email page print pageAll Topic Reviews
Health Care in America The Happiness of Burnout"Guns Don't Kill People, People Kill People""How Come Boys Get to Keep Their Noses?"17 Lies That Are Holding You Back20 Jazz Funk Greats50 Popular Beliefs That People Think Are TrueA Brief History of the SmileA Child of One's OwnA Citizen Legislature/A People's ParliamentA Clinician's Guide to Legal Issues in PsychotherapyA Colorful History of Popular DelusionsA Cultural History of Modern Science in ChinaA Cursing Brain?A History of Intelligence and "Intellectual Disability"A History of MarriageA History of PsychiatryA Little F'd UpA Loving Approach to Dementia CareA Man's Guide to Healthy AgingA Mind ApartA Mind So RareA Natural History of RapeA Natural History of VisionA Red Heart of MemoriesA Short History of MedicineA Student's Guide to the History And Philosophy of Yoga A Tear is an Intellectual ThingA Therapist's Guide to Understanding Common Medical ProblemsA Universe of ConsciousnessA User's Guide to the BrainA World Full of GodsABC of Eating DisordersABCs to Positive LivingAbnormal Psychology in ContextAbout FaceAccessible Yoga for Every Body DVDActs of ConscienceAdvances in Culture and PsychologyAfter HarmAfter the Ecstasy, the LaundryAfter the Globe, Before the WorldAgainst the MachineAging Our WayAIDS & People with Severe Mental IllnessAkhenatenAl-JununAlgernon, Charlie and IAll About LoveAllergy ReliefAlone TogetherAlpha GirlsAltered EgosAltered StatesAlways On CallAm I Making Myself Clear?Am I Okay?AM/PM YogaAmerica in the FortiesAmerican Science Fiction Film and TelevisionAmong the Great ApesAn American ObsessionAn Anthropologist on MarsAn Illustrated Book of Bad ArgumentsAn Odd Kind of FameAnatomy of an EpidemicAnger, Madness, and the DaimonicAnimal ArchitectsAnimal MindsAnimals in TranslationAnother CountryAntimatterAre the Rich Necessary? Updated and Expanded EditionArtemis FowlAs Nature Made HimAsylumAsylum on the HillAsylum to ActionAt Liberty to DieAtonement and ForgivenessAttention Deficit DisorderAttitudeAuthentic HappinessBe Very AfraidBeautiful MindsBeauty's NothingBeckett and AnimalsBecoming a DoctorBeing VirtualBelle and Sebastian's If You're Feeling SinisterBest of the Brain from Scientific AmericanBetrayal TraumaBetter Sex Through YogaBeyond AIBeyond GreekBeyond HealthBeyond ReasonBeyond ToleranceBibliotherapyBipolar DisorderBlack Man in a White CoatBlack MassBlind SpotsBlinkBlood and GutsBodies out of BoundsBody Piercing Saved My LifeBorn Standing UpBrain LongevityBrain-Based Teaching for All SubjectsBrainchildrenBrainwashingBread Upon the WatersBreaking Murphy's LawBreaking WomenBreathingBrian Eno's Another Green WorldBrief EncountersBritain on the CouchBrothelBuddhism and ScienceBuilding Healthy MindsBullspottingBullying PreventionBurn UnitBuzzC StreetCalling Our Spirits HomeCamp ZCancer on $5 a Day* *(chemo not included)Cato's TearsCaughtChained to the DeskChickenizing Farms and FoodChild Slaves in the Modern WorldChildren's Learning in a Digital WorldChina on the MindChoices and ConflictChoosing CivilityChronic Fatigue Syndrome (The Facts)Classical Pilates Technique DVDCleopatraClinical Psychopharmacology Made Ridiculously SimpleClosing the AsylumsCognition, Creativity, and BehaviorCognitive Neuroscience of EmotionCollege Inc.Coming of Age in AmericaComing of Age in Ancient GreeceConceptual BlockbustingConcrete ReveriesConducting Insanity EvaluationsConfronting Postmaternal ThinkingConnected, or What It Means to Live in the Network SocietyConsciousnessConsider the LobsterConsuming InnocenceContagiousControlConversations About Psychology and Sexual OrientationCool WomenCorpora in Language Acquisition ResearchCorrect EnglishCorrupted CultureCount Us InCovered in InkCreative AngerCreative Core AbsCreative ThinkeringCreative Writing In Health And Social CareCreatures of AccidentCrime and Punishment in AmericaCritical ConditionCritical Perspectives in Public HealthCritical Psychology: An IntroductionCross-Cultural Topics in PsychologyCrossingCrossing the Unknown SeaCruddyCultural Healing and Belief SystemsCulture and Subjective Well-BeingCustomers and Patrons of the Mad-TradeCyber BullyingCyber-Safe Kids, Cyber-Savvy TeensDance the Chakras Yoga WorkoutDancing After HoursDangerous EmotionsDarwin's Dangerous IdeaDarwin's LegacyDeaf Identities in the MakingDeath in the AirDebunked!DeceptionDecoding DarknessDeep GossipDefenders of the TruthDefining Moments in ScienceDefying DementiaDeinstitutionalization And People With Intellectual DisabilitiesDematerializingDementiaDementia