Social Services and Psychiatry

Philip Hickey, PhD
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The controversy surrounding Justina Pelletier and her family has expanded its scope in recent months, and has now become a general public scrutiny of Massachusetts’s Department of Children and Families.

On April 29, State Governor Deval Patrick gave a press conference in which he announced the resignation of DCF Commissioner Olga Roche.

I think there’s a very real risk of confusing some issues here.  The sad fact is that, despite the enormous strides we have made as a society, there are still a great many children who are abused and neglected.  Every state in the US has a social services department, one of whose statutory responsibilities is to investigate reports of abuse and/or neglect.  The case workers who conduct the investigations are required to follow set procedures.  Often they find that the allegation is unfounded, and the investigation is terminated.  When they do find probable cause, they are required by law to present their findings to a judge, who scrutinizes the evidence in accordance with the normal judicial procedures.  The social services department, the parents, and the child are usually represented by attorneys.

A wide range of options is available to the court, from outright termination of parental rights to outright dismissal of the case. Both of these extremes are rare.  The usual outcome is some kind of remediation program, whereby the parents are encouraged and coached in childcare matters.  Sometimes the children are placed in foster homes pending resolution of issues in the home.   If the home issues aren’t resolved, the foster care placement can be lengthy.

The system isn’t perfect.  Mistakes get made, and sometimes the mistakes are serious. I have no way of knowing if the Massachusetts Department of Children and Families was more error-prone than social service departments in other states. Obviously the commissioner Olga Roche has to take responsibility.  But whether she was personally derelict in her duties or was just the designated fall-gal, I don’t know.

But this I do know: the spotlight has been taken off psychiatry.

The central issue in Justina’s case was, and is, the “diagnosis” of somatic symptom disorder and the allegation of medical child abuse.  And there’s a danger of losing sight of that when a departmental commissioner gets tossed to the wolves and the state governor says

“DCF has one of the toughest assignments imaginable. Every single day they’re called upon to intervene and make difficult decisions…And most of the time, DCF gets it right.”  (Quoted from a Metro article by Morgan Rousseau).

Most of the time, DCF does get it right.  Most of the time they’re dealing with allegations of blatant abuse and neglect; children being raised in unsanitary and unsafe conditions; children being sexually abused and even prostituted; etc… Social services case workers investigate these complaints on behalf of society.  They are bound by strict procedures, and when they go to court they are subject to cross-examination, and their findings are subject to official and legal scrutiny.

The issues are never simple, but the critical questions are usually clear and understandable.  If a child has a broken bone, X-ray reports are introduced into evidence, and the radiologist is subject to cross-examination.  If there are allegations of an unsafe home environment, photographs are produced.  If there are live electric wires protruding from wall sockets, everybody in the courtroom can see the pictures, and everybody knows the potential danger if there are toddlers in the home.  And so on.

But all of this changes in a case of “somatic symptom disorder” and alleged medical child abuse.  In these cases the issues, the “realities,” consist entirely of psychiatric opinion.  When a psychiatrist states on the witness stand that the child “has somatic symptom disorder,” the impression is conveyed that this is a real illness with the same kind of verifiable reality as asthma or diabetes or kidney failure.  So there’s a very strong tendency for the lawyers, and even the judge, to afford the same kind of respect to a psychiatrist’s statement as they would to a report from a radiologist or other genuine medical specialist.

What’s not routinely recognized is that the psychiatric “diagnosis” is nothing morethan the psychiatrist’s opinion.  In the case of Justina, the “diagnosis” was somatic symptom disorder, which simply means that Justina in the opinion of a psychiatrist, was inordinately preoccupied with her medical condition.

I have worked with a great many sick people over the years, and have struggled with chronic medical problems myself, and frankly, I can’t even imagine how one could assess whether a person’s concerns in these areas were excessive or inordinate.  And this is especially the case in that, since DMS-5, the “diagnosis” of somatic symptom disorder can be assigned even in cases where the person actually has a real illness!

And the allegation of medical child abuse simply means that, again in the opinion of a psychiatrist, Justina’s parents had been foisting on her the notion that she was sick, and had pressured various surgeons and other specialists  to subject their child to extreme and invasive medical procedures.

