Making Us Crazy: DSM, the Psychiatric Bible and the Creation of Mental Disorders.

• Author: Torrey, E. Fuller

By Herb Kutchins and Stuart A. Kirk The Free Press, $27.50

According to a recent news story, "road rage" is a psychiatric disorder that deserves to be recognized and added to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the sacred canon of the American Psychiatric Association. Dr. Arnold Nerenberg, a California (where else?) psychologist, claims that more than half of all Americans suffer from "road rage," which is clinically characterized by rude gestures, horn blowing, and generally aggressive behavior toward other drivers. Once "road rage" has been officially baptized, then pharmaceutical companies can market drugs to reduce its symptoms, sufferers will be eligible for special consideration by their employers under the Americans With Disabilities Act, and (most importantly) Dr. Nerenberg will be able to get reimbursed by insurance companies for doing psychotherapy with such individuals.

"Road rage" made the news too late to be included in Herb Kutchins and Stuart Kirk's Making Us Crazy, but the authors do facetiously propose including "Excess Motorized Speed Disorder" as a psychiatric disorder. But while Kutchins and Kirk's suggestion is all in good fun, the velocity with which equally absurd ideas are being transformed into serious proposals is a sad measure of the depths to which American mental health professionals have fallen. DSM, it is now clear, really stands for Dimwitted Sychiatric Muddle.

Making Us Crazy does a good job of stressing the lack of reliability of many psychiatric diagnoses and tracing the history of this intellectual haze. The chapter on homosexuality--including an account of how U.S. psychiatrists actually voted in 1974 on whether or not it was a disorder--is especially entertaining. Other chapters on post-traumatic stress disorder, self-defeating personality disorder, masochistic personality disorder, and borderline personality disorder contain useful historical anecdotes. On the other hand, a section on the history of racism in psychiatry is of questionable relevance to the book, and the book's style in general is rather pedantic.

Most disappointing, however, is the failure of the authors to deal with the consequences of DSM in more than fleeting fashion. DSM-IV, published in 1994, includes as mental disorders such behaviors as "disorder of written expression," "childhood conduct disorder," "pathological gambling," "adjustment disorder with anxiety," and "avoidant personality disorder." The...