The Book of Woe: The DSM and the Unmaking of Psychiatry - Couverture rigide

Greenberg, Gary

Couverture rigide

ISBN 10 : 0399158537 ISBN 13 : 9780399158537

Editeur : Blue Rider Press, 2013

Synopsis

The Book of Woe An expos of the psychiatric profession's bible from a leading psychotherapist that reveals the deeply flawed process by which mental disorders are invented and uninvented--and why increasing numbers of therapy patients are being declared mentally ill. Full description

A propos du livre

Extrait :

Chapter 1

Shortly after New Orleans physician Samuel Cartwright discovered a new disease in 1850, he realized that like all medical pioneers he faced a special burden. “In noticing a disease not heretofore classed among the long list of maladies that man is subject to,” he told a gathering of the Medical Association of Louisiana, “it was necessary to have a new term to express it.” Cartwright could have followed the example of many of his peers and named the malady for himself, but he decided instead to exercise the ancient Greek he’d learned while being educated in Philadelphia. He took two words—drapetes, meaning “runaway slave,” and the more familiar mania—and fashioned drapetomania, “the disease causing Negroes to run away.” The new disease, Cartwright reported in The New Orleans Medical and Surgical Journal, had one diagnostic symptom—“absconding from service”—and a few secondary ones, including a sulkiness and dissatisfaction that appeared just prior to the slaves’ flight. Through careful observations made when he practiced in Maryland, he developed a crude epidemiology and concluded that environmental factors could play a role in the onset of drapetomania.

Two classes of persons were apt to lose their Negroes: those who made themselves too familiar with them, treating them as equals; and on the other hand those who treated them cruelly, denied them the common necessaries of life, neglected to protect them, or frightened them by a blustering manner of approach.

But the most evenhanded treatment would not prevent all cases, and for those whose illness was “without cause,” Cartwright had a prescription: “whipping the devil out of them.”

Lest anyone doubt that drapetomania was a real disease—and, evidently, some Northern doctors did—Cartwright offered proof. First of all, he said, we know that Negroes are descended from the people of Canaan, a name that means “submissive knee-bender,” so it’s clear what God had in mind for the race. And in case a reader subscribed to the notion, taught in the “northern hornbooks in Medicine,” that “the Negro is only a lampblacked white man . . . requiring nothing but liberty and equality—social and political—to wash him white,” Cartwright called as witnesses the prominent European doctors who had “demonstrated, by dissection, so great a difference between the Negro and the white man as to induce the majority of naturalists to refer him to a different species.” Africans’ blood was darker, he said, and “the membranes, tendons, and aponeuroses, so brilliantly white in the Caucasian race, have a livid cloudiness in the African.” This historical and biological evidence, Cartwright concluded, proved that running away is neither willfulness nor the normal human striving for freedom, but illness plain and simple.

Drapetomania was never considered for the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s compendium of mental illnesses, but that may be only because there was no such book in 1850. (Indeed, the Association of Superintendents of American Institutions for the Insane, the organization that eventually became the APA, was only six years old at the time, and the word psychiatry had just come into use.) Certainly it met many of the criteria for inclusion. It was a condition that caused distress for a certain group of people. It had a known and predictable onset, course, and outcome.

Its diagnostic criteria could be listed in clear language that a doctor could use, for instance, to distinguish normal stubbornness from pathological dissatisfaction, or to determine whether a slave was running away because he was sick or just evil. Many people besides Cartwright had observed it. Its discovery was announced in a respected professional journal. Its definition was precise enough to allow other doctors to develop tests that distinguished normal (or, as the DSM puts it, expectable) from disordered dissatisfaction, and to conduct research that confirmed (or didn’t) that most runaway slaves had been sulky prior to absconding, or that slaves treated too familiarly or too cruelly were more likely to contract drapetomania, or that whipping prevented the disease from running its full course. Still other doctors might have recommended potions that would relieve its symptoms. As the years wore on, some doctors might have objected that the disease pathologized a normal response to atrocious conditions, while others might have fought bitterly and publicly over smaller issues: whether or not defiance also belonged on the list of criteria; whether to add Dr. Cartwright’s other discovery, dyaesthesia aethiopica, the malady causing slaves to “slight their work,” to the diagnostic manual; which gene predisposed slaves to drapetomania and dyaesthesia; where the thirst for freedom could be found in the brain; and, perhaps, whether or not these were real illnesses or only constructs useful to understanding what Dr. Cartwright called the “diseases and physical peculiarities of the Negro race.”