Here we have no photographs of exposed electric wires; no reports of young children being left home alone; no evidence of malnutrition or emaciation; no medical evidence of young children having been sexually abused; no X-ray reports of broken bones; etc… Only the opinions and the invented “diagnoses” of psychiatrists!

When Governor Patrick stated that DCF usually get things right, he made no distinction between the kinds of abuse/neglect that social services departments traditionally investigate and the inherently vague psychiatric “abuse” of which Justina’s parents stand accused.

It was perhaps inevitable that media coverage of Justina’s case would expand into a general criticism of DCF and the commissioner.  Criticism of that sort is healthy, and is one of the cornerstones of democracy.  But what’s noteworthy at present is that we’re seeing very little coverage of psychiatry or of the role that the psychiatric “diagnosis” played in this matter.  This is critical, because without the “diagnosis” of somatic symptom disorder and the subsequent allegation of medical child abuse, none of what’s happened to Justina and her parents could even have gotten off the ground.

Psychiatry captured Justina with one of their spurious labels, confident, presumably, that the parents would cave and play along.  But the parents rebelled, and the psychiatric sham was exposed for what it is.  Psychiatry, as usual, had no rational defense, so instead they side-stepped the issues, and the spotlight has moved elsewhere.

And let’s not forget that psychiatry’s leaders are being schooled by Porter Novelli, a major PR firm, in how to interact with the media.

* * * * *

This article first appeared on Philip Hickey’s website,
Behaviorism and Mental Health

25 COMMENTS

  1. I’ve done a little research into DCFS. My understanding is that DCS in many states gets paid when they place a child, so this gives them incentive to take children from homes. But my family’s experience is that if the child abuse occurred outside the home, and thus taking the child out of the home is not the solution / road to payment, DCS does not look into concerns of child abuse, even with medical evidence.

    I know this is slightly off topic, but do think it is part of the problem with how the DCFS system is set up. And I know that psychiatrists have historically, and do still, cover up child abuse by misdiagnosing children, or parents with concerns of child abuse, with “mental illnesses.” Covering up child abuse can be very profitable.

    http://en.m.wikipedia.org/wiki/The_Freudian_Coverup

    It’s been happening since Freud’s time, and covering up child abuse is still a major role of the psychiatric community. And I know ignoring my concerns of child abuse by some wealthy people, has resulted in that neighborhood high school having the highest suicide rate in the nation in their local high school. If you were a child who’d been sexually molested, and instead of the child molesters being arrested, they had psychiatrists defame and majorly tranquilize you, would you light yourself on fire or throw yourself in front of a train in protest? Maybe?

    We need psychiatrists to stop covering up child abuse for profit, and start reporting it to DCFS, so the child molesters can be put in jail instead.

    But, I do agree, blaming DCS does deflect blame from the spurious nature of psychiatric diagnosis, in general. Thank you for another truthful article, Dr. Hickey.

    • I hate Sigmund Freud. I don’t care how groundbreaking some of his ideas were, the facts remain that he diagnosed a woman with a psychiatric cause for her stomach pains, and she died shortly afterward with stomach cancer, and he created that horrible “theory” (hypothesis, brain fart) about girls falling in love with their fathers or uncles, or whatever man in their family was sexually abusing them. Even if most of patients hadn’t been sexually abused, did he think it never happened? Could he not see how cruel his interpretation was to actual victims of childhood sexual abuse?

      “What do women want?” They don’t want to be blamed for having been victimized as children, and they don’t want to be treated for a mental problem while they’re dying of cancer, so let’s start there, huh?

      What a great man. Golf clap.

    • Someone Else,

      You’re making an important point. One of the major flaws in psychiatry’s “diagnostic” system is that the problem is always located in the individual. So, even without intentional cover-up, psychiatrists are already committed to that kind of mindset. And, of course, their entire remuneration system is geared around a billable diagnosis. So there are strong forces in place to pathologize the child. I believe that as a culture we are getting more honest about child abuse – especially abuse of a sexual nature – but we have a ways to go.

      Best wishes.

  2. The Pelletier case and other cases wouldn’t be possible without the dx of somatoform. It starts with the opinion and the mayhem flows from there. The false validity of the dx bleeds over to Social Services, Courts, and Schools.
    A proposed solution to Mass. DCF’s issues was to hire on a larger psychiatric professional staff as if this would solve the problem of the “parent-ectomy”.
    Social Services are valuable for all the reasons Dr. Hickey mentioned, but there must be a way to disconnect DCF and the courts in being complicit with this aggressive maneuver.
    Thanks again Dr. Hickey. This is important.

