Terrific interview in The Atlantic with psychotherapist and author Gary Greenberg about issues surrounding the Diagnostic and Statistical Manual of Mental Disorders.
Psychiatry was in a crisis in the 1970s over questions like “what is a mental illness?” and “what mental illnesses exist?” One of the first things they did was try to finesse the problem that no mental illness met that definition of a disease. They had yet to identify what the pathogen was, what the disease process consisted of, and how to cure it. So they created a category called “disorder.” It’s a rhetorical device. It’s saying “it’s sort of like a disease,” but not calling it a disease because all the other doctors will jump down their throats asking, “where’s your blood test?” The reason there haven’t been any sensible findings tying genetics or any kind of molecular biology to DSM categories is not only that our instruments are crude, but also that the DSM categories aren’t real. It’s like using a map of the moon to find your way around Russia.
On the dangers of being so diagnosed:
A depression diagnosis gives people an identity formed around having a disease that we know doesn’t exist, and how that can divert resources from where they might be needed. Imagine how much less depression there would be if people weren’t worried about tuition, health care, and retirement. Those are all things that aren’t provided by Prozac.
On being a critic of psychiatry:
It’s the universal paranoia of psychiatry that everybody who disagrees with them is pathological. You can’t disagree with a psychiatrist without getting a diagnosis. I’ve been writing critically about psychiatry for ten years and I’ve always encountered that. Psychiatry is a defensive profession. They have a lot to protect and they know their weakness. To repel criticism in the strongest way possible, from their point of view, you diagnose the critic.
I also found it interesting to read how he distinguishes his critique from the critique of Dr. Allen Frances, former editor of the earlier version of the DSM who has launched a petition against it. But you have to read the whole interview to appreciate it.