Caregivers Share Their StoriesDemons of the Body and MindDemons of the Modern WorldDepression In Later LifeDirty DetailsDiscourse of Twitter and Social MediaDistractedDivine MadnessDMT and the Soul of ProphecyDo-It-Yourself Eye Movement Techniques for Emotional HealingDoes Science Need a Global Language?Doing GoodDon't Believe Everything You ThinkDon't Get Too ComfortableDr. Andrew Weil's Guide to Optimum HealthDr. Andrew Weil's Mindbody ToolkitDreaming and Other Involuntary MentationDSM-IV SourcebookDSM-IV-TR Case StudiesDuplicityDutiful DaughtersDying for TimeEarthly Bodies, Magical SelvesEastern Body, Western MindEating AnimalsEccentricsEcological MedicineEducating People to Be Emotionally IntelligentEinstein and OppenheimerElectroshockElliott Smith and the Big NothingEmergence and EmbodimentEmergencies in Mental Health PracticeEmotionEmotional Intelligence at WorkEmotions RevealedEncyclopedia of Asylum Therapeutics, 1750-1950sEntwined LivesErotic PassionsEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics for the New MillenniumEvamarie Pilipuf's Yoga Express DVDEvery Day Yoga for Every Body DVDEveryday GreensEveryday IrrationalityEveryday SimplicityEverything Is MiscellaneousEvolutionEvolution and Human BehaviorEvolution in MindEvolution's RainbowExploring the Edge Realms of ConsciousnessExuberanceEyes of SophiaFalling for ScienceFalse-Memory Creation in Children and AdultsFamilyFamily Desk Reference to Psychology Fashion and Its Social AgendasFashion, Desire And AnxietyFast, Fresh & GreenFat and FuriousFear and Other Uninvited GuestsFearless ConfessionsFeminist Philosophy And Science FictionFinal ExamFine LinesFixing My GazeFlesh of My FleshFlesh WoundsFlirting With DangerFlow and YinFlying ColorsFocusFood for Thought:Food, Medicine, and the Quest for Good HealthFool Me TwiceFreedom, Fame, Lying, and BetrayalFridaFrom Certainty to UncertaintyFrom Joy Division to New OrderFull Frontal Feminism: A Young Woman's Guide to Why Feminism MattersFull Steam Ahead!Galileo Goes to Jail and Other Myths about Science and ReligionGang of Four's EntertainmentGender and Its Effects on PsychopathologyGender and Mental HealthGeneration DigitalGenetics of Mental DisordersGeniusGenomeGetting a Good Night's SleepGetting Inside Your HeadGetting WastedGilded CityGirl in the CurlGirlfightingGirls Gone MildGirls on the VergeGod and the MultiverseGood FortuneGood KarmaGood MedicineGood WorkGracefully InsaneGrassroots SpiritualityGreat Psychologists and Their TimeGulpHabeas CorpusHalf a Brain Is EnoughHandbook of AttachmentHappinessHappinessHappiness Is.Hate Crimes in CyberspaceHealingHealing SpacesHealth And the MediaHealth OnlineHearing the Person With DementiaHeavier than HeavenHello from Heaven!HelmholtzHelvetica: A documentary filmHemalayaa's Yoga for Young Bodies DVDHemingway's Second WarHerbs for the MindHere Is New YorkHeroes, Rogues, and LoversHeterophobiaHidden MindsHistory of ShitHistory of SuicideHoly Sh*tHoly WarHooked!Hot Body Cool Mind - Level 1Hot Body Cool Mind: Waking Energy Hot Chocolate for the Mystical LoverHot SpotsHotHouseHouse and PsychologyHow Children Learn the Meanings of WordsHow Doctors ThinkHow Emotions WorkHow Our Lives Become StoriesHow Proust Can Change Your LifeHow Science WorksHow to Build a Robot ArmyHow to Cook Everything VegetarianHow to Grow OldHow to Handle a Hard-To-Handle KidHow We AgeHow We Are Changed by WarHumankindHungerHysteria Complicated by EcstasyI Contain MultitudesI Know Who You Are and I Saw What You Did: Social Networks and the Death of PrivacyI of the VortexI Only Say This Because I Love YouI, Little AsylumIdiot AmericaIf Men Could TalkIgnoranceIllness and ImageImagining NumbersImprove Your Writing With NLPIn Bed with MadnessIn Defense of FoodIn Praise of ScienceIn Pursuit of HappinessIn Search of FatimaIn the Line of DutyIn the Shadows of the NetIn Therapy We TrustIndivisible by TwoInsight Yoga with Sarah PowersIntegrative MedicineIntensive CareIntroduction to Ashtanga Yoga DVDIntroduction to Qi YogaIntroduction to Yoga DVDInvented KnowledgeInvestigating Digital CrimeIrrationalityIs Shame Necessary?It's Up to YouJanis Saffell Beverly Hills YogaJudo with WordsKanye West's My Beautiful Dark Twisted FantasyKids OnlineKilling MonstersKinds of MindsKissing DoorknobsKnowing the Nature of FearKnowledge MonopoliesKundalini Yoga for Beginners & BeyondLandscapes in My MindLaw, Mind and BrainLearning About School ViolenceLearning, Teaching and Education Research in the 21st CenturyLessons Learned on My Way HomeLicentious