Libra, is “the megaton novel James Joyce would have written if he’d moved to Iowa City and lived to be a hundred.”

But Joyce is more likely to have written the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The DSM’s predecessor, four, has a thousand pages, and we may be sure that five will have many more than that. It’s a megaton psychotropic prescription machine. As Allen Frances, editor of earlier, more sane, DSMs, writes, “DSM-5 is suggesting many new and untested diagnoses and also markedly reduced thresholds for old ones.”

Frances offers an example:

‘Attenuated psychosis syndrome’ will have a ridiculously high false positive rate ( 80-90%), no effective treatment, would promote unnecessary exposure to harmful antipsychotics, and would cause needless worry and stigma. Since studies prove conclusively that the symptoms are so very rarely predictive of psychosis, why in the world would DSM-5 give someone the stigmatizing and absurdly misleading label ‘attenuated psychosis syndrome’ and open the door to inappropriate antipsychotic use? Recognizing all these risks, a large portion of schizophrenia and prodromal researchers are sensibly opposed to the inclusion of ‘attenuated psychosis syndrome’ in DSM-5. But unaccountably, the work group stubbornly clings to its proposal and, without the petition, there is a good chance it may sneak into DSM-5.

In great part, the DSM-5 is a work of the imagination. Like all ambitious novels, it exhibits enormous scope and imaginative energy. Told from the point of view of a detached omniscient narrator, it chronicles the plummeting of populations into pre-psychosis, and their ultimate rescue by “the number one revenue producer of all classes of drugs,” anti-psychotics. Its pages evoke a les misérables America, massively prodromal, holding out its butyrophenone-bowl on every street corner.

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6 Responses to “The Warren Commission Report, Don DeLillo wrote in his novel …”

  1. Bill R Says:

    “Diagnostic and Statistical Manual of Mental Disorders” as a Joyce novel is a very funny concept, UD. I wish I had the talent to actually write the parody.

    Here’s root cause of the problem. Psychiatry is a pseudo-science. Shrinks are quacks.

  2. David N. Elkins, PhD Says:

    Your literary prose is brilliant!!
    There is a petition website for mental health professionals that Allen Frances (whom you quote above) encourages all mental health professionals to sign. An “open letter” that critiques the Diagnostic and Statistical Manual that is now being written can also be found at the website raises exactly the concerns that you have noted above in your brilliant literary style. As a clinical psychologist and professor of psychology, I am gravely concerned above the problems in the DSM-5, as currently proposed.
    The URL for the open letter and website where mental health professionals can sign is: More than 4000 mental health professionals and many psychology organizations have signed.

  3. dmf Says:

    DNE, thanks for the petition link I’ll be heading there shortly, I had a pathology prof who foretold the coming of a DSM based purely on brain chemistry as if this was the 2nd coming of the Enlightenment, but of course every human function has some correlate in terms of brain function/chemistry and the DSM’s imposition/overlay of social norms is a political and not “scientific” defining of pathology.

  4. Margaret Soltan Says:

    David – First, thank you for your kind words! And thank you for the link to the petition.

  5. Robert T. Rubin, MD, PhD Says:

    A clever and trenchant post; thanks for it. I’ve had recent email exchanges with Allen Frances et al. about a separate petition website for psychiatrists, with a place to note if one is an Amer Psychiatric Assn member. I think the psychologists’ petition is important, but I have concern that if psychiatrists sign it, their participation as a separate mental health profession will not be apparent. Let’s hope that a separate petition for psychiatrists will be forthcoming.

  6. Margaret Soltan Says:

    Robert: Sounds like a good idea.

    Thanks for the kind words.


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