The DSM 5 controversy: readings and related criticisms of the mental health profession

The two biggest critics of the DSM 5 are Allen Frances, former lead psychiatrist for the DSM-IV, and Gary Greenberg, psychotherapist and author of The Book of Woe: the DSM and the Unmaking of Psychiatry. Frances wants to save the psychiatric profession from the particular problems of the DSM 5; Greenberg is skeptical of the scientific validity of the entire profession.

I’ve learned from some folks in the industry that insurance companies are about to move over to the ICD-10. But others mental health professionals I know think the DSM-5 problems were merely the worst and most obvious, and that corruption and bad practices are endemic.

Here’s some further reading on the controversy, and some related issues from critics and questioners of the mental health industry

Allen Frances

Allen Frances has been writing furiously in criticism of the DSM 5 since he resigned from the DSM task force. His view is that the DSM 5 is a particular problem, but that something like it is absolutely vital to psychiatry as a profession and as a long-term research project.

DSM 5 Is Guide Not Bible—Ignore Its Ten Worst Changes summarizes Frances’ criticisms, including the expansion of “Major Depressive Disorder” to include normal grieving for the death of a loved one, diagnosing excessive eating 12 times in 3 months as a new “Binge Eating Disorder,” and creating a new set of loosely defined “Behavioral Addictions”.

He also thinks that Attention Deficit Disorder Is Over-Diagnosed and Over-Treated – he ties the tripling of ADD diagnosis rates to the deregulation of the FDA, and increased legality of pharmaceutical advertising.

He sums up his views in this NY Times op-ed: “D.S.M.-5 promises to be a disaster — even after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription…. Many critics assume unfairly that D.S.M.-5 is shilling for drug companies. This is not true. The mistakes are rather the result of an intellectual conflict of interest; experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabeled as mental disorders. Arrogance, secretiveness, passive governance and administrative disorganization have also played a role…”

Gary Greenberg

Gary Greenberg’s opus, The Book of Woe, is generally considered the most intimate and carefully researched criticism of the DSM-5. It’s a terrifying, meticulous hit-job, based on two years of interviews and research, that paints a portrait of the DSM-5 team as a desperate, scientifically shoddy, financially corrupted grab for authority and money. He’s more skeptical of scientific validity of the entire profession.

Inside the Battle to Define Mental Illness | WIRED is the 2010 article that would eventually become The Book of Woe

Some reviews: Gary Greenberg ‘The Book of Woe’ Reviewed by Martha … is particularly good. Book of Woe: The DSM and the Unmaking of Psychiatry by … gives a breezy overview of the whole scene. “The Book of Woe”: Psychiatry’s last stand takes a more scandals-and-payoffs overview of the whole scene.

More on the DSM 5

Lisa Cosgrove summarizes her team’s findings about conflict of interest in the DSM-5 task force, published in the New England Journal of Medicine: 70% of the task force has financial ties to the pharmaceutical industry, up from 20% in the DSM-IV. And: the DSM has entirely inadequate reporting of known side-effects from pharmaceuticals, even life-threatening ones.

Ian Hacking is one of the sharpest philosophers of science. Though frequently skeptical of arguments that scientific concepts are socially constructed, he’s also a critic of the DSM 5. Lost in the Forest is his review of the DSM 5. But it grows out of Kinds of People – his very subtle treatment of how classifying people changes the people classified.

Other interesting material

Marcia Angell has an extraordinary set of reviews overviewing some of the recent literature critical of the psychiatric and pharmaceutical industry.

There’s a lot of really interesting research about the effects of labeling somebody as mentally ill, or as having a chemical imbalance:

The role of biological and genetic casual beliefs in the stigmatization of ‘mental patients’ is a fascinating study that shows that ascribing biological causes, rather than psychological causes, to a patient’s mental illness creates, in others, decreased blame for the patient, but increases the others’ beliefs that the patient is unpredictable, dangerous, antisocial, and decreases the willingness to become romantically involved with the patient.

The Rosenhan Study, from 1973, is a terrifying study, in which non-psychiatric psuedopatients were inserted into mental institutions. They made a single statement of abnormal mental behavior at admission, and then reverted to normal behavior. The institutions were unable to detect any change in their behavior, and continued to believe the patients to be schizophrenic. The psuedopatients report the experience as alienating and dehumanizing. Rosenhan writes: “A psychiatric label has a life and an influence of its own. Once the impression has been formed that the patient is schizophrenic, the expectation is that he will continue to be schizophrenic… Such labels, conferred by mental health professionals, are as influential on the patient as they are on his relatives and friends, and it should not surprise anyone that the diagnosis acts on all of them as a self-fulfilling prophecy.”

Ray Moynihan is an academic and journalist who specializes in medical overdiagnosis.

Special thanks to Elle Hipol for helping me assemble much of this material.

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