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Most importantly, do you choose to refer to the DSM-IV (or earlier editions) to make definitive, scientific diagnoses?
Well, read this book to have your blinkers removed! The authors (a professor of social work and a professor of social care) argue persuasively that a large number of the identified behavioural disorders are defined because of political, social and economic reasons, sometimes with no scientific backing at all - sometimes even in direct contradiction to scientific evidence available.
This book however is no "anti-psychiatry" rant. Instead, the authors acknowledge the "reality" of mental illness, and the pain and suffering that it causes to many people and their families.
What they do object to is the increasing "medicalisation" of behaviours which never before have been considered "disorders" and which stigmatises the individual AND significantly alters peoples' rights in areas such as the courts and employment.
Don't unthinkingly refer to the DSM in the assumption that it is a valid, scientific resource...read this book and have your assumptions about mental disorders challenged.
This is a very detailed social/political history of the DSM, in and out of committee meetings and individual correspondence, providing the evidence of the point made so well by others such as Kaplan: that the DSM is in fact a political document, evolving to suit conflicting political and financial interests. More than a story of good guys and bad guys, much of this history includes the sad moral of unintended consequences, as in the fight to get PTSD into the DSM.
I teach undergraduate psychology, and I applaud the authors' coherent explanations of technical issues such as reliablity and validity of assessment. My teaching experience informs me that this is a tedious exercise for most students, and, I assume, for the educated lay readership to whom Kutchins and Kirk appeal. But it is critical to the central theme of the story: the misuse of the aura of science to mask a fundamentally political process.
Are there victims and villains of this process? Of course, and they are the usual villains: a system of managed care, and a variety of bureaucracies and agencies pursuing government funding, grants and influence based on ultimately manipulated numbers. And the usual victims: the over-labelled, over-prescribed and stigmatized recipients of "care".
The story wanders through so many mazes that a reader may lose the thread: PTSD, homosexuality, female masochism, borderline personality disorder. Each story differs in who started the process of getting a diagnosis in or out of the DSM, the motivation for doing so, the outcome of the fight, and the specific consequences. Fortunately, the authors provide an excellent summary in the last chapter, and weave those threads back together.
More than once in reading this book, I found myself thinking that every political or social issue fight needs its policy wonks. Kutchins and Kirk may be our wonks.
The book conveys facts in a neutral, understated tone, and from those facts develops reasonable beliefs. Which ideas did you disagree with? That the diagnostic categories lack reliability and validity? That DSM has been shaped more by special interests than by science? That the criteria for each diagnosis are purely arbitrary?
Read the book. You'll think twice about letting someone you care about be diagnosed.
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