The Selling of DSM: The Rhetoric of Science in Psychiatry (Social Problems and Social Issues) 1st Edition
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Stuart A. Kirk
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Editorial Reviews
Review
“Kirk and Kutchins provide a detailed and thoroughly documented critique of the development process of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), and of the resulting product. The authors' contention that DSM-III does not provide a diagnostic/classification system of high scientific credibility is a recurrent theme, and problems of diagnostic unreliability, in particular, are emphasized. But, more than the product, it is the process through which DSM-III was developed that comes in for detailed description and commentary. The role of Robert Spitzer, head of the DSM-III Task Force, and the extent to which he alledgedly permitted political as well as scientific considerations to influence the DSM-III development are the book's dominant themes. Serious concerns by dynamically oriented psychiatrists are documented; and from outside psychiatry, the American Psychological Association objections to the medical model and to the definition of mental disorders as a subset of medical disorders are noted. Recommended for undergraduate and graduate psychology collections and for medical libraries.”
—P. G. Romine, Choice
“Like the Zuni, whose intricate classification system projected their clan-based social order onto the natural world, modern psychiatry uses its classification system to embed its professional authority in the very definition of mental I llness. The official psychiatric nosology, published in the American Psychiatric Association’s Diagnostic and Statistical Manual, 3d edition (DSM-III), is thus both an instrument of professional dominance and the focus of resistance on the part of dominated mental health workers. The Selling of DSM is one such act of resistance, but one that offers a penetrating analysis of the political and rhetorical strategies by which the DSM-III was instituted. . . . This book is a critique of the field of mental health services that will help workers in that area take a more critical and reflexive stance toward DSM-III, IV, and beyond. For those interested in the sociology of psychiatry or the professions, it offers a fascinating, but decidedly partial, case study.”
—Daniel Breslau, Contemporary Sociology
"The Selling of DSM is a well-documented expose of the pretense that psychiatric diagnoses are the names of genuine diseases and of the authentication of this fraud by an unholy alliance of the media, the government, and psychiatry. I recommend this book to anyone concerned about the catastrophic economic and moral consequences of psychiatrizing the human predicament."
—Thomas Szasz, M.D., State Universityof New York, Health Science Center, Syracuse
"The book is fascinating, hard hitting, and well documented....Kirk and Kutchins describe the interlocked scientific and political issues clearly, precisely, and thoroughly. They show, convincingly, that DSM does not provide the diagnostic reliability its backers claim... .Kirk and Kutchins' judgments and interpretations are harsh, but also genuine. Supporters of DSM will recognize the events, structures, and processes described...."
—John Mirowsky, Department of Sociology, University of Illinois at Urbana-Champaign
"These authors have offered the reader their courage and their scholarship in this important book. Their analysis of the icon of DSM is both incisive and balanced, and it should provide all mental health practitioners fuel for thought and public debate."
—Carol H. Meyer, School of Social Work, Columbia University
About the Author
Herb Kutchins is professor of social work at California State University, Sacramento. He earned his doctorate from the University of California at Berkeley. In addition to his articles about psychiatric diagnosis, he has written about the fiduciary relationship, advocacy, and other issues involving law and social reform. He is currently doing research on prescription of psychotropic medication by nonphysicians.
Stuart A. Kirk is distinguished professor emeritus of social welfare at the Luskin School of Public Affairs, University of California, Los Angeles.
Product details
- Publisher : Aldine de Gruyter; 1st edition (June 30, 1992)
- Language : English
- Paperback : 280 pages
- ISBN-10 : 0202304329
- ISBN-13 : 978-0202304328
- Lexile measure : 1400L
- Item Weight : 12.8 ounces
- Dimensions : 0.64 x 6 x 9 inches
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Best Sellers Rank:
#2,259,912 in Books (See Top 100 in Books)
- #2,583 in Medical Mental Illness
- #2,715 in Psychopathology
- #2,873 in Psychiatry (Books)
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It opens promisingly with a delightful quote from Lewis Carroll's Through the Looking Glass:
"What's the use of having names," the Gnat said, "if they won't answer to them?" "No use to them, said Alice, but it's useful to the people that name them, I suppose."