GothamLies! Lies! Lies!Life CoachingLife MakeoversLimboListening in the Silence, Seeing in the DarkListening to PainListening to the WorldLittle PeopleLittle Red Riding Hood UncloakedLiving DeeplyLiving Well with Pain and IllnessLiving with ArthritisLiving with SchizophreniaLiving, Thinking, LookingLoneliness as a Way of LifeLong Shadow of Small GhostsLosing My MindLove and Sex with RobotsLove Your Body, Love Your LifeLove, Sex & TragedyLust in TranslationMad Mary LambMade in AmericaMadhur Jaffrey's World VegetarianMadnessMadness in CivilizationMaidentripMake It CountMake It Fast, Cook It SlowMaking Babies the Hard WayMaking Dying IllegalMaking SpaceMaking the Big LeapMaking Your Mind MatterMale Female EmailMalefemaleMan As The PrayerManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityManlinessManning UpMapping the MindMarriage ConfidentialMary Pope Osborne's Tales from the OdysseyMaster PassionsMasters of the MindMatters of SubstanceMean GenesMedia ArgumentationMedia in the Digital AgeMediating MadnessMedical AnthropologyMedicine and Health Care in Early ChristianityMedicine and Philosophy in Classical AntiquityMedieval Writings on Female SpiritualityMemoires 1995Memory, Brain, and BeliefMental Health and Social SpaceMental Health MattersMental Illness in Popular MediaMerchants of DoubtMild Cognitive Impairment and Early Alzheimer's DiseaseMiles to Go for FreedomMillennium GirlsMind in Everyday Life and Cognitive ScienceMind WarsMind, Matter and Quantum MechanicsMindstormsMisconceptionsMistakes Were Made (But Not by Me)Mollie Katzen's RecipesMom's OK, She Just ForgetsMoody BitchesMoral PanicsMore Than MedicineMortificationMothers Who Kill Their ChildrenMusicophiliaMy Bloody Valentine's LovelessMy Life Among the Serial KillersMy Misspent YouthMy Stroke of InsightNakedNaked CityNarratives in PsychiatryNations Have the Right to KillNatureNear Death ExperienceNeurons and NetworksNeuroscience in Science Fiction FilmsNew Versions of VictimsNew YorkNew York September 11Not by DesignNot Your Mother's LifeNothing to HideNurembergNymphomaniaOath BetrayedObesityObjects of Our DesireObliquityOdd CouplesOf Spirits & MadnessOf Two MindsOld AgeOn BlindnessOn Fact and FraudOn the BrinkOn the Origin of StoriesOne Nation Under TherapyOpening to Love 365 Days a YearOptimizing Teaching and LearningOtherhoodOut of the DustOutliersOutsider ArtOver My HeadOxford Guide to the MindPainParanoia of Everyday LifeParents Do Make a DifferenceParty GirlPassingPassionate VegetarianPathways through PainPeople Like OurselvesPerceptual NeurosciencePersons and ThingsPestos, Tapenades, and SpreadsPhilosophy of MindPhotography and LiteraturePilates for MenPink ThinkPlanning for UncertaintyPoets on ProzacPostcards from the Brain MuseumPosthumanismPotatoes Not ProzacPower HerbsPower Yoga for HappinessPoxPractical ClassicsPractical Plans for Difficult Conversations in MedicinePracticing Feminist Ethics in PsychologyPrader-Willi SyndromePredictably IrrationalPretty in PunkPretty Is What ChangesPreventing Misbehavior in ChildrenPrime Ministers of CanadaPrint Literacy DevelopmentPrison MadnessPrivate Life in New Kingdom EgyptProblems in MindProtecting the GiftProust and the SquidPrudePsychiatryPsychiatry in the New MilleniumPsychiatrylandPsychologyPsychology and the MediaPsychology for ScreenwritersPsychotherapy and ConfidentialityPublic Health LawPunishment in Popular CulturePure Yoga Pilates with Kerry BestwickQuantum ArchetypesQuantum LeapsR.I.P.Race in Contemporary MedicineRacial ParanoiaRaising a Self-StarterRaising AmericaReady for AnythingReady or NotReady or Not, Here Life ComesReal SexReckoning With HomelessnessReclaiming Our ChildrenReclaiming Soul in Health CareRed Lotus YogaReligion ExplainedRemaking a WorldRepublic.com 2.0Rethinking CommodificationRethinking Middle YearsReviving OpheliaReviving the LeftRewarding Specialties for Mental Health CliniciansRights, Risk and Restraint-Free Care of Older PeopleSabbathSame DifferenceSamuel BeckettSatisfactionSavedScared SickScienceScience and NonbeliefScience in the MarketplaceScience TalkScience WarsScience, Consciousness and Ultimate RealitySecond OpinionsSeeds of HopeSelected Ambient Works Volume IISelf Hypnosis for Cosmic ConsciousnessSelf-Help NationSelf-Help, Inc.Selling the Fountain of YouthSells like Teen SpiritSerious ShoppingSeven Challenges To Change Your Life DVDSex, Mom, and GodSex, Time and PowerSexing the BodySexual Orientation and School PolicySexy FeminismShadow, Self, SpiritShop Class as SoulcraftShrink RapSick to Death and Not Going to