From Canadian Book ReviewAnnual cbraonline.com/member/search/index.php?action=details&page=0&sort_col=TITLE&sort_dir=ASC&book_id=13481
There is a kind of free-floatingconsensus in our society that those members of the mental-health elite who determinewho is psychologically abnormal are guided by a combination of empiricalevidence and concern for the well-being of the patient. Paula Caplan, aclinical/research psychologist and former consultant to the creators of theinfluential American Psychiatric Association's (APA) Diagnostic and StatisticalManual of Mental Disorders (DSM), examines in this well-documented, closelyargued, and deeply disturbing book "the shockingly unscientific basis ofthe DSM, the politics and arbitrariness involved in deciding who is normal, andthe motives of the major players." Specifically, the book focuses on theopposition of Caplan and others to the proposed addition to the DSM-IV ofSelf-Defeating Personality Disorder (SDPD) (whereby female victims of abuse arepathologized for responding to abuse in self-denying, self-effacing ways--waysthat are, in fact, socially prescribed) and to the retention of Premenstrual
Dysphoric Disorder (PMDD), also known as Premenstrual Syndrome (PMS).
In painstaking detail, Caplan and others conveyed to APA officials the scientificinvalidity of these categories as well as their harmful consequences, only tobe met with evasiveness, outright dishonesty, and megadoses of obfuscation anddoublethink. Ultimately, adverse publicity forced the withdrawal of SDPD fromthe DSM-IV; PMDD, however, was not only retained but upgraded in status. Notsurprisingly, the largely conservative white male APA elite rejected Caplan'sproposed inclusion of Delusional Dominating Personality Disorder (DDPD), alsoknown as "Macho Personality Disorder," even though empirical supportfor it far exceeds that for PMDD. The baffling, perverse decision-making demonstratedby the APA begins to make ugly sense as Caplan explores the ties that bind bigbusiness and organized psychiatry: in particular, the unholy alliance betweendrug companies and the APA.
Besides exposing the shifting sands upon which the DSM rests, this book emphasizesthe cultural biases that underscore conceptions of "normality," aswell as the societal problems that are glossed over by convenient, quick-fixpathologizing labels. The powerful vested interests Caplan describes do not pointto an imminent reform of the status quo, but her level-headed, compassionate,and wholly persuasive wake-up call is an admirable start.
Review by Sarah Robertson, anassociate editor of the Canadian BookReview
Annual.
