published on May 21, 2013 by Paula J. Caplan, Ph.D.
in Science Isn't Golden
In recent weeks, as the publication of the psychiatric
diagnostic manual called DSM-5
approached, and media people paid it much attention, people who know that my work on exposing the truth about psychiatric diagnosis began more than a quarter of a century ago (1) have contacted me to ask why I was not adding my voice to the brouhaha.
I was aware of two of the answers to their question: (i)I had nothing to say beyond what I have been saying for decades, and (ii)I am busy.
Then I realized there was another: I was experiencing a kind of existential nausea, watching the sound and fury whipped up by both DSM
advocates and critics and by the media. Why the nausea? I struggle constantly against becoming jaded, but when for decades you've seen powerful people get away with distortions and even lies, lies that hurt the people they profess to help, it's hard not to want at times to flee from the field. In all the frenzy, what was appallingly left out -- as it has always been from the activities of those who have the power to make real change -- was any real work to redress the harm done on the basis of psychiatric diagnosis over decades to living, breathing human beings. More about this later.
Most of this essay will be the words of one of those who has been so harmed and who wrote to me out of her own existential nausea as the harm done to her by diagnosis continues, seemingly never to end. That is where the attention of all of us should go and remain.
At one point, I thought maybe I should write something more. It was when a top dog at the National Institute of Mental Health -- shortly before the manual's publication -- dissed the DSM-5
, noting that it lacks validity(2) and announced that the NIMH was going to develop its own method of psychiatric classification, and from his description, it looked like their emphasis would be heavily weighted toward looking for brain- and other biologically-based sources of emotional problems.
I was inclined to write an essay to point out that there was no sign in that announcement that the NIMH heads were aware of the wealth of solid evidence that nonbiological factors such as violence and other kinds of trauma
and oppression, as well as other social and environmental factors, cause vast amounts of human suffering that is manifested in a wide variety of ways. Why would the NIMH not announce that they would focus at least in part on such factors and on the well-documented ways of helping people heal when those are the causes of their pain?
I also considered writing an essay in which I would ask what took the NIMH so long to pronounce the DSM
undeserving of its support. I wondered why -- given that the NIMH had given the DSM
folks huge amounts of money to work on the new edition of the manual, which promised to earn the lobby group called the American Psychiatric Association vast profits from the book -- they would at this late date announce that the manual sucks. Since the NIMH is the U.S. government
entity with the greatest responsibility for funding and overseeing research about mental health, NIMH head Dr. Thomas Insel had either (A) been totally irresponsible in failing to notice long before this that no edition of the manual, and certainly not this one, had been shown to be valid, that is, to be useful for reducing human suffering or (B) concealed his knowledge of its lack of validity until the last minute, a concealment for which there could be no legitimate reason.
Then, within a few days, Insel pretty much recanted. He and the current APA president issued a joint statement in which they declared that the DSM
-- as well as the International Classification of Diseases
(the World Health Organization publication whose psychiatric section is purposely nearly identical to the DSM
) -- "represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM
is the key resource for delivering the best available care" (3). Good God: They promise that it helps! Did Insel suddenly discover that the DSM
is valid, really does reduce human suffering? Was his earlier announcement based on a whopping mistake? Clearly not, since, as noted, there is no evidence that the manual is helpful in that way. When I try to think why Insel would recant -- a recanting that is nothing less than
an attempt to cover up the dangers of psychiatric diagnosis -- the nausea intensifies.WHAT REALLY MATTERS
Please join me in focusing on what is most important, which is to listen to the voices of the many whose lives have been ruined in a cascade of events that began with psychiatric diagnosis as the "first cause." As you read the recent, heartfelt emails one such woman sent to me, I ask that you not forget that most of us never hear from most of those who have been so harmed.
Certainly neither the previous DSM
editor Allen Frances (who more than any individual in history is responsible for the psychiatric diagnosing of millions more people than ever before and who alternates between trashing psych diagnosis overall and falsely claiming that his edition of the manual was based on scrupulously scientific procedures) nor the DSM-5
heads nor past or current APA presidents or trustees has proposed any mechanism for seeking out and documenting instances of harm or any mechanism for redressing past harm. Frances very recently repeated my much earlier proposals for blackbox warnings on the manual and suggested Congressional involvement. This guy loves my ideas! I had organized two Congressional briefings starting in 2002, have for a decade had a petition calling for Congressional hearings about psych diagnosis, posted another such petition at change.org in December, 2011 -- but he has fled from working with me to make real change and appears not even to have signed these petitions.
No one currently or formerly part of a DSM
project nor anyone in the APA has acted on the requests made by the "DSM-9," those who filed ethics
complaints about harm from diagnosis with the APA's ethics department. The requests included vigorous attempts to gather and make public information about harm from diagnosis, steps to prevent future harm, and steps to redress harm already done.
Now see what one person wrote to me on May 15 -- in the midst of the DSM
media circus:My therapist asked me today, why, if I don't agree with the bipolar "diagnosis", do i cash the social security check I receive each month...my main source of income...the only income I had once I was labeled bipolar as an adolescent and the drugged into total disability for over 15 years of my life. During that time, I couldn't work or get through college even though I maintained a 4.0 while I was there. But I was loaded up on debilitating drugs and shuffled through the system's revolving doors, where I was taught over and over that the best I could hope for was to take the "medication" and "maintain in the community". I was violently assaulted by staff and have permanent injuries, terrorized, threatened, humiliated and degraded in that system. I was never safe.I don't feel safe from them to this day. I don't think I'll ever feel safe from them again and all the harm those dehumanizing, reducing labels have brought to my life. And this one person who is supposed to be able to listen and not judge and maybe help me move past that trauma, just wants to use the same labels in response to the effects of the trauma they caused. I never got that label until they drugged me. There's no help out there for psychiatric trauma. There's none. I barely make ends meet and pay for therapy out of that social security check and my part time work. I work that job just to cover the therapy. My finances were destroyed when I was being drugged and locked in hospitals 3-4 times a year. I have almost no work history at all, because they turned me into a professional patient. I can't even get a job on the books without having income seized. I can't even afford bankruptcy, and I can't get it through legal aid, because according to them, I "have nothing to lose". They have to help people who could lose their homes and cars and other assets. I have a studio apartment and a leased car and about $80,000 in student loan debt. I have diabetes from the psych drugs, and no health insurance. Why do I cash in on the social security check that lets me survive after all that was taken away from me?What am I supposed to say to that, and why do they insist on pathologizing with these fake "diagnoses"? They took everything, but my feelings about it all are unreasonable and excessive. Survivors of psychiatry are invisible and unheard. That doesn't change. After today, I know I'm never going to escape it. Never.And all I can think of is thank god you're doing the work you're doing. Thank you. You'll be able to save some people from the practices that have killed my friends and will eventually to kill me.