Take It AnymoreSimulation and Its DiscontentsSinfully VeganSister CitizenSleeping With Extra-TerrestrialsSlut!Snake Oil ScienceSnoopSo Brilliantly CleverSocial RepresentationsSolar Flow Yoga DVDSold on LanguageSome Kind of GeniusSometimes Madness Is WisdomSorting Things OutSoul Made FleshSounds from the Bell JarSoupsSpace, Place and Mental HealthSpeaking Our MindsSpiritual CrisisSpontaneous HealingStates of MindStatus AnxietyStiffedStill HereStill LivesStrange BehaviorStrategies of Commitment and Other EssaysStrength, Grace, HealingStroke DiariesStumbling on HappinessSun SalutationsSuper Natural CookingSuperstitionSupersurvivorsSurgery JunkiesSwordfishtrombonesSylvia Plath ReadsTalk to HerTalking About RaceTalking Back to PsychiatryTalking Heads' Fear of MusicTalking ScienceTeach Yourself MeditationTeaching OnlineTeaching SexTeen LoveTeenageTextbook of Cultural PsychiatryThanks!The 101 Best Graphic NovelsThe Age of American UnreasonThe Alice Behind WonderlandThe American HotelThe American ParadoxThe American Psychiatric Publishing Textbook of Clinical PsychiatryThe Americanization of Social ScienceThe Anatomy of HopeThe Anatomy of MelancholyThe Angelica Home KitchenThe Antibiotic EraThe Ape and the Sushi MasterThe Architecture of MadnessThe Arctic IncidentThe Art of ChoosingThe Art of Exceptional LivingThe Bard on the BrainThe Barmaid's BrainThe Beginner's Guide to Healthy EatingThe Better to Eat You WithThe Biotech CenturyThe Birth of PleasureThe Birth of the PillThe Black DeathThe Blackwell Handbook of Organizational Learning and Knowledge ManagementThe Book of the PenisThe Brain That Changes ItselfThe Breathing FieldThe Bridge to HumanityThe Bully SocietyThe Cafe Brenda CookbookThe Call of the WeirdThe Cambridge Illustrated History of MedicineThe Case Against SugarThe Childless RevolutionThe Clitoral TruthThe Complete Guide to Herbal MedicinesThe Complete Vegetarian HandbookThe Consolations of PhilosophyThe Contemplative HeartThe Couch and the TreeThe Course of Gay and Lesbian LivesThe Creation of the Modern WorldThe Cult of PharmacologyThe Cultural Origins of Human CognitionThe Culture of FearThe Culture of PunishmentThe Da Vinci DogThe Dark Night of the SoulThe Deadly TruthThe Decency WarsThe Disobedience Of The Daughter Of The SunThe Dynamic NeuronThe Easy Yoga WorkbookThe Emotional BrainThe Emotional Journey of the Alzheimer's FamilyThe Employee Assistance Treatment PlannerThe End of MaterialismThe End of WarThe English and their HistoryThe Enigma of HealthThe Era of ChoiceThe Eternity CubeThe Event of LiteratureThe Evolving WorldThe f WordThe Fabulous ImaginationThe Faces of TerrorismThe Farm Colonies: Caring for New York City's Mentally Ill In Long Island's State HospitalsThe Fat Studies ReaderThe Fate of Early MemoriesThe Female ThingThe Final LeapThe Firmament of TimeThe Five Things We Cannot Change ...The ForgettingThe Game of TruthThe Get Healthy, Go Vegan CookbookThe Gift of FearThe Gold Leaf Lady and Other Parapsychological InvestigationsThe Good Enough ChildThe Great BetrayalThe Greatest Experiment Ever Performed on WomenThe HandThe Handbook of Disability StudiesThe Happiness HypothesisThe Healing Remedies SourcebookThe Health Psychology HandbookThe Healthy KitchenThe Heart of YogaThe Hedgehog's DilemmaThe Hero's JourneyThe History of Rhetoric and the Rhetoric of HistoryThe History of White PeopleThe Homework MythThe Hungry SoulThe Identity CodeThe Immortalization Commission:The Importance of Being LazyThe Indian VegetarianThe Insider's Guide to Mental Health Resources OnlineThe Insider's Guide to Mental Health Resources OnlineThe Insider's Guide to Mental Health Resources OnlineThe Insider's Guide to Mental Health Resources OnlineThe Intelligibility of NatureThe Interdisciplinary Science of ConsumptionThe Intuitive WriterThe Invisible PlagueThe Irreducible Needs of ChildrenThe Irritable Male SyndromeThe Jewel Tree of TibetThe Joy of MeditatingThe Language ImperativeThe Language Of YogaThe Language PoliceThe Language WarsThe Last PhysicianThe Last Self-Help Book You'll Ever NeedThe Law Is a White DogThe Lie DetectorsThe Little Book of Healthy TeasThe Little Book of HeartbreakThe Little Soy BookThe Little Yoga BookThe Lives and Loves of Daisy and Violet HiltonThe Lives of AnimalsThe Lolita EffectThe Lonely PatientThe Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related DisordersThe Lucifer EffectThe Lucifer PrincipleThe Madness of Adam and EveThe Madwoman in the AtticThe Magic of RealityThe Making of Dr. PhilThe Manual of EpictetusThe Marketplace