APA Does Not Care about Weaponized Diagnosis

Note: This essay was first posted November 11, 2012, at http://whenjohnnyandjanecomemarching.weebly.com/blog.html under the headline: Psychiatrists' Major Lobby Group Does Not Care about "Weaponized Diagnosis"

Let us put ourselves in Jenny McClendon's place...and think how we would feel. And at the end of this article, you will see what some have recommended in order to right the kinds of wrongs to which she has been subjected.

Jenny is one of nine people who filed groundbreaking complaints last summer with the ethics department of the American Psychiatric Association, the powerful and totally unregulated lobby group that publishes the "Bible" of psychiatric diagnosis and reaps the more than $100-million profit its current edition has earned. That manual has made Jenny's life a living hell, as it did for the other complaints (sometimes colloquially called "The DSM 9"). And the APA has just summarily dismissed all nine complaints without regard to their merits, that is, without showing the slightest concern about the suffering it has caused. The array of kinds of harm done to the complainants because of being diagnosed as mentally ill is chilling.

At http://www.madinamerica.com/2012/10/p20137/ you will see more description of the APA's cold-blooded, minimalist communications about these complaints, and soon I will report the details of their bizarre but not surprising dismissal, as well as the responses to the dismissal.

At http://www.youtube.com/watch?v=9mihEgmfQKA there is a brief video in which I explain some of what has happened with the complaints and in the coming weeks you will see posted many of the videos by some of the complainants as they tell their stories. Jenny is the only veteran among the nine, and the irony that her case was among the nine dismissed just before Veterans Day is not to be missed.

Jenny McClendon has bravely given me permission to use her real name here, and she has spoken about some of her story on CNN. As you read on, notice how much trouble she needlessly suffered because, instead of listening to the terrible things that befell her and offering appropriate support and help, she was diagnosed as mentally ill.

While serving in the Navy on a ship at sea, Jenny's work center supervisor repeatedly raped her. Later, someone else in the Navy raped her at a shore installation. Understandably, she began to feel constantly on high alert, to struggle with frequent sleeplessness, to have flashbacks during which she loses track of where she is, and to have "profound nightmares." Now, years later, these forms of suffering have never gone away, although she has worked long and hard to find ways to get through these consequences of the rapes and has brought them under some degree of control.

We might have expected that the Navy psychiatrist she saw would tell her both that her responses were totally normal, given the trauma, and that indeed they are ways that people actually resist being further damaged emotionally and try to recover. This morning, Jenny wrote to me that when she sought help, she hoped that, after the total powerlessness and helplessness of rape, the therapist would offer her some kind of "empowerment,...even some sleep." What she got instead was the announcement that she was mentally ill. . She says, "I was treated like trash." Specifically, the psychiatrist told her she had "Bipolar II Disorder," one of the more severe-sounding categories. It is all too common for therapists (not just psychiatrists) to classify people as mentally ill, even when their feelings are completely understandable. And as nearly always happens these days once a person is given any diagnosis of mental disorder, the psychiatrist put her on psychiatric drugs: "Pills were practically thrown at me. I had no idea how dangerous these pills were." But being already in an intensely vulnerable state because of the rapes, and, like most laypeople (and many professionals), having no idea that psychiatric diagnoses are extremely unscientific, are unlikely to improve outcome, and carry many risks of harm, she believed that the authority responsible for her care knew what she was doing. She took the pills, Zoloft prescribed after she was raped at sea. She was still taking the Zoloft when the next rapist attacked her. During that last rape, her heart pounded, and she felt a number of what she calls "hyper sensations" (likely what is technically called akathisia, an intense agitation) that she finds hard to describe but that she has been told can come from Zoloft itself, from being raped, or from a combination of the two. Sometimes, she would detach from her feelings, become inexpressive, and go numb, other common reactions to sexual assault.

When she became a veteran and thus under the VA's care, she sought help with her ongoing problems from the Department of Veterans Affairs Trauma Clinic in Washington, D.C. The intake interviewer, learning that she had been diagnosed with Bipolar II after being raped in the Navy, attributed to this alleged mental illness the fact that Jenny was continuing to suffer and did not fight off her second rapist, rather than attributing these problems to the awful shock of being victimized yet again or to the Zoloft or both. When she refused to take the whole array of psychiatric drugs prescribed for her. she was treated as an unreasonable and difficult patient, something that is far more likely once a person has been diagnosed as mentally ill.

Another VA therapist added a second severe diagnosis — Borderline Personality Disorder — rather than considering Jenny's suffering as the result of the rapes and the subsequent mistreatment of her in both the Navy and VA systems.

Of course the Navy therapist and VA staffers Jenny saw ought to have known better than to do what they did. But their ammunition was what Emmy-winning composer and co-producer of the important film, "SERVICE: When Women Come Marching Home," Patricia L. Stotter calls "weaponized diagnosis." Just imagine: If the American Psychiatric Association had not been wildly successful at persuading professionals and the public that its diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is scientifically grounded, helpful, and not harmful, then the therapists would have been much more likely to consider Jenny's reactions to being raped as understandable and to be deserving of support and the many kinds of assistance -- such as what rape crisis centers give -- that actually help move victims toward healing.

