The Argument against DSM-5: Gary Greenberg's Book of Woe

The Book of Woe - Gary Greenberg

Gary Greenberg is a psychotherapist who has written extensively on various aspects of psychology and therapy. His latest book, The Book of Woe: The DSM and the Unmaking of Psychiatry, is a scathing, hard-hitting book that denounces the Diagnostic and Statistical Manual, especially its new fifth edition.

The DSM-5 is the "bible of psychology" and is the resource most people in the industry turn to for formal diagnosis criteria and treatment suggestions. It is also the book that often determines whether or not insurance will pay for the treatment and whether or not the patient is eligible for disability and other claims due to mental illness.

Yet the DSM is not without controversy, and at the center of that argument today is Gary Greenberg, a psychotherapist with 30 years of experience and a long resume of written work on various mental health subjects in the field.

Identifying DSM fallacies

His book outlines the numerous fallacies he sees with not only the DSM itself, but the entire paradigm of "physical cause medicine" it endorses. He argues that not everything is a "chemical imbalance" and that there is little, if any, evidence that most psychiatric disorders involve any kind of biochemical problem.

He cites examples of psychiatry gone wrong under this thought process, including the long-held belief that homosexuality was a "sociopathic personality disorder" that could be "treated" and "cured" with various experimental ideas such as electric shocks, behavior modification and even surrogate sex therapies. Now, of course, the idea that homosexuality is a mental disorder is not only politically incorrect, but has largely been debunked and dismissed from the clinical process.

Other disorders – some new, some long-held – are also questioned by Greenberg and many of his colleagues in psychiatry and psychology. They examine the expansion of bipolar disorder criteria, the near-universal definition of attention-deficit hyperactivity disorder (ADHD) for children, and the rapid rise of pharmaceutical influence in the field of psychiatry.

Greenberg's language is often blunt and unfettered, using terms like "fiction" to describe subjects. Yet it resonates with some in the field who've cited his work and added points of their own to the arguments against the DSM.

When credit is due, Greenberg doesn't hesitate to give it. The DSM and its wide acceptance by insurance carriers, he says, were instrumental in bringing attention and resources to often-ignored and untreated problems like Asperger syndrome (now no longer recognized in DSM-5). But the book does more harm than good.

Examining inaccurate treatments

Much of The Book of Woe focuses on the "false epidemics" of over-diagnosis and over-treatment the DSM and many of its proponents have created over the years. In his view, the DSM's expanded criteria for bipolar disorder – a well-documented and heavily-researched disorder to begin with – created not only a huge new swatch of patients diagnosed with the disease, but also a large acceptance of mood stabilizers which often have dangerous side effects. In the U.S., six million people are diagnosed with bipolar disorder. The numbers are even higher, at 1 in 100, in the United Kingdom.

Bipolar disorder was expanded to include children in its possible population for diagnosis, putting kids as young as 6 years old on powerful antipsychotics. With side effects like obesity, diabetes and suicidal thoughts, these drugs are hardly appropriate for children, Greenberg contends.

The book is a scathing but important read for those following psychology and psychiatry. Whether or not you agree with the premises Greenberg proposes, his arguments are hard to ignore and demand some thought.


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