of IdeasThe Mature MindThe Measure of Our DaysThe Meat Lover's Meatless CookbookThe Medical AdvisorThe Medicalization of SocietyThe Metaphysical ClubThe Mind's PastThe Misunderstood GeneThe MIT Encyclopedia of the Cognitive SciencesThe Monster WithinThe Mood CureThe Moral Intelligence of ChildrenThe Mystery of Mary RogersThe Myth of Freedom and the Way of MeditationThe New BrainThe New Cancer SurvivorsThe NineThe Nordic Theory of EverythingThe Norm ChroniclesThe Normal OneThe Omnivorous MindThe Orchid ThiefThe Origin and Evolution of CulturesThe Oxford Book of Modern Science WritingThe Pain AntidoteThe Paradox of ChoiceThe Paradox of SleepThe Paranoia SwitchThe Passion PlanThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Physics of ConsciousnessThe PlaceboThe Placebo Effect and HealthThe Playful BrainThe Pocket Life CoachThe Portfolio and the DiagramThe Power of FocusThe Power of Full EngagementThe Praeger Handbook of Learning and the BrainThe Private Life of the BrainThe Professor and the MadmanThe Psychoanalytic MysticThe Psychology of Religion and CopingThe Psychology Of The InternetThe Psychotherapy Documentation PrimerThe Quantum UniverseThe Quarter-Acre FarmThe Race for ConsciousnessThe Real Rules for GirlsThe Red DevilThe Republican BrainThe Richer SexThe Rise of Mental Health NursingThe Roman Search for WisdomThe Root of All EvilThe Routledge Companion to Landscape StudiesThe Same Stuff as StarsThe Savage CityThe Science of Good and EvilThe Science of Optimism and HopeThe Scientist In The CribThe Seat of the SoulThe Second SelfThe Secret History of DreamingThe Secret Lives of GirlsThe Secret World of Doing NothingThe Seven Sins of MemoryThe ShakeressThe ShallowsThe Social Psychology of StigmaThe Sociology of PhilosophiesThe Sociopath Next DoorThe Soul Knows No BarsThe Spa DeckThe Spiritual Anatomy of EmotionThe Split MindThe Star ThrowerThe Story Is TrueThe Storytelling AnimalThe Strange Case of Hellish NellThe Symmetry of GodThe Talking CureThe Thing You Think You Cannot DoThe Three CulturesThe Three Failures of CreationismThe Toxic ConsumerThe Triumph of NarrativeThe True PathThe Truth About Chronic PainThe UndertakingThe Volitional BrainThe Wages of SinThe War Against BoysThe Way of StretchingThe Weblog HandbookThe Weight of the NationThe Why CaféThe Wild Ass’s SkinThe Will to Live and Other MysteriesThe Wisdom of PsychopathsThe Wisdom of Your DreamsThe Words We Live ByThe World of CaffeineThe Worldwide Practice of TortureThe Worst-Case Scenario Survival HandbookThe Wow ClimaxTheaters of MadnessTheatre and AnimalsTheories of Scientific MethodTherapeutic LandscapesTheraScribe 4.0Think CatThink SmartThinking for a ChangeThinking With AnimalsThrough Deaf EyesToo Big to FailTooning InTop ChefTortured SubjectsTotal AstangaTotal PilatesTotally WiredTowards a Science of Consciousness IIITrain Your Brain to Get RichTransforming MadnessTraumatic PastsTreatment and Rehabilitation of Severe Mental IllnessTreatment Kind and FairTribal ScienceTrick or TreatmentTrusting DoctorsTry to RememberTutoring as a Successful BusinessTwelve Examples of IllusionTwinsUnder the Medical GazeUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding FitnessUnforgettableUnholy MadnessUnscientific AmericaUnspeakable Acts, Ordinary PeopleUnto OthersUp From DragonsUrban Tourism and Urban ChangeUseful BodiesValues in ConflictVarieties of Anomalous ExperienceVegan ExpressVegetarian Turkish CookingVertigo VisionsVictorian Popularizers of ScienceViniyoga Therapy for the Low Back, Sacrum and HipsViolence Against WomenVoices Of Alzheimer'sVoices of CaregivingVoices of MadnessVoluntary SimplicityWaking Up to What You DoWalkingWalking a Literary LabyrinthWall: A World DividedWarWays of KnowingWays of KnowingWe Shall Be No MoreWe Shall Not Be MovedWe've Got BlogWellbeingWhat Emotions Really AreWhat I Learned in Medical SchoolWhat in the World Are Your Kids Doing Online?What Makes Us Think?What Nietzsche Really SaidWhat Our Children Teach UsWhat Science Offers the HumanitiesWhat Video Games Have to Teach Us About Learning and LiteracyWhat's Holding You Back? What's So Wrong with Being Absolutely RightWhen a Family Member Has DementiaWhen Experiments TravelWhen Good Thinking Goes BadWhen History Is a NightmareWhen Johnny and Jane Come Marching HomeWhen Mothers KillWhen Sex Goes to SchoolWhen Someone You Know Is Living in a Dementia Care CommunityWhen Things Fall ApartWhere Biology Meets PsychologyWhere Good Ideas Come FromWhere is the Mango Princess?Wherever You Go, There You AreWhile They