And later that day, in response to a reply I sent her, she wrote:It's like you're the only person seeing the harm or listening to us when we tell our stories. There's a clip on the youtube Recovery and Hope channel from a talk you gave on this topic that I watch over and over again at times likes this, just so I know that it's not me being crazy with my ideas about the harm. I even sent it to my therapist today.I was about to send her a message earlier, telling her that after today, I realized it was not going to work out and that I think we should terminate, when the phone rang, and she was calling to tell me she'd be away next week and had forgotten to tell me today. So, I told her right then and there on the phone that it's time to start termination. And she suddenly changed her whole tune. She wanted to know why. I explained yet again, and this time she was telling me that I explained it to her in a different way, and that I was having a breakthrough with how I communicate, and that we could work on this or that if I wanted and...blah blah blah. I was stunned. But when I talked a little more about the problems I am having with her pathologizing language and her dismissal of my lived experience, even about the harm done by diagnosis and how the DSM is a load of crap, she got very defensive again, and said then maybe we aren't a good fit due to "the differences in our philosophies". I have lived experience. This is my trauma we're supposedly working to resolve. It's not just a philosophy for me. But every single time this comes up, she will repeat back how awful and terrible it is that I had those experiences and then comes the BUT........."BUT, other people think diagnosis is helpful. They also find medication very useful. They can get out of bed and function because of it." etc. This is followed always with the statement that I am just generalizing based on my own experience. What is she doing with hers? So, again we came back around to me saying I think it's just time to terminate, and again...she changes her stance with me. I am confused. I don't know what she is doing. I know what she believes she is doing. She thinks she is pointing out some kind of faulty thinking, and that my inability to accept, or frankly, even tolerate her imposition of her own philosophy onto to my lived experience is just emotional "reactivity" and "mood swings" on my part, both related to some category in the DSM, which she believes is a valid and reliable and useful diagnostic tool. We just go around and around.I don't see her again until the 29th, because she'll be away, and I'm relieved. As it stands, we left it that we'll see how things go, but I said I'm leaning towards termination. After talking to my sister tonight and going over all of this, I know I need to definitely begin terminating when I see her again. It's just re-traumatizing me.I've looked into other therapists, but even with a sliding fee, I really can't afford anyone else that I've found. Aside from that, I just can't do this anymore. No one gets it. I can't put myself through it anymore. Realizing that I can't have the help I need is the hardest part, but I've realized I will only continue to get hurt worse if I keep trying, and I have so many other things I need, that the money is better spent elsewhere.It would also be okay to share [my emails on your Psychology Today blog]. It would be helpful, because no matter what, when survivors tell our stories, we mostly don't get heard at all. I just feel de-voiced and paralyzed.
(1) See, for example, Paula J. Caplan. (1995). They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal.
(Addison-Wesley), as well as many essays on this blog.
(2)http://www.reuters.com/article/2013/05/17/us-science-psychiatry-dsm-idUSBRE94G04420130517 and http://www.nimh.nih.gov/about/director/2013/transforming-diagnosi...
©copyright 2013 by Paula J. Caplan All rights reserved
Originally published on March 30, 2013, here.
(This is the second of two essays about the New York Times
' Sunday Dialogue called "Defining Mental Illness.)The New York Times
asked psychiatrist Ronald Pies to write a statement about psychiatric diagnosis for its March 24, 2013, Sunday Dialogue, and his statement was sent out ahead of time with invitations for others to respond. Some responses would be published right below Pies' piece, and Pies' answer to those responses would wind up the section.
Pies was an interesting choice. His Sunday Dialogue statement was a written as though psychiatric diagnosis were as scientifically grounded as clearly medical problems such as migraines — he says that psychiatric diagnoses are made like diagnoses of migraines, in that they are based on patients' history, symptoms, and observations — and that, if done carefully, assigning such diagnoses can even be humanizing, because patients are relieved to have their suffering given these labels. (For instance, he writes that it is important to tell one diagnosis from another but neglects to mention that the scientific research has shown conclusively that psychiatric diagnostic categories overlap hugely with each other as well as with clearly nonpathological behavior and feelings.) It is reprehensible that he failed to disclose the now well-established facts that psychiatric diagnosis is unscientific, does not reduce human suffering, and causes many kinds of serious harm. What is downright weird is that just over a year ago, he published a strong critique of psychiatric diagnosis (http://psychcentral.com/blog/archives/2012/01/07/why-psychiatry-n...
) called "Why Psychiatry Needs to Scrap the DSM System: An Immodest Proposal," in which he advocated doing away with that system in favor of carefully listening to the patient and trying to understand them rather than label them.
After his Times
piece appeared, I wrote to draw the attention of the newspaper staff to his striking and total inconsistency, andI asked if they publish letters to the editor about Sunday Dialogue so that this could be made known. The response was that they do not publish letters about that column but that in any case they would not do so "mainly to attack the credibility of the writer; we prefer that the focus stay on the issue." How strange to cast my query as attacking the credibility of the writer rather than to make the point that readers have a right to know when someone given the prominent position of authorship of the lead piece in their special feature totally contradicts himself, because that surely sheds light on the way the issue is addressed.
The first "reader's" reaction printed was by Allen Frances, hardly an average reader, given that he headed the group that wrote the current and previous editions of the diagnostic manual. Frances, whose manuals are responsible for millions more people being pathologized than at any time in history, actually complained in the Times
that "the realm of normal is shrinking." Less than anyone on earth should he be surprised. When at his invitation I served on two of his committees and repeatedly sent evidence of the abysmal quality of the "science" he was using to create and justify diagnoses and the devastation caused to people, he not only ignored but actually publicly denied that that was true. (That was why I resigned from his committees, feeling it was unethical and unprofessional to participate in that enterprise.) Even today, he professes to have had no way to predict how many more people would be diagnosed, despite his having added 77 categories to the 297 in the edition published just seven years before. (see Paula J. Caplan. 1995. They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal
In the Times
piece, Frances called diagnosis "the essential prelude to effective treatment," though he more than anyone has seen ample evidence that this is untrue. In fact, the chances even that two therapists simultaneously meeting with the same person will assign that person the same label are poor, which of course means that diagnosis is not helpful in choosing treatment or improving outcome. (see Caplan, 1995, as listed above)
And Frances is a Johnny-come-very-lately when in the Times
he presents as his own, new idea the proposal for Congressional action that I had initiated in 2002 with the two Congressional briefings I organized while he would continue until recently to defend uncritically his diagnostic empire. He seems to love my ideas, though, because also very recently, without attributing this one to me either, he suddenly proposed that the DSM carry a blackbox warning, one of the nine demands in "The Need and the 9 Demands" documented that I had written and that Jenny McClendon, Leah Harris, Debra Turkat and I had attempted to deliver last November 13 to APA headquarters (http://www.madinamerica.com/2012/11/the-apa-refuses-to-listen-to-...