Throughout the book I found myself nodding, not only in agreement, but also because I kept falling asleep. The book is incredibly boring. It needn't have been that way. Many names that become familiar once you've been reading on this subject for a while march across its pages, such as Sabshin, Andreasen, and the Big Star of the DSM, Robert Spitzer. The book could have read like a psychiatric soap. I don't know whether to praise the authors for resisting the temptation or criticize them for failing to highlight the personal intrigues involved. Boring or not, rest assured that I read it from cover to cover, as I do not wish to join the ranks of reviewers who publish reviews of books they have not (completely) read.
Among the intrigues the authors do mention are the mutual hostilities between research psychiatrists and clinicians - the latter being the ones who actually deal with the people who will wind up with diagnoses. The authors bracket clinicians with the general public in regard to their ability to understand research psychiatrists' methods and jargon. They suggest that mystification is in fact a conscious aim of the research psychiatrists who are instrumental in creating the DSM. The DSM-III was also intended to hammer the final nail into the coffin of psychoanalysis, settling that long-running controversy within the American Psychiatric Association.
Most of this book deals with the revision of the DSM-II into the DSM-III even though the DSM-III-R was by this time already published, and the DSM-IV already planned and mentioned in the book. It was the DSM-III which launched the DSM into the position of authority it enjoys today. The key word employed by its proponents to justify and promote the DSM-III was reliability. That is what you achieve when different clinicians (the DSM carefully avoids the word "psychiatrist") independently from each other arrive at the same diagnosis for the same patient at the same time. Reliability is crucial to research, which was the stated aim of the DSM-III, though not at all how it is actually used. But reliability says nothing about validity. What's the point of attaining high reliability of invalid diagnoses? The point it is that it squelches criticism.
Reliability was found to be low due to the variation in clinical information gathered for specific patients, and the criteria used by individual clinicians. To tackle this, the DSM makers set out to do two things: limit the criteria at clinicians' disposal, and restrict the information employed to judge those criteria by creating standard questionnaires. This is of course working backwards. One might expect that a disease or disorder is first thoroughly investigated and only afterwards a method is devised for identifying it, not that the existence of the disorder is decided upon only after the criteria have been set. Furthermore, to achieve this aim, clinicians have to be discouraged from allowing the patient to lead the discussion or establishing a rapport with him.
Nonetheless, reliability remains an illusion, supported neither by the data provided by the DSM makers themselves nor by outside researchers. The research was marked by a low number of participants and various procedural techniques ensuring that only outcomes favorable to the aim would be reported. Kirk & Kutchins put it this way:
The developers of the DSM-III repeatedly asserted that careful, systematic field trials established the improved scientific reliability of DSM-III. However, important information about the methods and findings of the field trials was never reported. Some of the reports were inconsistent and unclear. The field trials themselves could more accurately be described as uncontrolled, nonrandom surveys in which several hundred self-selected and unsupervised pairs of clinicians throughout the country attempted to diagnose nonrandomly selected patients and, after some sharing of information, made "independent" assessments of these patients.
The triumphant mood around the reliability of the DSM-III was, according to Kirk & Kutchins, structured rhetorically much like a political campaign.
Politics, indeed, very much entered into the matter, as gay activists staged protests at APA conventions to have homosexuality removed from the DSM, and feminists demonstrated to prevent diagnoses specific and disparaging to women from being included. The authors fail to comment that gays and feminists seemed quite content to leave all the other diagnoses unquestioned.
So what has psychiatry gained from the revisions in the DSM, besides a false air of science and the accompanying respectability? It has gained regulation of the client flow (meaning that psychiatrists control who they take on); the power to attain certain services or protections for their clients; acquisition of fiscal resources (otherwise known as tax money) and reimbursement from insurance companies; rationalization of decision-making; and the fulfillment of a political agenda. That magic word reliability, which supposedly was what the DSM-III was all about, dropped out of the APA's vocabulary at the very next revision.
Copyright © MeTZelf
Too bad the United States are so science illiterate, they have not any idea in what dangerous and possible harm they live in. The American Psychiatric Association should be legally suite for malpractice. The time is ripe, if only the attorneys knew a little science to understand how dangerous this whole problem is. And how much the APA is not willing to give it up. There is money to be made, follow the money.



