The Book of Woe: The DSM and the Unmaking of Psychiatry Read Online Free PDF

white coat be recognized? Or, to put it more simply, why should we trust them with all the authority they’ve been granted?
    •   •   •
    That’s a question that psychiatrist Allen Frances has been asking recently. Frances knows a great deal about power and psychiatry. Indeed,
The New York Times
once called him “perhaps the most powerful psychiatrist in America 35 .” That was in 1994, when Frances, who then headed the psychiatry department at Duke University School of Medicine, was chair of the DSM-IV task force, the APA committee responsible for that revision. He’s retired now, and not as powerful, but he’s a lot more famous, mostly because he has spent the last four years waging a scorched-earth campaign against his successors, largely on the grounds that they are abusing their power. He’s warned anyone who will listen that the DSM-5 will turn even more of our suffering into mental illness and, in turn, into grist for the pharmaceutical mill.
    Frances is seventy years old, a big, swarthy man with a prominent brow set off by a shock of white hair. I once heard a bartender tell him he looked like a cross between Cary Grant and Spencer Tracy. The bartender may have been flirting or fishing for a bigger tip, but he had one thing right: Frances, like those stars, exudes charm and authority in equal measure. He’s soft-spoken, his voice high and reedy, and his patter is compulsively self-effacing, but like certain dangerous animals, he’s unpredictable, and always ready to spring.
    I hadn’t known Frances for very long before he said something to me that he came to regret. It was just before dawn on a morning in August 2010. He’d finished his workout and cracked open his first Diet Coke of the day in the kitchen of the California home he shares with his psychiatrist wife, Donna Manning. The jihad Frances had launched against his former colleagues had made him appealing to magazines like
Wired
, which had sent me to get the skinny on this loyalist denouncing the new regime. Since I’d arrived the day before, he’d been giving it to me, volubly and forcefully; and now we returned to one of the recurring themes of yesterday’s conversation: the way the DSM seemed to grant psychiatrists dominion over the entire landscape of mental suffering, a perch from which they could proclaim as a mental disorder any aberration they could describe systematically. I asked him whether he thought a good definition of mental disorder would establish the bright boundary that would sort the sick from the unusual, and thus keep psychiatry in its proper place.
    “Here’s the problem 36 ,” Frances said. “There is no definition of a mental disorder.”
    I mentioned that that hadn’t stopped him from putting one into the DSM-IV, or the people who were then making the DSM-5 from fiddling with it.
    “And it’s bullshit,” he said. “I mean you can’t define it.”
    This was the comment that Frances would come to regret—or at least, when it appeared inthe lead of the
Wired
article 37 , to regret having said to me. He soon found himself explaining it—to other writers, to his mildly titillated grandchildren, to attorneys who used it to discredit his testimony as a forensic expert, and, worst of all from his point of view, to Scientologists and other opponents of psychiatry who used it to draft Frances into their cause. Frances never quite blamed me for having turned his words into aid and comfort to the enemy. But even so, he was pretty sore about it, especially, he said, because my use of his words might encourage mentally ill people to go off their medications. I had turned him into my Charlie McCarthy, he complained—not by putting words in his mouth, but by throwing my tone into his voice.
    I’m sure Frances would have used a different phrase if he’d thought about it. He didn’t intend to dismiss the diagnostic enterprise, let alone all of psychiatry, but rather to say only that it is impossible to find that