). One can only hope that soon he will act on the pleas issued to him more than a quarter of a century ago, that he act to prevent future harm and redress harm that his editions have already caused. Instead, his emphasis is on trashing the next edition of the manual, which will indeed be terrible, in large part (though not entirely) because it is likely to include so much of the content of Frances' editions.
The next response in the Times
feature came from Sera Davidow, who wrote as one who was diagnosed but who now directs "a recovery community for others who have been so labeled." She decimated Pies' absurd attempt to draw an analogy between psychiatric categories and migraines by saying that no one "attempted to hospitalize or medicate me against my will for [migraines]," and she describes how a person's psychiatric label often becomes their sole and demoralizing identity.
After Davidow's response came one from Patrick Singy, a historian and philosopher of science, who emphasized the need "to reflect on the much larger ethical, legal and social consequences of creating (or deleting) diagnoses."
Psychiatrist and psychoanalyst Leon Hoffman urged that each person be approached not for purposes of choosing a diagnosis but "as a unique individual" who, with the therapist, will decide on the best treatment.The New York Times
includes in its print edition only some of the responses they post online. My own did not appear in the print edition but followed Hoffman's online. Because some people have asked me about this, I can tell you that I have no idea how they choose which ones will appear in print, but it troubles me that only one response in the print version was from a woman. This is the version, slightly shortened from what I submitted, that appeared online:
"Surprising though it may seem, psychiatric diagnosis is not scientifically grounded, does not reduce human suffering, and carries risks of a wide array of serious kinds of harm. Even more disturbingly, it is totally unregulated, making it even less regulated than the financial institutions in this country.I served for two years on two committees that wrote the current DSM but had to resign on ethical and professional grounds when I saw the way they ignored or distorted what high-quality research showed but presented junk science as though it were good when it suited their purposes.The potential damage caused by a diagnosis is virtually limitless, including loss of custody of a child, loss of employment, skyrocketing insurance premiums, and loss of the right to make decisions about one's medical and legal affairs."
Omitted from my list of kinds of harm was the ultimate one: The physical death that too often results from various consequences of psychiatric diagnosis, sometimes caused by the unwanted effects of psychiatric drugs (and their interactions with each other) and sometimes from other causes, with the diagnosis always as the first cause.
Also appearing online but not in print was Laura Delano's description of how her initial relief at being diagnosed as mentally ill soon gave way to her feeling "stripped...of an authentic sense of self and of a connection to those around me, because my 'condition' made me different. Only in leaving behind that psychiatric
diagnosis and the treatment it required did I find a path through my emotional struggles to the other side, where I could accept myself as I was, and be fully human again."
Two more responses appeared only online. Psychiatrist Michael F. Grunebaum was an argument that psychiatric diagnosis is a work in progress "with the shortcomings of any human endeavor in which scientific knowledge is incomplete." He apparently is entirely unaware that the DSM
is not based on solid scientific knowledge, in contrast to being simply incomplete, and that difference matters enormously. Just ask the people whose lives have been ruined because of the mistaken belief that the labels they were given were scientifically supported and would lead to better things. The other response was from psychiatrist Victor A. Altshul, who pointed out how his profession has horribly stigmatized -- through diagnosis -- large groups of people. And he eloquently echoed the point that people are not their diagnoses: "It's all very well for a patient to know what he [sic] 'has.' But what he [sic] really needs is to know who he [sic] is. When that happens, the 'diagnosis' tends to disappear. It's just too little an idea to account for human complexity."
Finally, there came Pies' response to a few of the comments. Unsurprisingly, he selectively agreed that diagnosis leads to effective treatment, despite the absence of data supporting that claim. He took offense at Ms. Davidow's comments, claiming that it is "unfair" to blame psychiatric labels for the abridgement of civil liberties and excesses of the drug companies and that instead one must blame Pharma. It is nothing less than unconscionable for him or Frances or anyone else to try to steer the blame away from diagnosis, because psychiatric diagnosis is the first cause of virtually everything bad that happens in the mental health system
. Few, if any, people have been deemed psychiatrically normal but then had terrible things done to them in the name of treatment or protection of themselves or others.
©Copyright 2013 by Paula J. Caplan All rights reserved
Strange Goings-on in the New York Times about Psychiatric Diagnosis This blog post, of relevance to active duty military and veterans, was first published March 24, 2013, here.
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 athttp://psychcentral.com/blog/archives/2012/01/07/why-psychiatry-n...
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 athttp://www.nytimes.com/2013/03/24/opinion/sunday/sunday-dialogue-...
) 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...
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 happenings 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-...
These survivors’ memories were not impaired. They were right. (Think back to the cartoon described above.)
What Will and Will Not Stop Acts of Violence [Please see special mention of war trauma here below.]
Published on January 21, 2013 by Paula J. Caplan, Ph.D.
in Science Isn't Golden
at http://www.psychologytoday.com/blog/science-isnt-golden/201301/mlk-birthday-address-stopping-gun-violence Note:
I delivered the following brief address today and was asked to post it here.
Who among us does not yearn when we hear the lyrics of John Lennon's song, "Imagine": "Imagine all the people living life in peace" and "Nothing to kill or die for.
In the nonviolent tradition of Dr. Martin Luther King Jr., whose birthday we celebrate today, and in the wake of the Newtown shootings, we search for ways to live in peace. But the intensity of the outcry about Newtown, which was undeniably a tragedy, also highlights the lack of outcry over decades about the gun violence that has led to the killings of enormous numbers of poor children and children of color.
