Psychiatry

Comedy, History, and the Future of Mental Disorder Labels

Strange Goings-on in the New York Times about Psychiatric Diagnosis

Posted March 24, 2013

Today (March 24, 2013) the New York Times devotes its Sunday Dialogue column to the topic of psychiatric diagnosis, and my essay here – which will be the first of two about that column – is focused on the comedy…or perhaps the irony.

Last week, an announcement went forth about the topic for today’s Sunday Dialogue, including the information that the column would begin with a statement by Dr. Ronald Pies, in which he defended the use of psychiatric diagnosis, a topic in the news as the next edition of the psychiatric manual, known as the DSM, is scheduled for publication in May. Pies’ statement was in fact strongly supportive of psychiatric labeling, and the New York Times editors wanted people to send in responses to the Pies piece, some of which they would publish.

The first source of amusement: This was apparently the same Ronald Pies who just over a year ago wrote “Why psychiatry needs to scrap the DSM: An immodest proposal,” that can be found at http://psychcentral.com/blog/archives/2012/01/07/why-psychiatry-needs-t… How curious that he would within just over a year write articles in which he takes two such opposite approaches. Why might that be? I will not even speculate. It was interesting that the sources he cited in his critique of the DSM did not include those who have shown over decades that psychiatric diagnosis is not scientifically grounded, does not improve outcome, and carries immense risks of harm. One had to wonder why he cited Allen Frances, who as head of the current edition of the DSM was responsible more than any human being in history for the diagnosing of millions more people than ever before as mentally ill. Frances is a johnny-come-lately to a critique of psychiatric diagnosis, and his is very partial and inconsistent.

Many readers, seeing the New York Times announcement last week, wrote to urge me to write a response and send it to the Times, because I had served for two years at Frances’ request on committees tasked with writing the current DSM, resigning in horror when I saw how fast and loose they played with the science and how they ignored the evidence I presented of the harm caused to so many people because of being psychiatrically diagnosed. (I wrote about this in They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal and in an edited book, Bias in Psychiatric Diagnosis.)

I submitted a response to the New York Times and received a notice that it was being considered for possible publication in the print and/or online versions. It had been shortened considerably. Last night, many people emailed me or posted on Facebook that they were pleased to see that my response had been published. It turns out it was published only in the online version, and neither my response nor that from Laura Delano, a brave psychiatric survivor harmed severely by having been psychiatrically labeled, made the print version. (The online version is at http://www.nytimes.com/2013/03/24/opinion/sunday/sunday-dialogue-defini…) It is interesting that in the print version, only one statement was by a woman.

Back to the comedy, sort of. Years ago, I saw a cartoon of a great many men and one woman sitting around a boardroom table, and the caption, spoken by the Chair of the Board, was something like, “Thank you for that excellent suggestion, Ms. Jones. Now, just as soon as one of the men makes it, we can act on it.” Many people who have been harmed by psychiatric diagnosis belong to the Facebook page called Stop Psychiatric Diagnosis Harm or the one called Occupy Psychiatry. Some of them, after reading Allen Frances’ Sunday Dialogue response, wrote to me, worried that they were having disconcerting déjà vu experiences. They saw that Frances suddenly opines today that a Congressional investigation of psychiatric diagnosis is needed, but they would have sworn that as long ago as 2002, I had organized the first of two Congressional briefings about that very subject.(1) At the time, those who wrote to me thought they recalled, neither Frances nor his DSM predecessor, Robert Spitzer, had been willing to acknowledge the unscientific, unhelpful, and harmful nature of their editions of the DSM. They only began to do that a few years ago, when they no longer belonged to the DSM in-crowd and suddenly were shocked, shocked to discover the truth about psychiatric diagnosis. I told those who wrote to me that they were remembering the history correctly.

