I have been immersed in the field of psychiatric diagnosis – and resistance to it – for more than a quarter of a century. In the late 1980s, I was a consultant to two committees appointed by DSM-IV Task Force head Allen Frances to decide what DSM-IV should contain. I resigned from those committees after two years because I was appalled by the way I saw that good scientific research was often being ignored, distorted, or lied about and the way that junk science was being used as though it were of high quality . . . if that suited the aims of those in charge. I also resigned because I was increasingly learning that giving someone a psychiatric label was extremely unlikely to reduce their suffering but carried serious risks of harm, and when I had reported these concerns and examples of harm to those at the top, they had ignored or even publicly misrepresented the facts. I wrote about what I learned from my insider’s position in my book, They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal (Caplan, 1995).
From about 2009 until DSM-5 was published in 2013, there was massive coverage in popular and professional media about outcries against DSM-5. The outcries were largely based on the assumption that it would represent a break with DSM-IV (published in 1994 and minimally altered for a 2000 edition), which was seriously misrepresented as having been solidly scientific, helpful, and – for all but a tiny number of its hundreds of categories -- not harmful. The rewriting of history has continued in publications since DSM-5 appeared, so that there has been a massive and damaging rewriting of history, and it lends a legitimacy to DSM and other diagnoses in general, when, in fact, the recurring problem is that psychiatric disorders have never been validated, in fact not even shown to be reliable.
The rewriting has serious consequences, becoming the basis for wrong assumptions, misplaced outrage, lack of outrage where it would be justified, and failure to take action in order to prevent harm to currently uncountable numbers of human beings. The rewritten version of this history is used to justify depriving psychiatrically labeled people of their human rights on the grounds that it is good for them or society or both. It draws attention of professionals and the public away from the facts related to psychiatric diagnosis; draws energy and resources away from stopping, redressing, and preventing harm; draws everyone’s attention from the most important people, those who have suffered from being psychiatrically labeled; helps maintain damaging features of the status quo; and causes history to repeat itself in destructive ways.
Never highlighted and virtually never even mentioned in most writing about psychiatric diagnosis is that it is totally unregulated. As a result, the coverups and misrepresentations of truth and the harm to which they lead continue, because those who are harmed have no recourse, no way to hold accountable those who create and market the hugely profitable “first cause” of the trouble, the psychiatric diagnostic classifications.
I recently wrote a paper in which I documented this rewriting of history, because if professionals and the public know the historical facts, any critique of DSM-5 will be seen as part of a larger historical critique of the DSM since its beginnings, as well as of psychiatric diagnosis in general, for then we can see a larger history of harm done. You can download my paper here.
Paula J. Caplan, PhD, is a clinical and research psychologist, activist, Associate at the DuBois Institute, Harvard University, and the author of 11 books, including one that won three national awards for nonfiction and two about psychiatric diagnosis. Her books include They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal and the edited Bias in Psychiatric Diagnosis.