The money and resulting power of the National Rifle Association (NRA) have gone far to distract us from what really would reduce gun violence: Reducing the availability of guns, especially those with the greatest power to kill. I have read that the rate of suicides by people serving in the Israeli Army led to that army's establishment of this rule: That when their soldiers went home on leave, they had to leave their guns behind. The suicide
rate declined. Find a Therapist
Search for a mental health professional near you.
I am a clinical and research psychologist, so my brief remarks today are about not only the NRA's stupid claim that "Guns don't kill people. People kill people" but also about the widely acclaimed proposals since Newtown for the implementation of background checks on people diagnosed as mentally ill and more treatment of those so diagnosed.
To claim that people who are diagnosed as mentally ill need more help to prevent gun violence is a huge cash cow for the stunningly powerful and wealthy lobby groups for therapists, such as the American Psychiatric
Association and the American Psychological Association, and the drug companies. Anyone who is suffering deserves help, whether it comes from therapists or from others, and I would never want to deny them that help. But would such background checks and increased therapy
reduce violence? Let us look at the facts.
To begin with, people diagnosed as mentally ill are not statistically more likely to be violent. It is especially amazing that this is the case, because increasingly, when someone is charged with a violent crime, therapists are brought in to diagnose them as mentally ill, so there is an apparent but actually artifactual (alleged), increasing correlation of being diagnosed with committing violence.
The RAND Corporation -- not particularly known as a bleeding heart organization -- has made it clear after its staff reviewed the relevant research that a diagnosis of mental illness is not a predictor or correlate of violence, but what are are being male and living in a particular geographic region (http://www.rand.org/blog/2013/01/can-improved-mental-health-care-...
). In some regions, purchasing a gun is much easier than in others.
In the same report, the RAND staff said that it is wrong to assume that mental health professionals have treatments that reduce the likelihood of violence, when in fact they do not. My own review of the research about both predicting and preventing violent behavior is consistent with their conclusions. They say it is wrong to assume that mass killings would not have happened if only the killer's therapist had done some particular thing.
The RAND staff note that there is a "dramatic gulf between what people imagine mental health professionals can do to prevent gun violence and what the current science will support." As a trained clinician, I have been distressed to learn how often people assume that therapists can fix anything. Sadly, we cannot. It is naive and wrong to assume that background checks for potential gun purchasers to see if they have been diagnosed with a mental illness will help.
Huge numbers of people, as I have seen in my four decades as a psychologist, are upset, bereaved, frightened, etc., by life events but should never be diagnosed as mentally ill are given psychiatric labels. So singling out those with diagnoses to try to prevent gun violence gives the false impression that knowing that people have been diagnosed as mentally ill will tell us how to prevent them from committing acts of violence will not in fact reduce violence.
A few further points about psychiatric diagnosis are relevant here. One is that about half of the United States population will during their lifetimes be diagnosed as mentally ill. Imagine the enterprise -- the financial cost and the time and energy -- of doing background checks on 150 million people...and with no chance of using those checks to reduce violence. Another point is that I served for two years on committees that were writing the manual of psychiatric diagnosis, and there I learned that these diagnoses are not scientifically based, and giving someone a psychiatric diagnosis simply does not improve the outcome, does not reduce the person's suffering (Paula J. Caplan. 1995. They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal). In fact, giving these labels can cause a vast array of kinds of harm. To give just one increasingly common example: People who have been devastated by going to war are regularly psychiatrically diagnosed, most often with "Post-traumatic Stress Disorder
," which is officially a psychiatric condition. But being devastated by war is not itself a mental illness; it is a deeply human reaction. And we need to remember that psychiatric diagnosis is also very often sexist, racist, ageist, classist, and homophobic and heterosexist (Paula J. Caplan & Lisa Cosgrove [Eds.]. 2004. Bias
in Psychiatric Diagnosis.).
A final point about being diagnosed with mental illness is that these days, hardly anyone gets such a diagnosis without being put on one or two or three or even many more psychiatric drugs simultaneously. Although these drugs do help some people sometimes, at least for awhile, research has shown that far more often, they do more harm than good (Robert Whitaker. 2010. Anatomy of an Epidemic). Most relevant for why we are here today is that it is well-documented that they increase the likelihood of violent behavior, including both suicide and homicide. It is a secret too well kept that most or all of the school shooters in recent years have been on psychiatric drugs.
Speaking of the question of who is mentally ill, I will close with some words from Dr. King, noting that in today's Presidential Inauguration, much was said about the importance of truly equal opportunity and respect for all, and that needs to include people diagnosed as mentally ill. Remember that the line between the so-called mentally ill and everyone else is too often drawn by the wrong people, especially those who gain financially or otherwise from drawing that line.
Dr. King said: "The saving of our world from pending doom will come, not through the complacent adjustment of the conforming majority, but through the creative maladjustment [my italics] of a nonconforming minority." He also said in a speech to the June 27, 1956, annual convention of the National Association for the Advancement of Colored People: "...there are some things in our social system that I'm proud to be maladjusted to, and I call upon you to be maladjusted to. I never intend to adjust myself to the viciousness of lynch mobs; I never intend to become adjusted to the evils of segregation and discrimination; I never intend to become adjusted to the tragic inequalities of the economic system which will take necessity from the masses to give luxury to the classes; I never intend to become adjusted to the insanities of militarism, the self-defeating method of physical violence." (Many quotations about this subject from Dr. King are available at the MindFreedom.org website)
To reduce violence, we cannot allow the money of the NRA, the drug companies, and the mental health lobby groups to dictate what we do.
© copyright 2013 by Paula J. Caplan All rights reserved
(first posted 12/16/12 at
Reasons for the Rush for Answers to Tragedy, and What To Do Instead
Someone dies. Even if they were very old or terminally ill, although we may not be surprised, the mystery, the incomprehensibility of death itself torments many.
When the deaths are utterly unexpected and totally unprovoked, and especially when they are unbearably young and innocent, a frenzy of "explanations" fills the airways, and neighbors and even strangers ask each other, "Why?"
Our nation perhaps more than any other seems plagued by pressure to seize instantly on explanations, and besides the all-American belief that we can find answers -- solutions -- for everything, there are, I think, two primary reasons.
One is that even many of those who believe in an afterlife find their belief is inadequate to end their grief. Perhaps if there is something to understand, people hope, an explanation will make the grief easier to bear, for in the throes of grief, it is impossible to imagine it will ever be anything less than unbearable.
