- Paperback: 304 pages
- Publisher: Free Press (September 18, 2003)
- Language: English
- ISBN-10: 9780743261203
- ISBN-13: 978-0743261203
- ASIN: 0743261208
- Product Dimensions: 6.1 x 1 x 9.2 inches
- Shipping Weight: 13.6 ounces (View shipping rates and policies)
- Average Customer Review: 10 customer reviews
- Amazon Best Sellers Rank: #1,461,301 in Books (See Top 100 in Books)
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Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders Paperback – September 18, 2003
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This is a very detailed social/political history of the DSM, in and out of committee meetings and individual correspondence, providing the evidence of the point made so well by others such as Kaplan: that the DSM is in fact a political document, evolving to suit conflicting political and financial interests. More than a story of good guys and bad guys, much of this history includes the sad moral of unintended consequences, as in the fight to get PTSD into the DSM.
I teach undergraduate psychology, and I applaud the authors' coherent explanations of technical issues such as reliablity and validity of assessment. My teaching experience informs me that this is a tedious exercise for most students, and, I assume, for the educated lay readership to whom Kutchins and Kirk appeal. But it is critical to the central theme of the story: the misuse of the aura of science to mask a fundamentally political process.
Are there victims and villains of this process? Of course, and they are the usual villains: a system of managed care, and a variety of bureaucracies and agencies pursuing government funding, grants and influence based on ultimately manipulated numbers. And the usual victims: the over-labelled, over-prescribed and stigmatized recipients of "care".
The story wanders through so many mazes that a reader may lose the thread: PTSD, homosexuality, female masochism, borderline personality disorder. Each story differs in who started the process of getting a diagnosis in or out of the DSM, the motivation for doing so, the outcome of the fight, and the specific consequences. Fortunately, the authors provide an excellent summary in the last chapter, and weave those threads back together.
More than once in reading this book, I found myself thinking that every political or social issue fight needs its policy wonks. Kutchins and Kirk may be our wonks.
They wrote in the Preface to this 1997 book, "It is precisely because issues of psychiatric diagnosis, commentary by psychiatrists on all manner of social issues, and the use of medical authority are so ubiquitous in our lives and because we are so vulnerable to the misuse of psychiatric diagnosis and authority that we wrote this book. There is a growing tendency in our society to medicalize problems that are not medical, to find psychopathology where there is only pathos, and to pretend to understand phenomena by merely giving them a label and a code number... in this book we question the legitimacy of this tendency and describe its risks. To pursue this goal, we take the reader into the world of the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM)... As the authoritative manual of the American Psychiatric Association (APA), DSM defines, classifies, and describes what the association says are mental illnesses." (Pg. x) They add, "In this book we examine critically how the APA creates categories of mental disorders.... we trace how the psychiatric profession struggles with various political constituencies to create categories of mental disorder and to garner support for their official acceptance." (Pg. 15-16)
They note, "The psychiatrists had to fight with the psychologists' association over professional turf. The dispute arose when Robert Spitzer... attempted to develop a general definition of mental disorder... When he presented his ideas ... he made the assertion that 'mental disorders are a subset of medical disorders.' This statement... attempted to establish that mental disorders are fully within the province of medicine, a notion that caused a storm of protest from the American Psychological Association... when DSM-III was released in 1980, the disputed passage had been dropped. What was learned, however, was that defining mental disorders is not only conceptually difficult but also politically controversial." (Pg. 30)
They say, "Most of these changes passed without controversy, until feminist psychotherapists confronted the APA about the proposed inclusion of three new psychiatric disorders, which they viewed as having serious negative consequences for women---Paraphilic Rapism, Premenstrual Dysphoric Disorder, and Masochistic Personality Disorder." (Pg. 47)
They record, "Spitzer ... was dissatisfied with the definition of mental disorder he had used to justify replacing the psychiatric diagnosis of homosexuality with Sexual Orientation Disorder in DSM-II... it finally appeared... as Ego-dystonic Homosexuality (EDH)... The adoption of EDH proves that not every change in DSM was the result of outside political pressure or new scientific evidence... There was some opposition to EDH... Gay activists decided against another public battle, one they feared they might lose... The wisdom of the gay activists' decision was confirmed in 1987, when Ego-dystonic Homosexuality was quietly eliminated from ... DSM-III-R." (Pg. 78) They observe, "Throughout the entire struggle over the inclusion or exclusion of homosexuality from DSM, the minor role played by scientific research has been striking... it was a political debate, not a scientific one." (Pg. 99)
This is an excellent, very informative book, that will be of great interest to a wide variety of readers interested in issues relating to psychiatry and psychology.