Free The Book of Woe: The DSM and the Unmaking of Psychiatry by Gary Greenberg Page A

nearly ninety minutes. He may not have been losing sleep over it, but the editors did their best to torment him with the discrepancy between the DSM’s authority and the actual science behind it.They “asked questions 11 such as ‘How do you diagnose mental illness?’ and ‘How do you tell if it’s real?’ and ‘Do you have a science base like the rest of medicine does?’” Mirin told the
Psychiatric News.
    Mirin was prepared for this inquisition. His press office had briefed him about the ways of reporters, and his staff had subjected him to a mock grilling. Nor did he have to face it alone. He’d brought with him an expert on diagnostic questions: Darrel Regier, whom he had recently hired to head up the APA’s research arm, the American Psychiatric Institute for Research and Education. Mirin had recruited Regier from the National Institute of Mental Health, where he had risen to the rank of vice admiral in the Public Health Service. Regier was attractive to Mirin in part because of his familiarity with the ways of government bureaucracies, but at least as important was the fact that Regier, an epidemiologist as well as a psychiatrist, had been measuring the levels of mental illness in the population since the earliest days of DSM-III.
    What Regier had seen didn’t inspire confidence. As the head of the NIMH’s Epidemiological Catchment Area (ECA) team, he had overseen a group of researchers who, starting in 1980, fanned out across five U.S. cities armed with a questionnaire keyed to the diagnostic criteria in DSM-III.They’d asked twenty thousand people 12 , selected to reflect the general population, about their worries and their sadness, about whether they heard voices, about how they slept and ate. They tabulated the results and, in 1984, began to release them in a series of journal articles.
    The ECA’s findings 13 were stunning. In any given year, more than 20 percent of Americans qualified for a DSM-III diagnosis. Nearly one-third of us—eighty million people, according to the 1990 census—would have a mental illness in our lifetimes.And the sick among us were really sick 14 . Sixty percent of those diagnosed with a mental illness had a
comorbid disorder
, meaning they qualified for at least two diagnoses. Ninety-one percent of people with schizophrenia had at least one other diagnosis, as did 75 percent of people with a depressive disorder. Fifteen percent had three or more diseases. More than half of the people with a drug-related diagnosis, such as Cannabis Abuse, also had a second (or third) diagnosis. Even more alarming,only 19 percent 15 of the afflicted had sought help for their troubles, a number that dropped to 13 percent in the cases where only one diagnosis was warranted. It seemed that America had an enormous but unacknowledged and untreated public health problem whose effects on productivity, on family life, and on the body politic were unfathomable.
    This potential fivefold increase in the size of the market for psychiatry wasn’t so much an embarrassment of riches as a plain embarrassment. Even accounting for the fact that epidemiological studies, in which researchers go out looking for trouble, almost always yield bigger numbers than studies that rely on numbers gleaned from doctors’ offices and hospitals, the results beggared imagination. They also cast doubt on the DSM. The questions at least had to be asked: Was the problem in the minds of the people or in the methods of the doctors? Did the DSM-III make it too easy to turn people’s everyday troubles into disease? Was the book that saved the profession going to lead it to another downfall?
    Two decades later, Regier thinks the answers are all too clear. I interviewed him in 2010, in his spacious office on a high floor of APA headquarters in Arlington, Virginia. At sixty-seven, he has a smooth, unlined face. His tie is tightly knotted, his shirt as crisp and neat as his office. He gives off a quiet confidence, the certainty of a