Those who wrote to me asked if Frances were aware that many years ago, at psychdiagnosis.net, I had started a petition – signed by many wonderful individuals and heads of organizations – calling for Congressional hearings about psychiatric diagnosis. Sure he did. But he never signed. Nor did he or Spitzer sign the one I created in December, 2011, at change.org that is called “Call for Congressional Hearings about Psychiatric Diagnosis” and is still there if either of them – or anyone else – would like to sign. (http://www.change.org/petitions/everyone-who-cares-about-the-harm-done-…)

What prompted me to organize those Congressional briefings, as well as the late-1980s petition challenging DSM categories (which resulted in signatures from individuals and major organizations representing a total of six million people) was the utter disregard by Frances and Spitzer and their cronies of the urging to come clean about their manuals and to try to prevent further harm and redress the harm their editions have caused. In fact, for all their railing about how bad the forthcoming edition will be – and truly, their critiques have often been equally applicable to their own editions, something they only intermittently or quite minimally mention (usually, in Frances’ case, blaming others and saying he could not have foreseen the harm that would be caused, though he had been given ample evidence of harm in plenty of time to have prevented more) – they have yet to call for the American Psychiatric Association, publisher of and profiter from the DSM – to solicit and collect and publish reports of harm from the manual. And where are their calls for the APA – or they themselves as the former DSM head honchos – to prevent and redress further harm?

In the years since the briefings I organized, not one of the many members of Congress I have contacted has been willing to push for Congressional hearings. Whichever party is in the minority in the House or the Senate cannot make the hearings happen, and members of both parties in the respective majorities there have said there are too many important things happening for them to focus on psychiatric diagnosis. This is troubling, because half of all Americans will be psychiatrically labeled during their lifetimes, and people have, as a result of being diagnosed, lost jobs, custody of children, health insurance, and the right to make decisions about their medical and legal affairs. Victims of sexual assault in the military have had diagnoses used against them, to cast their understandable upset about being assaulted not as understandable but as proof that they have personality and/or serious mood disorders and thus will not have support and help from military or VA mental health professionals paid for. These labels have been used in fact to deprive them of security clearance and career advancement, even to turf them out of the military. (On Youtube under the title “Watch the Stories of Harm the APA Refused to Hear,” you will find a number of brief videos of some of the people who have been variously harmed. Please watch them, then email, post, or tweet about them, please, to help educate the public about these dangers.)

Psychiatric survivors also wrote to me recently, concerned that they might have memory problems, when they read a piece by Frances in which he calls for a black-box warning on the DSM. They thought that psychiatric survivor and veteran Jenny McClendon and I had called for that very black-box warning previously, in a document called “The Need and the 9 Demands” that we attempted (unsuccessfully) to deliver to APA Headquarters. (The story of this and the full text of “The Need and the 9 Demands” is at Caplan, Paula J. (2012). The APA refuses to listen to the voices of those harmed by diagnosis…and refuses and refuses. Mad in America: Science, Psychiatry, and Community. November 19. http://www.madinamerica.com/2012/11/the-apa-refuses-to-listen-to-voices… These survivors’ memories were not impaired. They were right. (Think back to the cartoon described above.)

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I have tried many times in the past to work with Spitzer and Frances and now hope that, despite the partial nature of their critique of psychiatric diagnosis and what may be their understandable fear of what a Congressional investigation might turn up, I hope they will join me in spreading the word about the abovenamed petition and also, given the snail’s pace at which Congress too often moves, and also take immediate steps to implement measures for documenting, publicizing, and redressing the harm done to so many by psychiatric diagnosis, as well as warning of the harm that will continue to be done.

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(1)Caplan, Paula J. (2002). You, Too, Can Hold a Congressional Briefing: The SMCR Goes to Washington About “Premenstrual Dysphoric Disorder” and Sarafem. The Society for Menstrual Cycle Research Newsletter, Summer, 1-5.

--Reprinted in Women’s Health: Readings on Social, Economic, and Political Issues. Fourth Edition. Nancy Worcester & Marianne Whatley (Eds.). Kendall-Hunt: Dubuque, IA, pp.246-9.