Paula Caplan, Ph.D. on psych diagnosing
http://www.psychologytoday.com/blog/science-isnt-golden/201112/who-will-protest-against-the-dsm-harm
Who Will Protest Against the DSM Harm? Integrity, Concern, and Action is needed for DSM Protest Published on December 19, 2011 by Paula J. Caplan, Ph.D. in Science Isn't Golden
Problems
The good news: More people than ever before are learning that psychiatric
diagnosis is not grounded in good science and causes a vast array of harm
to people who have turned for alleviation of their suffering to those who
are called helping professionals.
The bad news: The forces keeping the psychiatric diagnosis juggernaut
rolling and misleading the public are more powerful than ever.
I have written about these concerns here before, as well as elsewhere
(They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide
Who's Normal and Bias in Psychiatric Diagnosis, as well as at
psychdiagnosis.net), so I will not repeat most of what I have already
said. Today I focus on the danger of assuming that organized protest
against the Diagnostic and Statistical Manual of Mental Disorders (DSM) is
well in hand and likely to be effective in stopping the harm. There is no
reason to believe that this is the case.
You may have heard about the petition started by several divisions of the
American Psychological Association, who express concern about possible
harm to children, adolescents, and the elderly and ask for an external
group (the DSM is published by the American Psychiatric Association) to
evaluate the proposals for the next edition, called DSM-5. This petition
has garnered thousands of signatures and the support of additional
American Psychological Association divisions. Although it is wonderful
that these brave divisions have at last spoken out about the devastation
caused to untold numbers of people over the many decades of the DSM's
existence, it is stunning that they would specifically omit mention of
harm to adults who are not elderly.
When I wrote petition coordinator David Elkins to inquire about this, he
did not respond to the question. (Note added December 19: Please see in
Comments section after this article that Dr. Elkins has now responded
there to the question I had emailed him about this awhile back. I am
delighted to hear that his group is also concerned about adults who are
not elderly, and I hope they will take pains to make clear in the future
that they are concerned about everyone who has been hurt by psychiatric
diagnosis. This does not change the other concerns in this essay, and in
his comment here below, Dr. Elkins did not address those.) It is hard not
to wonder whether this is due to the association of Allen Frances with
this petition.
Former Psychiatric Manual Chief Demonizes Those Hurt By His System
Frances, the psychiatrist who headed the work on DSM-IV -- on which I
served as a member of two committees before resigning in horror at the way
they ignored, distorted, and even lied about the scientific basis for
their diagnoses -- recently wrote in an article called "The user's revolt
against DSM-5: Will it work?" in the November 10, 2011, Psychiatric Times
that he was worried that the "harmful anti-psychiatry movement" would
damage this petition campaign.
He pointed out that, although "DSM-5 is such a mess," nevertheless,
psychiatry "is essential and extremely helpful -- DSM-5 is nor more than
an unfortunate and temporary aberration." His intense need to defend and
protect psychiatry in general is clear.
I simply could not believe my eyes when I read Frances' opening statement
in that article. He wrote: "When it comes to DSM-5, experience has proven
conclusively that the American Psychiatric Association (APA) will not
attend to the science, evaluate the risks, or listen to reason. A user's
revolt has become the last and only hope for derailing the worst of the
DSM-5 suggestions."
I thought of the many years during which he steadfastly ignored the
questions that were raised about the woeful state of "science" in his
edition of the DSM, his dismissive attitude when concerns were raised
directly with him about the patients whose lives had been ruined because
of psychiatric diagnosis, and his claim, when asked, "Is there at least
some evidence that more people have been helped than harmed," that "Well,
of course there's no way of knowing that." Hardly the response of someone
who understands that science is useful in answering exactly such
questions.
Frances' disdain for those adults (who include some proportion but by no
means the majority who are elderly members) who joined the anti-psychiatry
movement because they were so profoundly harmed by the traditional mental
health system is revealing... and terrifying.
Are the only good ex-patients those who stuff deep inside themselves the
ways the system hurt them? And I have to wonder, does he not grasp the
point that, even though he believes the anti-psychiatry movement is
harmful, he might want to refrain from publicly tarring a movement that
includes such sterling organizations as MindFreedom International, The
Icarus Project, PsychRights, the National Empowerment Center, and the
International Society for Ethics in Psychology and Psychiatry (which
includes some survivors as well as some professionals)?
This would matter less if the APA petition had a prayer of leading to
change. I fervently hope I am proven wrong, but here are two of the major
reasons for doubt:
(1) In the mid-1980s, beginning at the Association for Women in Psychology
conference, I coordinated the first petition campaign in which any DSM
categories were challenged.
This was in regard to then-forthcoming DSM-III-R, whose Task Force was
headed by Robert Spitzer, who is now, like Frances, suddenly speaking out
about the lack of science and the harm from psychiatric diagnosis.