Dr. Cartwright’s disease, in short, and the promise it held out—that a widely observed form of suffering with significant impact on individuals and society could be brought under the light of science, named and identified, understood and controlled, and certain thorny moral questions about the nature of slavery sidestepped in the bargain—might have spawned an entire industry. A small one, perhaps, but one that would have no doubt been profitable to slave owners, to doctors, maybe even to slaves grateful for their emancipation from their unnatural lust for freedom—and, above all, to the corporation that owned the right to name and define our psychological troubles, and to sell the book to anyone with the money to buy it and the power to wield its names.

Even if you’re one of the many people who are suspicious of psychiatry and skeptical of its claims to have identified the varieties of our suffering and collected them in a single volume, you might be thinking that I’m not being entirely fair here, that even if the Civil War hadn’t come along ten years later and rendered Cartwright’s outrageous invention moot, doctors would have quickly consigned drapetomania to the dust-bin of medical history. You might point out that even at the time sensible people objected—Frederick Law Olmsted, for instance, whose Journeys and Explorations in the Cotton Kingdom includes a mordant account of “the learned Dr. Cartwright” and his diseases, and the unnamed doctor who satirized Cartwright in the Buffalo Medical Journal by suggesting that drapetomania occurs when “the nervous erythism of the human body is thrown into relations with the magnetic pole . . . thus directing [the slave’s] footsteps northward.” You might say that in introducing a book about the DSM with an anecdote about a diagnosis that is so obviously specious, and in implying that this is somehow emblematic of the diagnostic enterprise, I am taking a cheap shot.

And you may be right.

On the other hand, especially if you are a gay person, you might not be so quick to think that drapetomania is merely a low-hanging cherry that I’ve picked to flavor my tale. Because you might be old enough to remember back forty or fifty years, to a time when homosexuality was still listed in the DSM. Which meant that doctors could get paid to treat it, scientists could search for its causes and cures, employers could shun its victims, and families could urge them to seek help, even as gay people conducted their intimacies in furtive encounters, lived in fear and shame, lost jobs, forwent careers, and chained themselves to marriages they didn’t want. They underwent countless therapies—shocks to the brain and years on the couch, behavior modification and surrogate sex, porn sessions that switched from homo to hetero at the crucial moment—in desperate attempts to become who they could not be and to love whom they could not love, to get free of their own deepest desires, all in the name of getting well. And all this, at least in part, because a society’s revulsion had found expression in the official diagnostic manual of a medical profession, where it gained the imprimatur not of a church or a state, but of science. When doctors said homosexuality was a disease, that was not an opinion, let alone bigotry. It was a fact. When they wrote that fact down in the DSM, it was not a denunciation. It was a diagnosis.