The other is that we live in a death-avoidant culture, where we often succeed in forgetting our mortality, but we are desperate to know what it is about. The horrible question that war veterans tell us is the most common first -- often only -- questions civilians ask them is, "Did you kill anybody?" Those who have been near death, who have seen it happen or lost loved ones may, we hope, tell us something that makes us less afraid of it. Perhaps at some level, we believe that if we learn more about it from those who have been close to it, we will ourselves escape it.
So we watch and listen and read nonstop, vulnerable to the talking heads' claims that the Newtown youth shot all those people, because he was mentally ill. But to say that the cause of the tragedy was his mental illness explains nothing. One reason is that the huge category "mental illness" has never been defined to the satisfaction of even the therapists with the greatest power to define it (the authors of the handbook of psychiatric diagnosis: see Caplan, Paula J. (1995). They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal.), and since hundreds of millions of people are labeled with one or more kinds of mental illness, but hardly any of them -- no matter which label(s) they have been given -- commits even a single murder, those who say "It's because he was mentally ill" are in fact explaining nothing. It's as though we are saying, "There's something called 'X,' and we kind of, sort of know a little about what 'X' is, and we are experts, but yes, other experts disagree with how we define or describe it, and there is no good evidence that people with, um, 'X' are more likely than other people to do 'Y,' but in this case, 'X' did lead to 'Y.'" This cacophony of arrogant, unthinking "experts" in the media makes me wonder whether producers of these publications and shows ever learned the most minimal critical thinking skills or whether they are simply told to throw critical thinking to the winds in favor of offering apparent answers that hold no water.
Undergraduate psychology students are taught about homunculus theories, theories that are presented as explanations but really explain nothing at all. The word homunculus means little man, and such a theory goes something like this: "Why do people do bad things? Because there is something in them (like a little man) that makes them do bad things." The "explanation" that mental illness was the cause of this school shooting is a homunculus theory.
There are some things we do not understand. Not yet. Perhaps never. Must we stop trying to understand? Surely not. But we must beware of prematurely declaring we have found the answer on the grounds that that's what Dr. _____ said on television.
Thoughts about What We Can Do
We cannot bear feeling helpless in the face of tragedy, and there are actions we can take, although one such action may at first seem like inaction.
Two kinds of action are:
(1)to work hard to reduce the availability of guns and other forms of quick and easy killing
(2)to press for answers to the question of why most media play down the possibility that psychotropic drugs precipitated this tragedy and many like it. Consider that it is rare these days for anyone diagnosed as mentally ill not to be put on one or more or a great many psychotropic drugs and that, as Robert Whitaker documents in Anatomy of an Epidemic, based on World Health Organization and National Institute of Mental Health data, even the allegedly "mild" ones significantly increase acts of violence against oneself and/or others. Consider the enormous and often rapid changes in personality and behavior that psychiatric drugs can cause (see, for instance, the short videos -- and more to come in the next week or two -- in the YouTube series, "Watch the Stories of Harm the APA Refused to Hear"), and it is hard to not to conclude that this possible connection cries out for exploration.
My own position about psychiatric drugs is that for some people, some drugs can help more than they harm, but that the reverse is more often true (see Whitaker's book), and anyone considering taking such a drug has the right to make that choice, but professionals and Pharma must take responsibility for ensuring that the person is offered all available information about its known benefits and dangers and is also offered all available information about the wide range of kinds of help that have been shown to be effective for people who are going through what they are going through. This degree of disclosure is exceedingly rare. I say all this to make it clear that I have not yet seen proof that this school shooter or any other murderer was driven to violence by psychiatric drugs, but we must ask the crucial question, "Why do the media focus so much on 'mental illness' and so little on psychiatric drugs as a possible explanation for violence?" I know some individuals and organizations claim that all school shooters were on psychiatric drugs, and that may or may not be true. But hundreds of investigative journalists should be ferreting out the information and climbing all over each other in their haste to get that information out there if it is correct.
A Washington Post story (http://www.washingtonpost.com/local/crime/adam-lanza-is-recalled-as-a-rambunctious-kid-with-family-problems/2012/12/14/795ad0fe-4641-11e2-8e70-e1993528222d_story.html) includes as its only reference to these drugs that a former neighbor said the shooter was "on medication." It seems that he had been on medication for some period of time, though nothing is said about how long ago that neighbor had obtained that information. And now I am speculating, but here is one possible scenario, putting together the tiny fragments of possibly relevant information: In a photo, the shooter appears pale and drawn. There are many potential causes of that appearance, but certain drugs can cause it, and some have been shown to cause dramatic changes in thinking, emotions, and behavior, including sometimes in violent directions. I repeat: This is speculation, but it is the kind of thing that any talking head in the media ought to check out.
When we want to stop our pain or the pain of others, taking action often feels like a solution, and I do not advise against action. Political engagement and activism can help people heal, as can reasonable attempts to explain or comprehend. But in the presence of pain, a particular kind of inaction is essential and humane. Let me explain.
As many media people press for news angle after news angle, they ask the "experts" how people hit by tragedy can cope. I am stunned. Do we not understand that most or all of the grieving parents, other relatives, and friends of all the dead surely still feel at this early time that their spirit has been knocked out of them, that they can barely breathe? But in dominant American culture, we want to race beyond the pain as fast as we can: Let's get started right this minute on the coping and the healing. It is cruel to do so. Instead, Dr. Joanne Cacciatore of the Center for Grief and Trauma in her essay yesterday writes with her usual gentleness and sensitivity about what we can and ought to do instead. Rather than reprint her essay here, I urge everyone to read every word of it at http://drjoanne.blogspot.com/2012/12/no-words-for-such-tragedy.html It is meaningful and full of heart.
And I highly recommend Dr. Phyllis Silverman's deeply insightful, humane work, such as her book, Never Too Young to Know, which is purportedly about talking with children about death in honest and compassionate ways but which applies to all of us. As one example of her wisdom, she warns us not to tell people who are mourning at any point that it is time to "let go and move on," detach from the one who has died; instead, she urges, the mourners can search for different ways to remain connected to those who have died, through memories, feelings and thoughts, and actions in keeping with what they would have loved.