Jenny reports that the Borderline diagnosis can limit benefits that would have been available to her at the VA if she had been described as traumatized by events during her military service rather than allegedly suffering from a lifelong personality disorder. No one thought of diagnosing her when she enlisted in the military, but the military and VA frequently pathologize people whom war or military sexual trauma have harmed, because that gives them an easy way to avoid paying benefits. They just say the person's suffering is not "service-connected." As for the Bipolar label as Jenny writes that legal redress "is often foreclosed because reviewing courts themselves regard the Manual's diagnostic pigeonholes as 'authoritative,' holding that 'the inclusion of bipolar and depression in the [DSM] lends further support [to] the characterization of these disorders as mental. conditions.' Michaels v. Equitable Life Assur Soc'y, 305 Fed. Appx. 896, 906 (3rd Cir. 2009)."

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Here is more of Jenny's story:

"After being dismissed from the Military Sexual Trauma Clinic, I was afraid to accept treatment at the VA, because I was afraid that I would be billed for services for problems that, because of the Bipolar II label, were not considered service-connected, and I cannot afford to pay cash for VA services.... This problematic Borderline diagnosis could also threaten my federal security clearance and therefore my job. ...I may have lost benefits at the VA, which may result in a pricey bill for services from the VA."

Here she lists many of the losses she has suffered:

"-My understandable reactions (mood and behavior) about the repeated sexual assaults were discounted or minimized by the focusing on my allegedly having Bipolar Disorder, and this was dehumanizing and otherwise upsetting.

-I was denied treatment on the grounds of allegedly having Borderline Personality Disorder.

-My refusal to take psychiatric drugs was pathologized because of my having received these two psychiatric diagnoses, rather than being regarded as a reasonable request from a person who was not mentally disordered.

-I have steered away from seeking services at the VA to which I would be entitled had I not been diagnosed with these two labels, because both of them imply that my upset was not service-connected but instead due to abnormalities in my brain or to chemical imbalances within me. Problems not classified as service-connected do not carry treatment that is covered by my VA benefits, so I would have to pay out of pocket. While seeking services at a VA currently, I may therefore end up having to pay for those services.

-Being diagnosed with Borderline Personality Disorder could cost me my security clearance and therefore my job, and this causes me intense apprehensiveness.

-Being diagnosed with Borderline Personality Disorder could result in my losing custody of my children, and this causes me intense apprehensiveness.

-I am concerned that I might be denied treatment again because of the two unwarranted “pre-existing conditions” with which I have been diagnosed."

It is worth noting that the therapist Jenny currently sees -- as much to deal with all of the fallout from diagnosis as with the original rape trauma -- does not believe she is mentally ill. A personality disorder is defined as a lifelong set of problems, so by definition, if she had Borderline Personality Disorder, she would still have it. The very low probability that any two therapists will give the same patient the same label was revealed decades ago. Some complainants were given two, three, or four labels, had some deleted or still more added, then had their labels altered yet again. The whole thing is not simply absurd but frankly destructive and dangerous.

Weaponized diagnosis can target anyone, veteran or civilian. Since this is Veterans Day, we must recognize that Jenny's story is just one among countless veterans -- both women and men -- for whom psychiatric labels have led to shocking mistreatment at the same time that their real problems were ignored and likely approaches to healing were simply not tried. And the number of nonveterans also harmed by being pathologized is legion. How large are the numbers? No one knows, because the APA is unlike even the pharmaceutical giants or the financial institutions, in that Pharma and Lehman are at least minimally regulated or at least in theory subjected to some regulation. But neither the APA nor anyone else has bothered to try to document the harm.

Imagine that, like Jenny -- or like the complainants who lost custody of their children or their jobs or their health insurance or their homes or every shred of self-confidence and self-respect...or lost a loved one who died...because of being psychiatrically labeled -- you painstakingly and bravely write your story, simply asking for those responsible, the APA's Ethics Committee, to take responsibility for the harm and to take steps to redress some of it. Imagine hoping against hope that those whose work and cover-ups are the first cause of the diagnostic damage done to you will care enough to respond with some shred of humanity. Imagine that, after waiting nearly four months, you receive -- not even through the courtesy of an individual letter but just one email sent to all nine complainants -- a single paragraph of dismissal that contains not the least indication of the realities of their lives. Various complainants feel wounded, rendered invisible, aghast, and enraged. As Jenny wrote tonight:

"A capricious dismissal of legitimate claims is not ethical. How can the APA masquerade as an entity that honors a commitment to help people when they did nothing to contact any of us or tell us when they were planning to meet. Secrecy and collusion appears to be the only transparent quality of the APA ethics committee. I felt dismayed and powerless."

The Grassroots Group to End Harm from Psychiatric Diagnosis, whose website is psychdiagnosis.weebly.com -- where many stories of harm from diagnosis of civilians as well can be read --- has a suggestion for people who are troubled by the APA's failure to take action to redress the harm to the complainants or to prevent harm to others. They urge concerned citizens to ask the APA to overturn its summary dismissal of the complaints and instead give serious consideration to their merits by doing any or all of the following: (1) emailing Linda Hughes, who is apparently the head administrator in the APA's Ethics Department (the names of the psychiatrists who make up the Ethics Committee that is tasked with reviewing complaints were not disclosed to the complainants, despite their repeated requests), Colleen Coyle, the APA's General Counsel, and current APA President Dilip Jeste at "Linda Hughes" <LHughes@psych.org>, "Colleen Coyle" <CCoyle@psych.org>, and djeste@ucsd.edu; and (2)making the same requests to them by telephone at 703-907-7300 (for Hughes and Coyle) and at 858-534-4020 for Jeste).

Watch this space for updates in the coming weeks.

©2012 by Paula J. Caplan All rights reserved