SleptWhispers from the EastWho Rules in ScienceWhy Does E=mc2?Why Don't Students Like SchoolWhy God Won't Go AwayWhy Have Kids?Will They Ever Trust Us Again?WisdomWise Mind, Open MindWitch Beliefs and Witch Trials in the Middle AgesWitchcrazeWith Their EyesWithin ReasonWomanWomen and Mental IllnessWorking With Emotional IntelligenceWriting in FlowYogaYoga & Pilates Workouts for DummiesYoga Beauty BodyYoga for EveryoneYoga for People Who Can't Be Bothered to Do ItYoga for Regular GuysYoga for Regular Guys DVDYoga In BedYoga on DemandYoga SanctuaryYoga SculptYoga ShaktiYoga To Go's Yoga Quick Fixes DVDYogalosophyYou Are Not Your IllnessYou'd Be So Pretty If . . .Your Miracle BrainZen Encounters with LonelinessZen-Brain Reflections
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) presents the official classification scheme of mental disorders which is widely used by clinicians, researchers, educators, administrators, policy makers, jurists, and others to guide their mental health related practices. The manual contains over 300 categories of mental disorder, each associated with diagnostic criteria and accompanying explanatory text, and it explicitly embodies a medical approach to the understanding of such disorders. The DSM-IV is a descendent of DSM-III which, in the wake of much dissatisfaction and associated unrest concerning earlier DSMs and psychiatric practice generally, was introduced in 1980 as a central component of the "Neo-Kraepelinean" movement to put psychiatric classification, and psychiatric practice, on firm scientific foundations. At present, the DSM-IV is an exceedingly influential document which has an impact on a broad range of cultural practices and deeply informs how an important domain of human suffering, disability, and deviance is observed, understood, and engaged.
The deep cultural entrenchment of the DSM system of classification is based to a significant extent upon its claim to scientific credibility, a claim which has been repeatedly made and nurtured by its developers. The system is alleged to be grounded on a massive scientific research effort which has informed, and continues to inform, the processes of development which led to DSM-III (1980) and to its successors, DSM-III-R (1986) and DSM-IV (1994). These same processes are now in place for the production of DSM-V, expected to be published sometime in the middle of the current decade. As a consequence of this scientific research framework and the decision making processes informed by it, the DSM is now presented by its developers as a system of classification which rests upon an empirical basis and whose development is appropriately and rigorously responsive to evolving science. As we shall see below, this image of the DSM is somewhat overstated.
Building upon the system presented in DSM-III-R, the process by which decisions were made regarding production of DSM-IV was a complex hierarchical process that proceeded roughly as follows. Final decisional authority for revision of DSM-III-R rested with the Board of Trustees of the American Psychiatric Association, although the final decisions were informed by the APA membership and by recommendations of the Task Force assigned the job of proposing and attempting to resolve issues concerning: the addition or deletion of diagnostic categories and sub-categories, the development or modification of diagnostic criteria associated with existing or new categories, the development or modification of text associated with existing or new categories, and any other issues associated with the production of the DSM-IV manual. The Task Force, appointed by the Board, was composed of 27 individuals responsible for oversight of the development process and for making final recommendations to the Board. Many members of the Task Force also functioned as chairs or co-chairs of the 13 work groups, each responsible for the study of a specific set of mental disorders. The work groups were charged with identifying issues and possible options for resolution concerning their assigned disorders, developing an empirical basis for deciding among the options, and making recommendations regarding each of the issues. The work groups were also provided with general guidelines regarding how they were to proceed with, and report upon, their various tasks. In addition, they worked in concert with a large number of advisors, each of whom was invited to participate in the process because of their possession of relevant expertise regarding particular mental disorders or types of issues.
