Dear Dr. Paris,

Get over it.

That instruction is one that no competent therapist would use to a client. But it's what Joel Paris seems to be saying to his patients with this book. I bought it because it claims to be a guide to the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition ("DSM-5") -- a thousand page tome full of minutia required to diagnose psychological conditions. The DSM-5 is so big and bulky that it genuinely requires a guide.

What it does not require is a book that should be titled I Hate the DSM-5, Make It Go Away! Wa! Wa! Wa! Wa!

This book is not a guide. It has a few summary comments about some of the conditions in the DSM-5. These are not reliable. For the one I know best, autism spectrum disorder, the overview basically boils down to, "There is nothing wrong with most of these people." Well, Dr. Paris, you can call it autism, or you can call it mass delusion, or you can call it FGHGHGitis for all I care, but the people who have it are still better off for being granted proper interventions. Introversion, contrary to Dr. Paris, is not autism, and autism is not introversion -- some autistics are very outgoing; they just make a lot of social mistakes.

Similarly ADHD. Dr. Paris thinks it is over-diagnosed -- but if someone can't concentrate, and ritalin makes it possible for that person to concentrate, isn't it better to give the poor person ritalin than say "Stop fooling around and concentrate"?

Much of what Dr. Paris is arguing is that this is all the result of Big Pharma wanting more diagnoses so it can sell more drugs. But there are no drugs for autism, and very possibly never will be, so why does Dr. Paris think that that category is being expanded? Because it's "fascinating." "Fascinating" to have to care for an adult who can never tie his shoes or use a bathroom? If data supports Dr. Paris's conclusions, it's good; otherwise, it's to be waved away. That's not science; it's politics.

Or take the procedures used by the work groups to try to reduce industry influence. Dr. Paris, who deplores industry influence, also deplores when "the rules were stretched in a way that reduced... industry influence" (p. 22; italics mine). So which way will you have it, Dr. Paris? Is reducing industry influence good or bad?

On p. xvi, we read that "clinicians... prefer to make diagnoses intuitively" rather than based on hard rules -- rules being what the DSM-5 supplies. This is very likely true. It is not, however, a reason to dislike the DSM-5. It is a reason to get a second opinion from a clinician who actually knows how to do a proper diagnosis.

It will perhaps strike some as ironic that every criticism Paris levels -- that the DSM criteria are not based in sound biology, that diagnoses overlap, that there is too much co-morbidity (that is, too many people who are diagnosed with multiple conditions), that industry influence is too great, that the process is too complicated -- is acknowledged by the editors of the DSM-5, and discussed at length (a good book for this purpose is Regier, Narrow, Kuhl, and Kupfer, editors, The Conceptual Evolution of DSM-5, which is at least twice the size of Paris's book and correspondingly detailed). Two of those editors headed the DSM-5 task force, and they know that the DSM still has problems. But their whole goal is to solve them.

They have not succeeded. They know they have not succeeded. Indeed, some of their proposals for improvement were slapped down. And, yes, in some places, the DSM-5 is worse than what came before. But most of it is better, and they're still working on it. At least the DSM editors have a program. Dr. Paris seems to have nothing except a desire to go back to 1979, before the DSM-III (which set the format of today's DSM-5) came out.

If you truly want a full-throated attack on the DSM-5, Dr. Paris has edited another book which is arguably better, Making the DSM-5: Concepts and Controversies. If you read my review of that volume, you'll find that I have the same complaints about it as I do about this book. But at least it doesn't pretend to teach you how to use the DSM-5. This book, from its title down, gives an utterly wrong impression of its purpose. Most clinicians, I think, will see through that. But I pity the patients of those who do not. ( )

Varous comments off users that this is extremely helpful. Samantha Roberts