Or maybe you’re among the 11 percent of the U.S. adult population whose daily regimen includes taking a dose or two of Lexapro or Paxil or some other antidepressant, and you’ve been doing that for years, ever since a doctor told you that you had Major Depressive Disorder (or maybe she just said you had clinical depression), meaning that your sulkiness and dissatisfaction were symptoms of a mental disorder, and that this was a chemical imbalance that those drugs would fix. And maybe they did, because at least for a little while you felt better; but then you got tired of feeling numb, of gaining weight, of not wanting sex and not being able to have an orgasm even if you did; and then you tried to get off the drugs only to find that your brain off drugs is an unruly thing, that your old difficulties returned or new ones arose when you stopped taking them. Which might mean, you told yourself, that you indeed have that disease, but every once in a while—when you read about the placebo effect, or you hear that this chemical imbalance does not, as far as doctors know, really exist, or when you look at the DSM and realize that there are more than seventy combinations of symptoms that can result in this one diagnosis and that any two people with the diagnosis may have only one symptom in common—you wonder whether what your doctor told you is true and whether you have now changed your brain chemistry, perhaps irreversibly, to cure a disease that doesn’t exist.

Or maybe you’re a parent of a child who drove you to despair with his tantrums and defiance, whom you took to doctor after doctor until finally you found the one who told you that he had Bipolar Disorder, but that this was really good news, because that disease could be cured with a daily dose of Depakote or Risperdal. And sure enough, your kid calmed down, but now he weighs twice what he should and there’s sugar in his urine and dark circles under his eyes, and you’re beginning to think—especially since you heard about how drug industry money influenced doctors to make that diagnosis and how pharmaceutical companies still haven’t fully tested these drugs on children and how doctors massaged those diagnostic criteria to fit your kid—that maybe your psychiatrist was wrong when he said that Bipolar Disorder is the same kind of disease as diabetes, a chemical problem that you leave untreated only if you are a bad parent.

Or maybe you’re like me—a mental health professional who has been faithfully filling out insurance forms for thirty years, jotting down those five-digit codes from the DSM that open the money taps, rendering diagnoses even though you are pretty sure you’re not treating medical conditions, and for just a moment you hesitate, contemplating the bad faith of pouring a lie into the foundation of a relationship whose main and perhaps only value is that it provides an opportunity to look someone in the eye and, without fear of judgment or the necessity to manipulate, speak the truth. And, having contemplated it, you tell yourself whatever story you have to and you sign the paper, and the best you can do is to curse the DSM in a kind of incantation against your own bad faith.

Or maybe you’ve never had truck with the mental health industry, but the other day you were talking with a friend and explaining to her that you had to wash your dishes before you could leave your house, and you found yourself saying, “I’m just so OCD, you know?” Or you’ve heard your friends do the same thing with their own or others’ quirks. “He’s pretty ADHD,” they might say. Or, “She’s clinically depressed.” Or, “Sorry, that’s just my PTSD.” And maybe you’ve been brought up short by the way the DSM’s lingo has infiltrated our self-understanding or wondered what it says about us that we describe the habits of our hearts in a pastiche of medical clichés.

If you are one of those people, which is to say if you have had occasion to take the DSM seriously (and even the book’s most ardent defenders will tell you this was your first mistake), then you may be sympathetic to my rhetorical move. You may understand that Dr. Cartwright did what he did because he could, because the power to give names to our pain is a mighty thing and easy to abuse. Cartwright seems to have intended to serve the interests of slave owners and white supremacists and their economic system by providing “another [of ] the ten thousand evidences of the fallacy of the dogma abolition is built on,” but surely the doctors who insisted that homosexuality was a disease were not all bigots or prudes. Nor are the doctors who today diagnose with Hoarding Disorder people who fill their homes with newspapers and empty pickle jars, but leave undiagnosed those who amass billions of dollars while other people starve, merely toadying to the wealthy. They don’t mean to turn the suffering inflicted by our own peculiar institutions, the depression and anxiety spawned by the displacements of late capitalism and postmodernity, into markets for a criminally avaricious pharmaceutical industry.