The apparently overriding and frequently rehearsed charges to the groups were to pursue their deliberations in an open-minded fashion, to base their deliberations and proposed changes as much as possible on the "best data available," to maximize congruence with the ICD-10 as much as possible (in order to establish international consistency regarding psychiatric diagnostic practices), and to take a relatively conservative approach to revision (in order to preserve stability of criteria across editions of the DSM), and, hence, to propose changes only when there was a solid basis for doing so. The combination of these ideals and the impressively long list of distinguished consultants contributes substantially to the prima facie scientific legitimacy of the development process.
The DSM-IV Sourcebook is a four volume set of papers which are authored by participants in the development processes leading to the publication of DSM-IV and which are supposed to provide a detailed presentation of the empirical evidence and associated rationales for the many decisions involved in the production of DSM-IV. Volumes 1-3 present the literature reviews conducted by the 13 work groups. In these volumes, the critical issues addressed by the groups are formulated, the relevant scientific research based upon the literature reviews is identified, the bearing of this research on resolution of the issues is discussed, and tentative recommendations concerning possible revisions or the necessity of further research are made. This initial review process culminated in the production of the DSM-IV Options Book which was a compendium of the various recommendations for change resulting from the literature reviews and which was then widely circulated for the purpose of eliciting as much critical feedback as possible. Volume 4 of the Sourcebook presents the results of 40 data re-analyses (i.e., new analyses of existing data sets) which were proposed for the purpose of providing additional data relevant to issues not resolved by the literature reviews. Further, this volume also presents the results of 12 Field Trials conducted for the purpose of eliciting data and feedback on the potential clinical impact of changes in the DSM and on the reliability and performance characteristics of the criteria. The Field Trials were also conducted with an eye to collecting additional data to help resolve issues for which existing data were not sufficient. Lastly, volume 4 contains the final reports of each of the work groups outlining their final recommendations regarding proposed revisions. Thus, the DSM Sourcebook provides a unique glimpse of certain aspects of the DSM-IV development process, with specific emphasis on the empirical foundation and rationales for the recommendations which were made. As such, the Sourcebook may provide important insights into the character and quality of the decisions that led to the production of DSM-IV, and hence into the scientific credibility of contemporary psychiatric classification.
This last point is exceedingly important because the development of the various recent DSMs (III, III-R, IV) has taken place in an atmosphere of continuing controversy and discontent with the DSM system of classification. There are many dimensions of criticism and complaint; some concern the practical utility of the system while others bear directly upon its foundational assumptions and scientific credibility. Criticisms include: (1) continued objections that the concept of mental disorder lacks cogency and that a medical model for understanding and responding to many areas of human suffering and disability is inappropriate, (2) allegations that the methodological commitments of the approach to classification (e.g., commitment to a categorical and "atheoretical" approach) are misguided, (3) contentions that the DSM development process lacks objectivity and scientific rigor, (4) enduring charges that DSM criteria and categories have severe problems and lack reliability and validity, and (5) widespread concerns that DSM diagnostic categories lack clinical, research, and educational utility and that they are misused in a variety of contexts.
So, it is in the dual context of this broad ranging discontent with the philosophical, scientific, and practical value of the DSM combined with its deep cultural entrenchment supported by claims of scientific credibility, that I place the present review. Because of the controversial character of this context and the unique glimpse the Sourcebook provides into the DSM-IV development process, one can and should study the DSM Sourcebook with at least two questions in mind: (1) How well does the process, as reflected in the Sourcebook, live up to the ideals, aspirations, and claims of the developers?, and (2) How responsive is the process, as reflected in the Sourcebook, to the deeper concerns about the utility, fundamental commitments, and scientific credibility of the DSM-IV system of classification? In this review, I focus upon Volume 1 of the Sourcebook; subsequent reviews will be devoted to the other volumes.
Volume 1 is organized in terms of five main sections each focusing on one major thematic grouping of mental disorders as follows: Substance-Related Disorders; Delerium, Dementia, and Amnestic and Other Cognitive Disorders; Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders; Sleep Disorders. Each section consists of an introductory overview chapter, discussing the main issues addressed by the work group and summarizing the findings and deliberations of the work group, and a set of detailed chapters each of which is devoted to specific issues concerning the mental disorders assigned to the group. The format of each of the 45 substantive chapters is the same, consisting of separate sections for the following: Statement of the Issues, Significance of the Issues, Methods, Results, Discussion, and Recommendations.
To begin, nowhere in these 45 chapters is serious attention given to the sorts of foundational issues of concern to the critics of the DSM (e.g., concept of mental disorder, commitment to an atheoretical categorical approach, appropriateness of a medical model, etc.) It is a serious shortcoming of the process of development to ignore or give short shrift to these matters in light of the broad ranging dissatisfaction with the DSM in clinical practice, the serious challenges which have been mounted to the commitments of the approach, and the necessity of secure foundations to the ultimate success of any approach to classification. Perhaps, Volumes 2-4 will contain such discussions, but it is more likely that such discussions will be left to future iterations of the DSM development process (e.g., in the future a Work Group should be assigned the task of studying foundational issues.)
