Gary Greenberg explores the complexities behind the fragile concept of brain death:

“Our sense that a body is not dead until it is still and cold may be uninformed and unscientific, but so is our sense that the sun moves across the sky from east to west, and most of us live our lives as if this were the case. Of course, you can’t plan a rocket trip to the moon based on that understanding of heavenly movement, and you can’t harvest organs from a body based on our instinctual understanding of death. The concept of brain death has its uses; organ transplants save many lives. But it has its limits, too.”

Photograph by Zephyr/Getty.

I’m trying to read this book about the DSM because it’s important, but I keep being frustrated by this practicing therapist’s cluelessness about some things. (It’s Gary Greenberg’s The Book of Woe.)

For instance, he notes research that based on DSM criteria, 25-30% of Americans qualify for a mental illness, but only 19% of them seek treatment. He tries to argue that if so few of those people actually have it “bad enough” to get treatment, could they “really” all have mental illness? Um, dude, you do realize that there are MANY reasons someone might not seek treatment for a serious mental health issue, right? 

He also consistently assumes the worst of psychiatrists, such as his claim that the reason they continue to promote the mostly-discredited serotonin hypothesis of depression is to “persuade reluctant patients to take their drugs.” What could’ve been a great commentary on the temptation of reducing complex problems to simple causes or the fact that mental health professionals don’t always keep up with current research to begin with turned into a passive-aggressive attack on psychiatrists as predatory liars.

Finally, even though Greenberg acknowledges that, as a practicing therapist, he has HAD to assign his patients diagnoses ~just so that their insurance would cover them~, he lays the blame on the existence of the DSM, not on insurance companies which are fucking greedy and have always had to be forced by law to cover patients fairly at all (i.e. the parity laws for mental illness coverage, which took forever to push through congress). 

He then continues to say that he no longer works with insurance companies in his practice, which he acknowledges limits the number of people who can afford his services quite severely, but at least he doesn’t have to use that evil DSM. Well, sorry dude, those of us who want to work with the majority of people who cannot pay for therapy out of their pockets have no choice right now.

I mean, I’m reading this because I do think there’s a lot to criticize about the DSM, but like, I’m only a fourth of the way into the book and I already have this much criticism of it.