As I wrote in my first blog, A Three Pronged Approach to Mental Health System Change, after I read Mad in America in 2002, the Law Project for Psychiatric Rights (PsychRights®) was formed to mount a strategic litigation campaign against forced psychiatric drugging and electroshock. Since then, PsychRights has won four Alaska Supreme Court decisions holding various aspects of Alaska’s adult involuntary commitment and forced drugging regime unconstitutional or otherwise illegal.
In defending such involuntary commitment and forced drugging cases, PsychRights has not challenged the diagnosis per se, or the invalidity of the diagnosing process as a whole, because the person seems clearly crazy and I have felt that challenging a diagnosis of “mental illness” in such circumstances would only serve to destroy my credibility in arguing that the person should not be locked up and forced to take the drug(s) against their will.
This tactical decision does not mean I don’t recognize that diagnosing, itself, can be very harmful. One obvious harm is the stigma that attaches once one is diagnosed, especially, a diagnosis of serious mental illness, such as schizophrenia. People with such labels can immediately lose their jobs and essentially become unemployable. They often become social outcasts, that has been described as “social death.”
In fact, the legal system often recognizes that having such a psychiatric diagnosis can be harmful. For example, in Alaska, where I practice, psychiatric respondents (those on the wrong side of the locked door and at the the sharp end of the needle) have the right to have commitment hearings closed from the public in order to protect their reputations. As an aside, they also have a right to have them open to the public, a right which is ignored except in the cases I take because I ask my clients their preference after discussing the pros and cons.
There are other harms from diagnosing. Just consider a diagnosis of “personality disorder.” To me, any profession that tells people they have a personality disorder has mainly served to expose itself as not a healing profession.
I do know that some people find getting a diagnosis comforting to have a name put on the trouble they are having, but I would suggest this is a false comfort. Accepting that one has a brain disease, must give up any hope of a full life, and must take debilitating drugs for the rest of their lives that will only allow one, at best, to spend one’s time in a day treatment room watching television and smoking cigarettes is not truly helpful. One thing that it does is remove responsibility for gaining control of one’s life, which is harmful in itself.
Of course, the extreme harm caused by the drugs for many is the obvious result and, indeed, I would say is ultimately the purpose of most diagnoses. That and to allow the diagnoser to get paid for their effort.
Let’s take a particular look at diagnosing mental disorders in foster children and youth. These children are in foster care because they have been found to be the subject of abuse or neglect. While many times these removals are not really warranted and it would be far better in any event to give the parent(s) help in being better parents, assuming the child or youth has been the subject of abuse or neglect, it is natural for the child or youth to “act out” in ways that disturbs the adults in their lives. Then, no matter how bad the home situation might be, for most, removing them from their home is upsetting, which is also a reason for acting out. The foster placements can be pretty horrific, which is another reason for a child or youth to be upset and act out. Finally, many foster children and youth experience multiple rejections with many different foster placements. It is not unusual for a youth who has been in foster care for many years to have been placed in 20 different foster homes without being adopted, which is the holy grail for most foster children. The rejection and lack of permanency is also inherently upsetting.
Instead of giving them diagnoses and drugs, we should be giving them help in dealing with the natural emotions they are experiencing and most importantly, we should be giving them help to become successful. At the end of a meeting I once had with the Alaska Commissioner of Health and Social Services when we were suing the State of Alaska over drugging children and youth in PsychRights v. Alaska, he said, “so what you are telling me is we should do a better job of diagnosing.” After I pulled out my hair I said, “No, we should do a better job of not diagnosing.”
Whether it is adults or children, or seniors, for that matter, is it moral to give people dubious, harmful psychiatric diagnoses in order to get paid?
With respect to the dubious nature of psychiatric diagnoses, there are two books I heartily recommend. The first, Schizophrenia: A Scientific Delusion, by Mary Boyle, Ph.D, analyzes the definition of schizophrenia and demonstrates that it is invalid as a classification, just considering that it does not distinguish schizophrenia from not schizophrenia. They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, by Paula Caplan, PhD, is an insider’s account of the unscientific process in promulgating DSM IV. Now the American Psychiatric Association is preparing to adopt its Fifth Edition of the Diagnostic and Statistics Manual of Mental Disorders, commonly called “DSM5.”
Dr. Caplan is a leader of what is called the PLAN T Alliance (PLAN T stands for Psychiatric Labeling Action Network for Truth), which recently launched a petition against the DSM5. As the PLAN T petition states:
It is increasingly clear that the editors of the major psychiatric manual, which reaps huge profits for the American Psychiatric Association that publishes it, are ignoring the massive evidence of harm done by the labels of previous editions of the manual and of likely harm from what they plan to put in the edition they are now preparing. Previous editors ignored the need for both reform of their work and concern for those it harmed, despite letters and petitions representing more than six million people. . . . The pledge we request here is one of the major kinds of action we recommend. It is a boycott. If you, like us, are deeply concerned about the lack of science behind the Diagnostic and Statistical Manual of Mental Disorders, the absence of evidence that it helps in identifying effective treatments, the absence of evidence that helps with outcome, and the abundance of evidence of people being seriously harmed by receiving a psychiatric label, as well as because the editors of the previous, current, and in-preparation editions of the DSM have been largely unresponsive to concerns expressed about these problems, please sign this petition as a statement that you take the pledge here below [to boycott the DSM].
In addition, a petition by the Humanistic Division of the American Psychological Association (Div. 32) protesting various aspects of the proposed DSM5 has garnered quite a few signatures.
Both petitions are worthy of support in my opinion.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.