The prejudices and fallacies behind psychiatric diagnoses, and even the interests they serve, are as invisible to all of us, doctors and patients alike, as they were to Dr. Cartwright’s New Orleanian colleagues or to all those doctors who “treated” homosexuals. The desire to relieve suffering can pull a veil over our eyes. And sometimes it takes an incendiary example or two to rip that veil away. So I apologize for my cheap shot. I apologize to the epidemiologists and sociologists alarmed by ever-rising rates of mental illness and disability; and to the patients who have benefited from a diagnosis; and to the interested civilians who have the intuition that there is such a thing as mental illness, that it belongs under the purview of medicine and that as such it ought to be cataloged, whatever the difficulties; and to the doctors who can argue cogently that the advantages of doing so far outweigh the costs. I apologize to the reasonable folks who think, reasonably, that the DSM is the culmination of a lot of honest hard work by smart and well-intentioned people doing their best at an impossible task, and that it should be given the benefit of the doubt. I apologize to the people who acknowledge that even if the DSM is not the Bible it’s cracked up to be, it still, as the backbone of a medical specialty that has done yeoman service, deserves its authority over our inner lives.

But that doesn’t mean I’m sorry. By apologize, I mean what the ancient Greeks meant. I mean to explain. Because I think drapetomania is not a historical novelty or an anomaly or an accident. It is not the exceptional error that proves the rule that science is self-correcting and will ultimately punish arrogance and incompetence. The story of drapetomania is a cautionary tale, just as the ones about homosexuality and childhood Bip...

Revue de presse :

“[I]ndustrious and perfervid... Mr. Greenberg [argues] that the [DSM] and its authors, the American Psychiatric Association, wield their power arbitrarily and often unwisely, encouraging the diagnosis of too many bogus mental illnesses in patients (binge eating disorder, for example) and too much medication to treat them....Mr. Greenberg argues that psychiatry needs to become more humble, not more certain and aggressive....Greenberg is a fresher, funnier writer. He paces the psychiatric stage as if he were part George Carlin, part Gregory House.”
—Dwight Garner, The New York Times
 
“Greenberg’s documentation of the DSM-5 revision process is an essential read for practicing and in-training psychotherapists and psychiatrists and is an important contribution to the history of psychiatry.”
—Library Journal

“The rewriting of the bible of psychiatry shakes the field to its foundations in this savvy, searching exposé.  Deploying wised-up, droll reportage from the trenches of psychiatric policy-making and caustic profiles of the discipline’s luminaries, Greenberg subjects the practices of the mental health industry—his own included—to a withering critique. The result is a compelling insider’s challenge to psychiatry’s scientific pretensions—and a plea to return it to its humanistic roots.”—Publisher’s Weekly, starred review

“Greenberg is an entertaining guide through the treacheries and valuable instances of the DSM, interviewing members on both sides of the divide and keeping the proceedings conversational even when discussing the manual’s pretensions toward epistemic iteration. He also brings his own practice into [The Book of Woe], with examples of the DSM falling woefully short in capturing the complexity of personality. Bright, humorous and seriously thoroughgoing, Greenberg takes all the DSMs for a spin as revealing as the emperor’s new clothes.”—Kirkus Reviews

“[A] brilliant look at the making of DSM-5...entertaining, biting and essential...Greenberg builds a splendid and horrifying read....[he] shows us vividly that psychiatry’s biggest problem may be a stubborn reluctance to admit its immaturity.”
—David Dobbs, Nature.com

“Gary Greenberg is a thoughtful comedian and a cranky philosopher and a humble pest of a reporter, equal parts Woody Allen, Kierkegaard, and Columbo. The Book of Woe is a profound, and profoundly entertaining, riff on malady, power, and truth. This book is for those of us (i.e., all of us) who've ever wondered what it means, and what's at stake, when we try to distinguish the suffering of the ill from the suffering of the human.”
—Gideon Lewis-Kraus, author of A Sense of Direction

“This could be titled The Book of ... Whoa! An eye-popping look at the unnerving, often tawdry politics of psychiatry.”
—Gene Weingarten, two-time Pulitzer Prize winning author of The Fiddler in the Subway