Turning to the deliberations reported in Volume 1, we find that many were significantly influenced by the ideal of promoting coherence with the ICD-10 (in order to maximize international agreement on criteria and categories of mental disorder.) Although sensible from a certain point of view, this raises concerns about whether attempts to promote such coherence might continue the process, clearly visible in the development of DSM-III, of basing categories and criteria on "expert consensus" rather than empirical evidence and theories. To a number of critics, the source of many of the problems of the DSM is an overriding concern with achieving consensus in the absence of constraints based on scientific research. If, as appears to be the case, good quality evidence concerning construct and predictive validity of DSM (and ICD-10) categories is in short supply, existing problems will in all likelihood persist.
Indeed, the deepest problem with DSM categories in general is their lack of demonstrated construct and predictive validity. Volume 1 of the Sourcebook provides little evidence that such issues were seriously addressed, let alone the issue of whether an adequate research base exists to validate the categories. It is simply not the case, for example, that systematic reviews of treatment efficacy research were conducted for each of the disorders, nor were systematic studies of construct validity conducted for each DSM-IV category. For the most part, categories in DSM-III-R, which were included in that edition without adequate evidence of validity or clinical utility, were largely retained in DSM-IV without any new or satisfactory evidence vindicating their original inclusion in the official diagnostic classificatory system. Although there are some discussions of validity issues in Volume 1 of the Sourcebook, these discussions are neither systematic nor deep. The inertial forces operating within the DSM development process are quite powerful and they all but guarantee the retention of categories of mental disorder that were not introduced on the basis of demonstrated validity and have not been vindicated in this regard by subsequent research.
It is somewhat puzzling that a process of development, widely advertised as bringing to bear scientific research on the classification of mental disorder, would give so little attention to the central research issues for any system of classification, and hence utilize so few pertinent empirical constraints on the development of the DSM system. Perhaps part of a solution can be found in the conservative stance adopted by the developers: only those issues for which there was a significant research literature to make meaningful discussion possible were considered and changes were made only when there was a substantial basis for doing so. This stance had the dual effect of narrowing the scope of the process and of making significant changes difficult to make. As a consequence, the vast majority of categories in DSM-III-R were retained in DSM-IV with at most mild revisions (there were, of course, some additions, deletions, and revisions of categories, despite the fact that those categories have yet to be validated by scientific research.) The rationale for this conservative approach is that (1) validation requires substantial time for building an appropriate research base, (2) we are still at an immature stage of research (i.e., there is not a lot of research sufficient for establishing validity of the categories), and (3) significant changes would violate the integrity of the gradually evolving research base thereby impeding the validation effort. However, the bottom line is that DSM-IV categories, at least those studied in Volume 1 of the Sourcebook, have not been validated by scientific research. And yet they continue to inform, not only current and future scientific research, but also numerous cultural practices (e.g., clinical, legal, educational, health care). Some critics of the DSM believe that this is a wasteful and harmful prospect requiring serious and immediate attention.
With respect to how well the deliberations concerning the issues addressed in Volume 1 lived up to the ideals and claims made about the development process (e.g., open minded and balanced treatment of issues, changes made only when a significant basis exists, basing decisions as much as possible on the best available research), the work reported in Volume 1 was quite uneven and there are several sources of concern about the rigor and empirical character of the process. First, the quality of the research base is questionable: the studies considered often date back decades, the methodological quality of the studies is too frequently not addressed, the comparability of the studies is in doubt (e.g., due to different conceptualizations of the disorders), and the relevance of the studies to the questions addressed is not always clear. Second, the poverty of the research base becomes evident when it is seen that numerous issues cannot be meaningfully addressed at all, let alone resolved, because of insufficient evidence (this is frequently acknowledged by the contributors to the Sourcebook). Third, empirical evidence is not used in many decisions; rather, loosely constrained speculations regarding concepts, coherence with other systems, face validity, and consensus of the field are taken to suffice for making a decision. Fourth, even when empirical evidence is employed, it is often not clearly relevant, or, even when relevant, the decisions are only loosely connected to the evidence cited. Finally, it should be noted that, given the lack of demonstrated construct validity of the categories, many of the issues discussed are potentially quite meaningless (e.g., deliberations about accuracy of diagnosis).
Thus, as evidenced by Volume 1, the process of DSM-IV development very imperfectly lives up to the ideals, aspirations, and claims made by the developers, and it neither seriously addresses nor allays the concerns of the critics of the DSM approach to classification. As a consequence, the idea that the process exhibited in this volume places the development of the DSM classification system on a solid empirical basis cannot be seriously entertained. The real and very significant value of the Sourcebook is that it provides us with a good look at how decisions about the DSM-IV were made. Unfortunately, far from establishing the scientific credibility of the DSM, it helps us to see more accurately just how far we have to go before a credible system will be achieved.
Jeffrey Poland, University of Nebraska-Lincoln