I learned a few years ago about a custom of Orthodox Jews at a time of grieving, and it touched me deeply. I was told that when we go to see a mourner, we should do nothing but sit silently nearby, because the mourner's needs and wishes at any moment -- and they may change greatly from moment to moment -- should be paramount. In our silence, we wait to see what they need. They may need silence, a drink of water, a story of someone's memory of the one who has died, a story about anything except the one who has died. If we even say, "I'm sorry for your loss," that puts a demand on them to respond, when responding may not be what they need. Grief, as the wonderful Dr. Nina Murray told me years ago, is exhausting. At time of, among other things, that exhaustion, it is respectful not to put mourners in a position of having to dredge up energy to speak. This is such a different approach from what most people do. How often have people heard from those who had been dear friends, "I wanted to call or come over, but I didn't know what to say." At times like this, the greatest gift we can give those struck by grief is to ask nothing of them at all and to make clear that we will sit with them through their sorrow and despair and rage, that we will bear silent witness, and that they can indicate to us what they need us to do. It means redefining inaction, respectful and caring silence, and waiting as the most important action we can take.
I want to close with a request that we consider ways to increase community. Stories about Adam Lanza and his mother, Nancy, have already included many references to degrees of their isolation from others. We may never know what drove Adam to kill his mother, then all those children and adults, and finally, himself. But it can do no harm for each of us to make it our mission to offer more connection to those who for whatever reasons reside walled off from the care and friendship that just might help reduce their pain.
©copyright 2012 by Paula J. Caplan All rights reserved
The following essay is relevant to servicemembers and veterans because of the multitude of ways in which psychiatric diagnoses have been used against far too many. It was initially published on December 9, 2012, at http://www.psychologytoday.com/blog/science-isnt-golden/201212/human-rights-day-dec-10-freedom-psychiatric-labeling
People labeled mentally ill deprived of human rights
In the Safeway store at King Farm in Rockville, Maryland, there's a little table scattered with used books. For one dollar a book — the money going to charity — you can but mostly romance novels, ragged children's books with chewed-up edges, an occasional thin book in a language you probably don't recognize. This fall, I spotted a book that was not only hardcover but awesomely old, a 1938 edition. Because of the combination of its age, the topic, and the author, gently picking this book off the table was about as close to a religious
experience as one could have.
Fifty years ago, a friend who was much smarter and far more widely-read than I, told me about a book she had read and loved that was called Microbe Hunters
. I read it and loved it. It was strange for two teenaged girls in the early 1960s to love a book about scientific research ... or perhaps strange only for each to know there was another girl who felt that way. I loved it because its author, Paul deKruif, led me one tiny step at a time through the world of scientific discovery. I loved going into that world of focus, of mystery, of drama, of the drive to discover something that would help humankind. The mystery was not a small part of it for me. I had long loved Nancy Drew mysteries. Now, at 65, what am I? In part, a psychological researcher one of whose specialties is research methodology.
The book I found on that little table is deKruif's later book, The Fight for Life
, is about what has absorbed much of my life since the late 1980s — the deprivation of people's human rights so that others may feel superior, amass wealth, or both...and doing it in the name of science. My particular focus has been on those who have been harmed as a result of being given a psychiatric
diagnosis. The shock of hearing each new story of harm, and acquiring over the decades the knowledge of how common it is and how wide an array the forms of suffering because of being labeled, is intensified because of what I learned when I spent two years as a member of two committees that wrote the "therapists' Bible," the Diagnostic and Statistical Manual of Mental Disorders
. I learned that, surprising as this will seem to many, the enterprise of psychiatric diagnosis is totally unregulated -- no regulatory entity of any kind oversees the creation and publishing of psychiatric categories, psychiatric diagnosis is not grounded in high-quality science, its use does not improve outcome (does not reduce human suffering), and it carries enormous risks of harm. The kinds of harm include but are by no means limited to the loss of custody of a child, a job, one's health insurance (or having skyrocketing premiums), and the right to make decisions about one's medical and legal affairs. People diagnosed as mentally ill often receive poor care for their physical problems, because their reports of physical symptoms are explained away as the imaginings of a disordered brain
. Victims of sexual assault are too often pathologized -- often diagnosed with Bipolar Disorder
, Borderline Personality Disorder
, or both -- rather than receiving the respectful, compassionate care they deserve. As a result, their utterly understandable upset about having been attacked is used to "prove" that they are mentally ill. Furthermore, being diagnosed makes it easy for the perpetrator to claim that the victim imagined the attack, lied about it, or brought it on herself.
In the vacuum left where scientifically-grounded information ought to guide what we offer those who suffer there rush in every conceivable kind of bias
, including but not limited to sexism, racism, classism, ageism, and homophobia. The combination of these biases and the deprivation of the human rights even of many white, wealthy, heterosexual, young or middle-aged men makes it all the more unconscionable that the United States Congress last week failed to ratify the international Convention on the Rights of Persons with Disabilities.
In The Fight for Life,
DeKruif makes detectives of his readers, leading us through scientists' search for cures for childbed fever, pellagra, polio, tuberculosis, and syphilis, asking us questions that at first seem rhetorical: Did Dr. Elliott's remarkable discovery that a particular internal heat treatment saved phenomenal numbers of the lives of women who were dying of ? And as we, having read his descriptions of these cures, are thinking, "Oh, surely yes! How could it be otherwise?" He tells us we are wrong, then asks, "How could that be?" Money and power are usually the answers.
History shows that only with massive efforts has anyone persuaded most people to stop looking away from and stop ignoring altogether those who have visible physical disabilities and instead to recognize their humanity and human rights. As for people who have been diagnosed as mentally ill, to classify them that way makes it easy for those not so classified (or who have the power to keep their own diagnoses concealed) to maintain or grab the power to marginalize and oppress the former, to the point of depriving them of the most basic of human rights, as noted above. The consequences can be so severe — the ultimate one being death — that the staunch and tireless human rights advocate Tina Minkowitz is including psychiatric diagnosis in a document for the United Nations about deprivation of the rights of people given psychiatric labels.
Decades of circulating petitions and writing papers simply stating concerns about the lack of science and validity, as well as the harm, from these diagnoses have achieved little or nothing. The first known petition, which I started in the 1980s to protest the planned inclusion of Self-defeating Personality Disorder
and Premenstrual Dysphoric Disorder (PMDD) in the then-forthcoming DSM-III-R,
was signed by individuals and heads of organization totaling more than six million people, but though all of the documentation was sent directly to DSM-III-R head Robert Spitzer, the only -- canny -- step he took was to declare publicly that for the first time he was creating an "Appendix for Categories Requiring Further Study," in which those two labels would go. It was canny because (1)he still got them into the manual, (2)there was no warning in that appendix to say that there was no evidence that either label represented a real entity or that it ought to be called a mental disorder and therefore no professional should apply it to any patient, and (3)despite his public claim that they were only going in that appendix, PMDD also went in the main text that was allegedly for solidly scientifically-supported categories. He had similarly claimed publicly in the 1970s that homosexuality would not go in the next edition (DSM-III
), but it did (Ego Dystonic Homosexuality), and even today, the category Sexual Perversion Not Otherwise Specified allows any therapist to decide on any basis that the patient in the consulting room is mentally ill in some way related to sexual behavior or thoughts or feelings.