“Bringing the full force of his wit, warmth, and tenacity to this accessible inside account of the latest revision of psychiatry’s diagnostic bible, Gary Greenberg has written a book to rival the importance of its subject. Keenly researched and vividly reported, The Book of Woe is frank, impassioned, on fire for the truth—and best of all, vigorously, beautifully alive to its story’s human stakes.”
—Michelle Orange, author of This Is Running for Your Life
 
“Gary Greenberg has become the Dante of our psychiatric age, and the DSM-5 is his Inferno. He guides us through the not-so-divine comedy that results when psychiatrists attempt to reduce our hopelessly complex inner worlds to an arbitrary taxonomy that provides a disorder for everybody. Greenberg leads us into depths that Dante never dreamed of. The Book of Woe is a mad chronicle of so-called madness.”
—Errol Morris, Academy Award–winning director, and author of A Wilderness of Error
 
 
“In this gripping, devastating account of psychiatric hubris, Gary Greenberg shows that the process of revising the DSM remains as haphazard and chaotic as ever. His meticulous research into the many failures of DSM-5 will spark concern, even alarm, but in doing so will rule out complacency. The Book of Woe deserves a very wide readership.”
—Christopher Lane, author of Shyness: How Normal Behavior Became a Sickness
“Gary Greenberg’s The Book of Woe is about the DSM in the way that Moby-Dick is about a whale—big-time, but only in part. An engaging history of a profession’s virtual bible, The Book of Woe is also a probing consideration of those psychic depths we cannot know and those social realities we pretend not to know, memorably rendered by a seasoned journalist who parses the complexities with a pickpocket’s eye and a mensch’s heart.  If I wanted a therapist, and especially if I wanted to clear my mind of cant, I’d make an appointment with Dr. Greenberg as soon as he could fit me in.”
—Garret Keizer, author of Privacy and The Unwanted Sound of Everything We Want
 
“The Book of Woe is a brilliant, ballsy excursion into the minefield of modern psychiatry. Greenberg has wit, energy, and a wonderfully skeptical mind. If you want to understand how we think of mental suffering today—and why, and to what effect—read this book.”
—Daniel Smith, author of Monkey Mind

“[Greenberg’s] fascinating history of the Diagnostic and Statistical Manual of Mental Disorders (the DSM)...show[s] just how muddled the boundaries of mental health truly are.”
—Chloë Schama, Smithsonian

“Greenberg argues persuasively that the current DSM encourages psychiatrists to reach beyond their competence....I’m impressed by Greenberg’s reporting, his subtlety of thought, his dedication to honesty, and his literacy....a very good book.”
—Benjamin Nugent, Slate.com

“The process of assembling [DSM-5] has been anything but smooth, as The Book of Woe relates....Greenberg argues—persuasively—that this fifth edition of the DSM arises not out of any new scientific understanding but from one of the periodic crises of psychiatry....invaluable.”
—Laura Miller, Salon.com

“In The Book of Woe, Greenberg takes the lay reader through a history of the DSM, which is really a history of psychiatry....[a] fascinating and well-researched account.”
—Suzanne Koven, The Boston Globe

“[E]ngaging, radical and generally delectable...Greenberg is a practicing psychotherapist who writes with the insight of a professional and the panache of a literary journalist....[a] brilliant take-down of the psychiatric profession...The Book of Woe offers a lucid and useful history.”
—Julia M. Klein, The Chicago Tribune

“This is a landmark book about a landmark book....Greenberg paints a picture so compelling and bleak that it could easily send the vulnerable reader into therapy....takes the reader deep inside the secretive world of the panels and personalities that have spent years arguing about which disorders and symptoms they would keep and which they would discard in the new DSM.”
—Robert Epstein, Scientific American
 

À propos de cette édition

• Éditeur: Blue Rider Press
• Date d'édition: 2013
• ISBN 10: 0399158537
• ISBN 13: 9780399158537
• Reliure: Relié
• Nombre de pages: 416