  3. And all of you Americans think you live in a free country? Think again!
    There is a young person held captive in Massachusetts today who is not allowed to participate in religious ceremonies, or visit family without
    government agents watching. No, it’s not the accused Boston Marathon bomber Dzhokhar Tsarnaev. It’s 15-year-old mitochondrial disease patient
    and non-terrorist Justina Pelletier. U.S. District Court Judge George O’Toole Jr. ruled Wednesday that the now-20-year-old charged with four deaths
    and injuring of more than 260 people should be able to see his sisters without an FBI agent present.
    “Can you believe it?” That was Jennifer Pelletier’s response when she was told about the ruling. She’s Justina’s older sister — and every visit she has
    with her wheelchair-bound sister is held under the watchful eye of agents from both the state’s Department of Children and Families and — since the
    story went national — armed state police! The family is only allowed one visit a week, for one hour a week, with their own sick daughter. “It’s hard
    for me to say this,” Justina’s father Lou told me Wednesday, “but a terrorist is getting better treatment in Massachusetts right now than a sick teenager
    who’s done nothing wrong.” And that’s the source of rage among Justina’s supporters. She’s the one who’s suffering and all she did was come down
    with an illness.
    Massachusetts Governor Deval Patrick had the executive power to pardon convicted criminals with the stroke of a pen, yet ignored the plight of an
    innocent, sick adolescent in state care. It’s a dereliction of duty that Governor Patrick did not take action to free Justina into the loving arms of her
    family,” commented Rev. Patrick Mahoney a spokesperson for the Pelletier Family. It is tragic that every young person in the Wayside Youth Facility
    was able to spend time with their family and celebrate Easter except one. That is Justina Pelletier. It appears that the DCF was punishing Justina and
    the Pelletier family rather than trying to reunite them, which is their stated purpose. How does this horrible Dr. Eli Newberger, have such enormous
    and unchecked power? This Juvenile Court Judge Joseph Johnson is even worse, he should be thrown off the bench. Is something involving illegal
    medical testing is going on at that hospital? Apparently, something illegal is going on? Let them all lose their jobs and their reputations for this
    unbelievable disdain for justice. By the way folks, why isn’t this news story on the main stream media (CBS, NBS, MSNBC, CNN, PBS, NPR, the
    Los Angeles Times, the New York Times, etc)? What are they hiding?
    A bill in the Massachusetts Legislature which would have overruled the judge and freed Justina immediately, HD 4212, written by MassResistance
    and filed on April 4, was blocked by the Democratic leadership in the House, despite national outrage and a flood of calls and emails from across the
    country. I thought the Democratic Party was for the people? Apparently not! Now, the DCF has announced that Justina will be moved to a hospital in
    Connecticutt instead of with her parents! 15 months this has been going on! Remember folks, never put your child in a Massachusetts hospital. Never
    Justice is coming Justina. Hang on.

  4. A parent’s civil rights to raise their child are accompanied by a CHILD’S RIGHT TO REMAIN WITH AND BE RAISED BY HIS OR HER PARENTS. When we, as a society, decide to interfere in the most basic human right that exists, to raise your young, we need to base it on solid evidence.

    The somatoform diagnosis CAN NEVER be demonstrated through evidence. It simply cannot. In fact, many people believe it doesn’t even exist outside of the minds of some psychiatrists. It is a social construct, not a disease.

    And, EVEN IF parents encourage their child to believe she is sick — how bad should it get before we deprive three people of their human rights, because the act of taking a child from her home is psychologically DEVASTATING. The act of locking a child into an institution and performing treatments on her body that she does not consent to is DEVASTATING. How do we justify the costs that we are imposing on this child. Do we REALLY believe we have made her life BETTER?

    After eighteen months, does she agree that her life is better?

    She’ll be an adult in 2 years. At this point, she is mature enough to assess her current situation, and her previous situation, and make a choice about where she wants to live. They’ve had 18 months to do whatever brainwashing they wanted to do on her. She should be thoroughly reprogrammed by now.

