”: Sedgwick, “Illness—Mental and Otherwise,” 37.

  Afterword

  1. an occasion to release some details: “American Psychiatric Association Board of Trustees Approves DSM-5,” news release, December 1, 2012.

  2. “We do ask that you focus”: This e-mail was provided to me by Roger Peele.

  3. one article—in The Washington Post: Peter Whoriskey, “Antidepressants to Treat Grief? Psychiatry Panelists with Ties to Drug Industry Say Yes,” The Washington Post, December 26, 2012.

  4. “DSM-5 includes material”: Statement of David Kupfer, http://www.psychnews.org/files/Response_to_Wash_Post.pdf.

  5. Dilip Jeste, the APA president, told Congress: Letter from Dilip Jeste to Harry Reid, John Boehner, Mitchell McConnell, and Nancy Pelosi, http://www.psychiatry.org/advocacy—newsroom/advocacy/apa-sends-letter-to-congress-regarding-recent-shooting-in-newtownct.

  6. Not only was LaPierre’s language “offensive”: “American Psychiatric Association Responds to NRA Comments,” news release, December 23, 2012, http://www.psychiatry.org/File%20Library/Advocacy%20and%20Newsroom/Press%20Releases/2012%20Releases/12-45-APA-Response-to-NRA-Comments.pdf.

  7. “The saddest day”: Allen Frances, “DSM 5 Is Guide Not Bible—Ignore Its Ten Worst Changes,” DSM-5 in Distress (blog), http://www.psychologytoday.com/blog/dsm5-in-distress/201212/dsm-5-is-guide-not-bible-ignore-its-ten-worst-changes.

  8. “one last act”: Allen Frances, “One Last Chance for the APA to Make the DSM-5 Safer,” The Huffington Post (blog), http://www.huffingtonpost.com/allen-frances/one-last-chance-for-the-apa-to-make-the-dsm-5-safer_b_2294868.html.

  9. “Any new boycott must unify the diverse opposition”: Allen Frances, “DSM 5 Boycotts and Petitions: Too Many, Too Sectarian,” Saving Normal: Mental Health and What Is Normal (blog), February 8, 2013, http://www.psychologytoday.com/blog/saving-normal/201302/dsm-5-boycotts-and-petitions.

  10. “I can confirm”: Michael First e-mail, November 27, 2012.

  11. “The good news”: Michael First e-mail January 7, 2013.

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