Did they suddenly discover this once they were no longer in command of the
manual? Our 1980s campaign ultimately netted signatures and letters from
individuals and organizations representing more than six million people
(in contrast to the thousands so far signing the Elkins petition), but
that did not stop the DSM authors from steamrolling ahead. And it
certainly did not stop Allen Frances from including in his edition,
DSM-IV, categories that he knew had led to harm.
How do I know he knew? I told him in a telephone conversation, and I sent
him documentation of harm. If another major lobby group, the American
Psychological Association, which long ago raised serious concerns about
the DSM but now refuses to challenge it as a body (hence the courage of
those of its divisions that started this petition) and in fact profits
from offering Continuing Education courses about the DSM that lack
critical components, would get on board with any anti-DSM petition, that
would carry considerable weight. Up to now, they have refused to do so.
In a recent press release (December 2, 2011), they stated that any
psychiatric classification system "must be based on the best available
science and serve the public interest." The disingenuousness of that
statement is striking, given that unless they have spent many decades
under a rock, they know full well that the DSM is unscientific and causes
harm.
Furthermore, according to the press release, they share the belief of the
petition's authors that "the purpose of any diagnostic classification
system should be to improve treatment outcomes." Yes, it should be. But as
I have learned through reading the research, diagnosis of mental disorders
does not help (except to get insurance coverage, and I have a proposal for
how to deal with that), does often cause harm, and does not correlate with
outcome.
We learn from the press release that the American Psychological
Association has "called upon the DSM-5 Task Force to adhere to an open,
transparent process based on the best available science and in the best
interest of the public." They might as well shut themselves in a closet
and whisper that request.
(2) So many powerful systems have a stake in maintaining the fundamentals
of psychiatric diagnosis that it strains credibility to think that the
DSM-5 heads would turn over the evaluation of their work to some outside
group.
Historically, under Spitzer and Frances, the DSM chiefs boasted about
"consulting" with many hundreds of professionals (note: they included
hardly any, if any, people who had been patients in their system) in
constructing their manuals, but I know from my experience and the
experiences of others that they compile an impressive list of all these
consultants but freely reject any opinion that goes against their aims, no
matter how grounded in science and/or humane concerns those conflicting
opinions might be.
Actions
Concerned about all of the above, a number of organizations and
individuals recently formed the PLAN T Alliance (Psychiatric Labeling
Action Network for Truth) and decided that it is time to stop asking the
DSM heads please to listen to reason, to look at the science, and to
consider the ways diagnosis hurts people. Instead, the PLAN T Alliance
decided to take action. Two actions are for those professionals who use
the DSM to boycott it and for Congressional hearings about psychiatric
diagnosis to be held.
The federal government through Medicare, Medicaid, the military, and
Veterans Affairs relies heavily on the DSM, as do many hospitals, clinics,
and other practices, which is the reason for the focus of the boycott on
the DSM. This should not be taken to indicate that the International
Classification of Diseases (ICD), which also includes some psychiatric
categories, is based on science and does not cause harm. But the initial
target of the boycott is the DSM, because it garners huge profits for the
American Psychiatric Association, which is actually a powerful, wealthy
lobby group. It remains to be seen what is done with the profits from the
ICD, but perhaps its publisher, the World Health Organization, uses them
for compassionate purposes. Find a Therapist
The rationale for calling for Congressional hearings is that no entity
regulates psychiatric diagnosis, and because of its lack of scientific
basis and the harm it causes, we need a national airing of whatever anyone
would like to say about it.
Those who report feeling relieved to be given a label for their suffering
can testify, as can those who report that they were harmed. (The former
ought, however, to be given the option of hearing from us, "We will listen
to you and believe that you suffer and will try to help you without
requiring you to accept a psychiatric label."). And this would lead to a
national conversation about how to prevent the harm and still provide help
and support for those who suffer. (Many such ways are already known, of
course.)
The PLAN T Alliance petitions are:
Boycott the DSM
http://www.change.org/petitions/boycott-the-dsm
and
Call for Congressional Hearings About Psychiatric Diagnosis
http://www.change.org/petitions/everyone-who-cares-about-the-harm...
Another kind of action, one in which anyone can take part in various ways,
is MindFreedom International's "5/5 Against DSM-5," a protest that will
take place in and around May 5, 2012, in Philadelphia, when the American
Psychiatric Association will vote on whether to accept the proposed
contents of DSM-5 and send it to press.
MFI will have space near the convention for people to assemble to make
speeches, do performances, and there will be events right in front of the
convention area itself. Information will increasingly appear on the MFI
website at http://mindfreedom.org/
My own view, first expressed in 1995 in They Say You're Crazy, has long
been that lawsuits would potentially be the most effective way to stop the
harm from psychiatric diagnosis. In a later essay, I may write further
about this.
In the meantime, it remains to be seen whether the APA divisions' petition
or the above-described kinds of action will be effective, but not to act
is to be complicit with the destruction of people's liberty, health, and
peace of mind through psychiatric diagnosis.
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Copyright 2011 by Paula J. Caplan
All rights reserved
