"1.5/5 stars

Ugg... Nope. Nope.

The premise intrigued me. Pathological: The True Story of Six Misdiagnoses is a memoir about a journalist who was diagnosed with six different mental illnesses (anorexia, ADHD, OCD, depression, anxiety, and bipolar disorder). She suspects that her conflicting diagnoses, the labels she's been given, and the high doses of drugs she's taking are making her feel worse, not better. She learns that diagnosing mental illness is more complicated than she thought, and the Diagnostic and Statistical Manual of Mental Disorders (DSM) is mostly to blame.

I learned about this book through Fay's (The essay also appears in this book.) Know that I have nothing bad to say about Fay as a writer. She's very talented. She is not, however, a mental health expert, and she doesn't appear to want to listen to anyone who is. If you were interested in this book, I invite you to read this essay (and the other three books I recommend at the end of this review) instead, if you haven't already.

There is some truth to the claim that the DSM sucks. It's legacy is rooted in racism, sexism, homophobia, all that bad stuff... Many professionals and neurodiversity advocates disagree with some of its recent changes, and their concerns should be taken seriously. I'm not a mental health professional, but I do understand why some people think it'd be best to scrap the DSM. Maybe developmental disabilities, neurological conditions, and psychological differences shouldn't all be lumped together in one book. Maybe "personality disorders" are outdated, useless labels. Maybe dissociative identity disorder should be considered a symptom of PTSD rather than an illness on its own. Maybe we should experiment with labeling some mentally ill people with symptoms rather than diagnoses. All valid perspectives.

There is some truth to the claim that some mental illnesses are misdiagnosed or over-diagnosed way too often. Misdiagnosis of bipolar disorder is especially dangerous, as the medications have a lot of nasty side effects.

There is A LOT of truth to the claim that doctors, especially psychiatrists, don't take thorough histories on their patients. The best parts of Pathological are Fay's anecdotes about visit after visit with doctors who ask the wrong questions and make quick assumptions. I don't believe that psychiatrists don't care about their patients or giving correct diagnoses. Doctors are overworked and overbooked. It's nearly impossible to tell whether your patient has OCD, anxiety, and/or depression when you only have 10-15 min to do a physical exam and take a history. Someone else, please write me a whole book about that.

The biggest problem with this is book is that it makes the unnecessary and irresponsible leap from: "Our mental health care system, including the system used to diagnose mental illness, is broken. We should fix it," to "All mental health diagnoses are stupid and I KNOW for sure that the DSM is useless."

Here's the thing... I'm a nurse by trade and a medical science nerd. I've found that the more you learn about medicine, the more complicated and frustrating the idea of a "diagnosis" becomes. There are some illnesses that you either definitely have or you definitely don't: influenza, for example. The virus is either in your cells or it's not. But if you're suffering from something other than an infection, it's harder to be 100% certain what you have.

I get a lot of headaches. Are they tension headaches or migraines? My doctor doesn't know yet. Turns out, a little more goes into diagnosing migraines than just fitting all the usual criteria. If you have any kind of complicated illness, your primary care doctor is going to want you to see a specialist. When you finally see that specialist, they may or not diagnose you correctly the first time. This is a big problem in mental health care but it's not only a problem in mental health care.

Fay states that there are no reliable tests for depression and other mental illnesses like there are tests for Parkinson's and cancer. Welp... what if I told you that we have no idea what causes Parkinson's and that there is not, in fact, one single test for Parkinson's? Also, that there is a lot of debate over whether certain "cancers" should even be called cancer. Yes, there is less of a biological basis for mental illnesses than some other illnesses. (Not all! Migraines, TMD, fibromyalgia, long-freaking-covid... no perfect, organic evidence for any of these! Doesn't mean they don't exist!). Diagnostic criteria are always changing in every medical field. Take the guidelines for hypertension as another example.

Also, speaking of hypertension. Can we please not argue that a diagnosis must be invalid if it's commonly given? Yes, more than 50% of Americans will be diagnosed with a mental illness in their lifetime. That's a lot. 47% of adults currently have hypertension. 42% are nearsighted. Common doesn't mean it's not a problem. And for heaven's sake, all illnesses should be de-stigmatized. I don't care if it's common or "natural" or "the cavemen had it and it helped them spear an elephant" (not a direct quote, just a vibe), or if you're the only one on the planet with your illness. If something's bothering you, you should be empowered to get treatment.

So, I'm not sure if the DSM should be scrapped or just improved. I would have liked to read a few different perspectives on this topic. I would also have liked to have read a few different perspectives on the usefulness of mental health labels. Maybe someone like Fay (or myself) who suffers from anxiety and depression on and off with some features of other illnesses would feel more comfortable with the broad label of "mentally ill" than anything in particular. However, someone with anorexia, autism, bipolar disorder, or schizophrenia may find that their label helps them more than it hurts them. (Btw, I'm not even going to get into the dangers of giving someone permission to deny that they have an eating disorder... but yikes .)

TLDR: Just another non-medical professional making a bold and dangerous statement about mental health care. Skip it. Read The Noonday Demon: An Atlas of Depression,My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind, and The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness instead. These books all explore the complexity of mental illness labels and treatments in much more responsible fashions."