A petition in which a gratifying number of mental health organizations or their divisions politely asked the editors of now-forthcoming DSM-5
to subject their planned contents to external review was at first ignored, then finally dismissed with a curt statement that they already external review. Yeah, sure. As I had seen since serving at the request of DSM-IV
head Allen Frances as a member of two DSM committees in 1988-1990, they appoint people from outside their old boys' club, then ignore or distort what we say if it does not fit with what they want. (See http://www.psychologytoday.com/blog/science-isnt-golden/201105/wh...
as well as many other essays on my Psychology Today blog for a wealth of examples that those preparing the next DSM
). So I had been certain that the current chiefs of the manual would pay no more attention than had Spitzer or Frances when simply asked to be honest and to follow scientific standards, as well as warning of harm and trying to prevent it.
It was time for action, so earlier this year, nine people filed ethics
complaints with the APA against the APA itself (publisher and beneficiary of the more than $100 million in profits from the current DSM
) and the DSM
editors and past and current officers who still belong to the APA. The complainants reported the terrible range of kinds of harm they had suffered because of being diagnosed. They had been going through difficult and upsetting times when they were labeled, but not every upset in life warrants the term "mental disorder," and according to the Americans with Disabilities Act, it is illegal to treat people who do not have disabilities as though they have disabilities as it is to fail to provide reasonable accommodations for people who do have them. The DSM
and its sister, the International Classification of Diseases (ICD:
published by the World Health Organization and being extremely similar in its psychiatric
section to the DSM
), powerfully promote the classification of virtually anyone with virtually any kind of feeling as mentally ill.
After the complainants were filed, the APA Ethics Department head Linda Hughes and APA General Counsel Colleen Coyle sent only a tiny number of communications, which I invite you to judge for yourself at http://www.madinamerica.com/2012/10/p20137/
In late October, the APA summarily dismissed all nine complaints in one brief, strange paragraph listing spurious or misleading "grounds" for dismissal and without having considered the merits of the complaints. Complainant Jenny McClendon's story is described at http://www.psychologytoday.com/blog/science-isnt-golden/201211/ap...
The next action we took was that four of us, including Professor McClendon, went to APA headquarters on November 13, 2012, after repeated email requests in which I simply asked for an in-person meeting were ignored. Our aims were twofold: to ask in person for a meeting, believing in the importance of having those in power in the APA confront in person the full humanity of the complainants, and to deliver a document called "The Need and the 9 Demands," in which the Grassroots Group to End Harm from Psychiatric Diagnosis lists nine steps the APA can and should take even without considering the complaints. That document is in the article at http://www.madinamerica.com/2012/11/the-apa-refuses-to-listen-to-...
, and we urge you to copy it and circulate and post it as widely as possible, because you will see that the demands are utterly reasonable. The same article includes a step-by-step account of our rapid ejection from the building in which the APA is housed in Arlington, VA, after we were prevented even from taking the elevator to the 20th floor to ask for an appointment and deliver the document. One complainant, reading that account, called it "beyond Kafka and Orwell."
We are exploring other options for action, and as we develop them, that news will be posted at psychdiagnosis.weebly.com. For now, other people wishing to file complaints should send a request for how-to information through the Contact form at that site. The fact that the APA has dismissed the first nine complaints is no reason not to continue to file, and we have prepared a template in which complainants need fill in only a little information about their particular stories and a few other things. The template now includes the addressing of the "reasons" for dismissal that the APA sent to the first nine complainants.
, Tina Minkowtiz argues that international law requires the payment of reparations. That is one of the nine demands in the document mentioned above.
"Watch the Stories of Harm the APA Refused to Hear" is a series of short videos stories of the complainants telling their stories. My introductory video in that series is at http://www.youtube.com/watch?v=9mihEgmfQKA
, Jenny McClendon tells her story at http://www.youtube.com/watch?v=6vj4JzOBb88Postscript:
I finished reading the deKruif book after writing this essay, and there is a lesson in the fact that in the 1930s, deKruif was a journalist who advocated with special passion for the rights of especially the poor to all of the health-promoting help that scientific medicine could provide, yet he says some demeaning things about African-Americans even as he says some admiring and respectful things about them. Whether or not one is inclined to excuse the negative statements as being "of his era," they remind us that even those who are progressive and caring in some respects have room to be educated in the arena of human rights as history marches on, and may it march only forward.
This essay is part of a series, Blogging for Human Rights. Find out more:
©2012 by Paula Joan Caplan All rights reserved
APA Summarily Dismisses Complaints about Harm from Psychiatric 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. Here
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.Here 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)."
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 firstname.lastname@example.org; 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
This essay was first published on November 8, 2012, here. Please note that it was written specifically for readers of my Psychology Today blog.
It's a good bet that few people will read this essay, because the word "veterans" appears in the headline.
When I wrote When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans
a couple of years ago, I said that Americans don't like to think about veterans. Why? Because war is upsetting, and if you don't know anyone who is directly involved, you don't have to think about it. Then, too, the strong American tradition of never admitting to fault clashes with the serious questions that have been raised about our most recent wars: Thinking about what veterans have been through carries the risk of making us wonder whether our government is always right. One more reason is the dangerous practice of our highly psychiatrized country's too-ready labeling as mentally ill anyone experiencing emotional devastation or moral anguish because of having been at war and the difficulties of trying to come home. All the time, I hear civilians say, "I'd like to do something to help veterans, but they're mentally ill, and I'm not a therapist, so there's nothing I can do."
How I hoped that I would be wrong, that I would discover that most Americans care deeply and meaningfully about veterans and want to get involved and help. To be sure, there are many people doing tireless, committed, effective work for veterans and their families. But how disturbing it has been to see hard evidence that few Americans are even willing to read an article about veterans. Of the many dozens of essays I have written on my Psychology Today blog since I began writing it about a year and a half ago, about one dozen have been about various subjects related to veterans, and the rest have been about an extremely wide array of subjects. On the running tally that shows me how many people have read each essay, I see that, with one exception, every essay I have written about veterans has had between 30 percent and 3 percent (that last number is not a typo -- it is indeed three percent) the number of readers of any other subject about which I have written. There, stark in black and white, is some sad proof that not enough Americans care enough.
