On May 22, the American Psychiatric Association will release the fifth Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. It classifies psychiatric diagnoses and the criteria required to meet them. Gary Greenberg, one of the book's biggest critics, claims these disorders aren't real -- they're invented. Author of Manufacturing Depression: The Secret History of a Modern Disease and contributor to The New Yorker, Mother Jones, The New York Times and other publications, Greenberg is a practicing psychotherapist. The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry is his exposé of the business behind the creation of the new manual.
Can you talk about how the first DSM, published in 1952, was conceived?
One of the reasons was to count people. The first collections of diagnoses were called the "statistical manual," not the "diagnostic and statistical manual." There were also parochial reasons. As the rest of medicine became oriented toward diagnosing illnesses by seeking their causes in biochemistry, in the late 19th, early 20th century, the claim to authority of any medical specialty hinged on its ability to diagnose suffering. To say "okay, your sore throat and fever are strep throat." But psychiatry was unable to do that and was in danger of being discredited. As early as 1886, prominent psychiatrists worried that they would be left behind, or written out of the medical kingdom. For reasons not entirely clear, the government turned to the American Medico-Psychological Association, (later the American Psychiatric Association, or APA), to tell them how many mentally ill people were out there. The APA used it as an opportunity to establish its credibility.