    • I’d be afraid that with the amount of coverup and ass saving that is going on right now she is likely to be involuntary committed even after she turns 18 on danger to self or other criterion (afterall if she has no insight into her “mental disorder” she may go on and ask normal doctors for medical help which is unacceptable).

  5. My child had functional disorder with no apparent medical disease for years. And, then a new blood test came out, and now she has a real medical disorder. That shows you how reliable a somatoform diagnosis is. You might as well declare that unicorns are real because you can’t prove they aren’t.

  6. “the spotlight has been taken off psychiatry”
    That was unfortunately to be expected. First, because attacking the DCF can be used as a political tool to attack the governor and his officials for incompetence, lack of oversight etc., whether legitimately or not, which is useful for their political opponents. Secondly that the DCF itself turned up to have more than just this one problem, with other kids missing or dead, which is unrelated to psychiatry but rather to their intrinsic problems. and finally because the doctors are not keen to speak ill about other doctors, even psychiatrists, publicly (in private, that’s another matter) and are bound by patient data protection laws, which prevent public discussion of the bogus diagnosis.

    • B,

      You’ve hit a very important point. Doctors don’t usually criticize other doctors. I think a great many real doctors do in fact see through psychiatry, and are pretty disgusted by it. But they are prevented from speaking out by “the code.” When this dam does break, it will be a torrent.

  7. I’m a little bit concerned about Stockman’s bill and the sentiment around it because it might allow parents who abuse their children to claim themselves as victims of an agency that really does exist to take children out of abusive and neglectful homes— the kind of people who think they have the right to deny their children much needed medical care and offer prayer instead, or the type that would starve a two year-old for not saying “amen” at the dinner table. Parents should not have the “right” to treat their children however they see fit when that “care” includes abuse and neglect. Child agencies do have a legitimate purpose and rescue children from hell on a regular basis.

    The focus, however, in this bad play, needs to be on psychiatry and somatoform disorder as a construct that allows psychiatrists to trump medical specialist over their impressions. The burden of proof should be on the psychiatrists and a medical team should be engaged to investigate the mitochondrial disorder and treatment that Justine has been given so far, and how she is doing now.

    • There needs of course to be a balance between the parental rights and the ability of the government agencies to protect kids against domestic abuse. It’s a delicate balance indeed and there needs to be accountability for the workers in cases of inaction but there should also be no incentive to take kids away from homes. Having more workers and better training of them is also crucial, often making a proper assessment of a family situation requires a lot of time and skill. Same goes for resolving the problem. You can’t have situations when kids are taken away from parents who are too poor or homeless – there should be ways to help the whole family rather than punish them for their difficult life situation. In the same time if there is sexual or physical abuse it should be no brainer that the kids need to be taken into a safe place but then again foster homes need to be controlled because the often turn out to be just as if not abusive than the families. It’s a complicated and sensitive issue and I have no personal experience on how exactly to reform this system.

      • B,

        Thanks for this comment. What you say makes sense, including “…foster homes need to be controlled…” But there’s a problem with this. Often the children who are removed from abusive/neglectful homes have medical needs that have been neglected for years. These can range from dental problems to serious medical illnesses. So foster parents are required to take these children to regular medical appointments, including check-ups. Often referrals are made to psychiatrists and, again, the foster parents take the children to these appointments also. The result is that we have inordinate numbers of foster children nationwide on neuroleptic drugs. These children are a captive audience and often difficult to manage. So psychiatrists drug them into submission. There is truly no human problem that psychiatry can’t make ten times worse.

  8. “Alert: imperial psychiatric empire is invading the mind”
    Jon Rappoport http://www.prisonplanet.com/alert-imperial-psychiatric-empire-is-invading-the-mind.html

    “Jeffrey Lieberman, president of the American Psychiatric Association: “We need a public-health initiative for mental health care that moves out of clinical settings into the community, whether it’s in primary care, education, the workplace, or faith-based organizations.”

    Meaning: tons of new propaganda about the need for psychiatric treatment; the building of community psychiatric centers all across the country; pressure to submit to treatment applied in ordinary doctors’ offices, in schools, in private companies, in churches.”

    Short but excellent treatment of a diabolical bit of legislation. $$ for the pharmaceuticals though.