As anyone reading the newspapers has heard, the DSM-5 went on sale earlier this year amidst a cacophony of DSM bashing and bashing of the profession in general. The most vehement critics also exhorted the public to not buy this evil book that would lead to the squandering of billions of healthcare dollars and leave millions hopelessly misdiagnosed and taking expensive unnecessary drugs. In some cases that I have recorded on this blog the criticism was even more extreme. Now that the DSM-5 has been out for several months I asked myself what the outcome of all of that bad press has been? Like thousands of my colleagues, I have picked up a copy and glanced at it from time to time. It certainly has not lead to any revolution in psychiatric practice or changed anyone's clinical interviewing or diagnostic process. In fact I have talked with many psychiatrists in the past several months and none of my conversations has touched on the DSM-5. What are the facts of the release after all of the pre-release spin?
First of all, the predicted apocalypse has not happened. I should say the apocalypse happened but it was 30 years ago when the managed care industry essentially converted mental illness into "behavioral health" and began to restrict access to psychiatric care, inpatient and medical care, psychotherapy, and certain medications to people with severe mental illnesses. The predicted apocalypse in response to the DSM-5 did not happen because as I have been saying all along, the DSM has never been the problem. Mental health care can be denied as easily on the basis of a DSM-5 diagnosis as a DSM-IV diagnosis. A diagnostic manual is partially relevant only for people who are trained to use it.
That said, is there any way to estimate whether people are buying it or not? I heard a sales estimate e-mailed by a colleague that suggested brisk sales, but did not have permission to quote him so I started to look for public sources of data on DSM-5 sales. I went to the usual New York Times Bestseller List and could not find it listed. I could not really find any academic books listed there so I wonder if there is not another list. I thought that Amazon would be the next logical stopping point and I did find some data there. I was looking for data in number of units actually sold and I could only find that as proprietary data that somebody would sell to me. I did find it as # 8 in Best Sellers of 2013 so far. This link shows it has been in the Top 100 books for 167 days but that it has fallen to the number 4 position. Interestingly the Publication Manual of the American Psychological Association had been on the same list 8 times as long. I also found it in a sequential list of DSM-5 products and related variants including 2 books about the DSM-5 by Allen Frances, MD. It made me think about obvious conflict of interest considerations in the psychiatry criticism industry that are never mentioned when they get free press. If somebody can suggest that I have been getting a free lunch from a pharmaceutical company when I haven't seen a drug rep in over 25 years, they should at least point out that somebody can currently make money - possibly even a good amount of money by criticizing psychiatry regardless of whether or not that criticism is remotely accurate.
That is all I have so far. If you have reliable public data on the actual sales of this manual and would like me to post it here, please send me the information. I have requested the actual sales figures in an APA forum but I doubt that anyone will provide them to me. The APA is a very conservative organization and I doubt that they would want you to see those sales figures posted here, even if if this is probably the only public forum that takes a very skeptical look at all of the critics of the DSM-5 and psychiatry in general.
George Dawson, MD, DFAPA