The more distance we put between ourselves and others, the easier it is to forget to care. The closer in touch we come to the full humanity of others, the more we care, and the less bewildered we feel about what we might do to help. That is why I wish that every American could see the phenomenal film, SERVICE: When Women Come Marching Home.
This beautiful movie, directed by Marcia Rock and co-produced by her and Patricia Lee Stotter, introduces us to a number of women who have been in the military and with sensitive, creative camerawork and a moving score by Stotter, lets us become their listeners as they bravely tell us the intimate details of the myriad of ways their time in the military and their experiences of coming home have changed their lives. We get to know them, we understand many kinds of things they have gone through, we see whom they care about, what devastates them, what makes them laugh, what makes them want to go on. It is impossible, after watching this film, to see servicewomen and women veterans as "other," as having nothing to do with the rest of us. And after all, finding our common humanity with others is what life is all about.
So for Veterans Day, please find a way to come closer to servicemembers and veterans. Go to the film's website
and start to find a way to bring this film to your community, perhaps through a local college or university or a local organization. Or go to a homeless shelter, look for a veteran there (a huge proportion of our homeless citizens are veterans, increasingly women veterans), and offer to listen, really just listen silently but with your whole heart and with respect, to their story (see short videos and other information about the listening sessions in The Welcome Johnny and Jane Home Project here
). Go to the website for "A Better Welcome Home" from the Harvard Kennedy School, Ash Center for Democratic Governance conference, watch a few of the five-minute videos about ways that every American can help, from working with veterans through the arts to meditation to physical exercise to service dogs and many more
, and choose how you will get involved. Somehow, show that you care, and connect.
©2012 by Paula J. Caplan
All rights reserved
Colleen Bushnell is one brave woman. After spending nine years in the military, she returned home as Air Force Staff Sgt. Bushnell, suffering from the effects of having been sexually assaulted while in the military.
Other brave women from outside the military who have spoken up about the torment of being sexually assaulted by someone in their own family or someone else they had reason to trust or were expected to trust have educated us about the self-doubt that results, as well as the desperate conflicts about what — if anything — to do and whom to talk with. They have been terrified about damaging their families or wider social circles, even about hurting the perpetrators, if they came forward and have often been unable to sleep, wondering if there was some way they could have prevented the attacks. They have feared that, like so many victims of sexual assault, they would not be believed and would only sully their own reputations by speaking up.
Imagine, then, how it is to be sexually assaulted in the military by someone of a higher rank or by someone of equal or even lower rank but with whom one has trained and is in, or soon will be in, a life-or-death situation in which they depend on each other. Imagine how it is to be a woman in the military, where women have fought hard for acceptance but are still light-years from achieving true equality.
Colleen Bushnell is one of five veterans participating in the Long Ride Home, bicycling across the United States to draw attention to the difficulties that women victims of sexual assault in the military have about whether or not to report (most victims choose not to, out of fear and unwarranted but understandable shame, and too rarely are the crimes successfully prosecuted even when reported), as well as about how hard it is upon returning home, to struggle with the longlasting consequences of the assaults themselves and the frequent mishandling of them if they did report them. (see http://www.timesunion.com/local/article/Battling-hostile-forces-mdash-at-home-3629210.php)
The brilliant film, "SERVICE: When Women Come Marching Home," (servicethefilm.com/) depicts such struggles and was recently shown in the U.S. Senate at the invitation of Senate Veterans Affairs Committee Chair Senator Patty Murray. The Service Women's Action Network (http://servicewomen.org/) and Protect Our Defenders (http://www.protectourdefenders.com/) are strong advocates for change in the handling of these complaints, as well as for finding ways to prevent the assaults.
I have written here previously about the appalling and too-frequent practice of using psychiatric diagnoses to try to silence, demean, or dismiss the accusations of survivors. Professor Jenny McClendon, now a logic instructor but formerly a sonar operator for the Navy (http://www.cnn.com/2012/04/14/health/military-sexual-assaults-personality-disorder/index.html,onewearysoldier.blogspot.com/p/jenny-mcclendon.html), spoke courageously on CNN about what happened to her. She was raped while in the Navy, and after reporting it, was diagnosed with a personality disorder. This happens all too often, conveying a shocking message and creating serious material consequences. The message is: "You are not upset because you were raped. You are upset because of a personality disorder. You are upset because of a maladaptive organization of your entire personality that has characterized you all your life." The material consequences include (but are certainly not limited to) failing to qualify for treatment in the VA system, because only treatment for "service-related disabilities" are covered, and the personality disorder is blamed for whatever upset the victim experiences.
This happens to men, too. It should happen to no one. These women and these organizations need all the support they can get, and if you look at their websites, you can see ways to support them, including by sending donations and contacting your members of Congress to urge them to support relevant legislation.
But above all, consider seeking out veterans who have been through this kind of trauma and labeling, offer to listen quietly, with respect, and without judgment to their stories, and let them know that being devastated by having been raped by those whom they had reason to believe they could trust is not a sign of mental illness but is instead a totally understandable, human reaction. Support Colleen Bushnell on her journey and those who go with her, as well as others like Jenny McClendon who also speak out bravely. And watch for screenings of "SERVICE: When Women Come Marching Home" (servicethefilm.com/), or better yet, arrange for a screening in your town. This film will move you.
It was so gratifying to experience the warm response this morning, when Col. Anthony Henderson and Lt. Col. Tony Forbes from the Warrior and Family Support Program in the Office of the Joint Chiefs of Staff, as well as Scott Monett from Quality of Life Plus, joined me in a presentation at Psychologists for Social Responsibility. The Pentagon program is humane, nonpathologiizing, and community-based, and Quality of Life Plus has specialists at Cal Poly Tech solve problems involving physical pain and physical function for veterans with injuries. All three speakers were terrific. I know that some people in the audience had never heard what it is like to experience war firsthand, and Colonels Henderson and Forbes spoke with great power and openness about what happens in combat, in the immediate aftermath, and after returning home. At least two people in the audience said they plan to implement The Welcome Johnny and Jane Home Project as part of what they are doing.