Sunday, December 9, 2018

Comments by Paula J. Caplan, PhD

Showing 56 of 56 comments.

  • Since Bipolar Disorder, like virtually everything in the three or four most recent editions of the DSM, lacks scientific grounding, lacks even interrater reliability and stability and therefore cannot have validity, a more appropriate question to headline this article might have been “Can ANYONE ‘Have’ ‘Bipolar Disorder’?” Although the author makes some crucial and interesting and helpful points, in troubling ways she reifies the notion that Bipolar Disorder for anyone is a valid or helpful and not harmful category.

  • Julie Greene, I am sorry to say I have absolutely no control over which of my books is ever put on kindle or not. In fact, there is now a different publisher distributing They Say You’re Crazy than the one who originally published it. (These publishing houses keep buying each other out.) But perhaps if people write to the current distributor — which I believe is Perseus — and request that it be put on kindle, they might listen.

  • Lawrence, I would love to know how you found out that Allen Frances had hoped to play a crucial role in DSM-5! I have always wondered whether he left that whole enterprise willingly or was turfed out…and if the latter, for what reason. Please either post more info about that here, or write to me directly.
    Also, no, no one on the DSM-IV Task Force ever admitted why they did what they did. In my book, They Say You’re Crazy, I included an entire section about their possible motives, and there is a whole chapter about the dozens of gatekeeping technique they used that I experienced directly (I am sure there are more, but these are the ones I could report having experienced myself).

  • Thank you, streetphotobeing, for the kind words about my work. You may know that I organized the filing of 9 complaints to the APA’s Ethics Department about harm from psych diagnoses, but they dismissed them with no attention to their merits and on totally spurious, manufactured grounds. I wrote about this in madinamerica. I also wrote in madinamerica about the 5 complaints I then helped file with the Office of Civil Rights of the U.S. Dept of Health and Human Services and got the same results. But all this provided an essential paper trail PROVING that PSYCHIATRIC DIAGNOSIS IS ENTIRELY UNREGULATED, AND THE TWO ENTITIES THAT OUGHT TO BE PROVIDING OVERSIGHT HAVE NO INTEREST IN DOING SO.

  • I totally agree with almost everything in this essay, and people wanting documentation of the points in the essay will find the inside story of how this came to be in They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal https://www.amazon.com/They-Say-Youre-Crazy-Psychiatrists/dp/0201488329/ref=sr_1_1?ie=UTF8&qid=1529109719&sr=8-1&keywords=they+say+you%27re+crazy As far as I know, I am the only person who actually served on a DSM Task Force (two of its committees under Allen Frances’ DSM-IV reign), resigned on moral, ethical, and professional grounds, then wrote about what I learned about how the DSM is put together, how science is ignored, distorted, or lied about, and how the harm it causes is concealed by the folks who publish the manual. One correction: It’s mentioned in the essay that Allen Frances has acknowledged that his edition of the DSM led to some epidemics of diagnosis, but it is crucial for people to understand that: (1) he named only three diagnostic categories that he said were the subject of epidemics; (2) he elsewhere has said repeatedly (I have the documentation if anyone wants it) that the process he oversaw of creating his DSM-IV was “scrupulously scientific,” when that is patently absurd (as I documented in the above named book); (3)in a book he wrote, he first says he is about to issue a mea culpa, then mentions the epidemics of the three categories, then says that he and his DSM colleagues could not possibly have foreseen these epidemics, and then goes on to blame for the epidemics just about everyone and every entity except himself and his colleagues; and (4) he continues to this day to talk out of both sides of his mouth about psych diagnosis, having said at one point that psych diagnosis “is bullshit,” as quoted by Gary Greenberg in an article in Wired, which Greenberg says in his Book of Woe led Frances to berate him for having quoted Frances accurately about that … and then he currently goes on to say that people who have “serious mental illnesses” are being under diagnosed and underrated. So please beware of simply citing without context his acknowledgement of a tiny number of diagnosis epidemics.

  • I have long been expressing my profound concern and even alarm that MadInAmerica continues to publish articles, essays, etc., that help to reify psychiatric diagnostic categories and labels, when it has been proven compellingly that (1)psychiatric diagnoses are NOT scientifically grounded — indeed, they are not even reliable, so they are even farther from being valid! (2)giving someone a psychiatric diagnosis does NOT increase the likelihood that their suffering will be reduced, and (3)giving someone a psychiatric diagnosis (even those that would seem to be the least severe) exposes them to a vast array of risks of harm. People interested in learning more about this can have a look at psychdiagnosis.weebly.com, at https://www.amazon.com/They-Say-Youre-Crazy-Psychiatrists/dp/0201488329/ref=sr_1_1?ie=UTF8&qid=1526958314&sr=8-1&keywords=they+say+youre+crazy and at https://www.amazon.com/Bias-Psychiatric-Diagnosis-Paula-Caplan/dp/0765700018/ref=sr_1_1?ie=UTF8&qid=1526958361&sr=8-1&keywords=bias+in+psychiatric+diagnosis as well as many essays in the Psychology Today blog I wrote for some years.

  • It is SO troubling that people writing for Mad In America would use totally unscientific and VERY harmful terms of psychiatric diagnoses and using those categories as the core of research! Even one of the greatest purveyors of the term “ADHD” has publicly, repeatedly acknowledged (in his rare moments of candor) the harm that the epidemic of use of that diagnosis has caused. I hope that people will stop doing this sort of thing, especially in Mad In America but also elsewhere. You yourselves cause terrible harm by reifying these diagnostic labels, which have been proven time and again to cause terrible harm. https://www.amazon.com/They-Say-Youre-Crazy-Psychiatrists/dp/0201488329/ref=sr_1_1?ie=UTF8&qid=1515602267&sr=8-1&keywords=They+Say+you%27re+crazy
    and
    https://www.amazon.com/Bias-Psychiatric-Diagnosis-Paula-Caplan/dp/0765700018/ref=sr_1_1?s=books&ie=UTF8&qid=1515602285&sr=1-1&keywords=bias+in+psychiatric+diagnosis
    and see my chapter in https://www.amazon.com/Power-Psychiatric-Apparatus-Repression-Transformation/dp/1472417313/ref=sr_1_1?s=books&ie=UTF8&qid=1515602341&sr=1-1&keywords=power+and+the+psychiatric+apparatus (available much more cheaply on Kindle)

  • I hope Mark and all the commenters here will read the brilliant work by Jeffrey Poland in his article about so-called schizophrenia (which is based on a THOROUGH review of the research literature and will give all of you a grounding to fortify your arguments) in the book called Bias in Psychiatric Diagnosis. What he wrote in that chapter would have given you a powerful way to support what you wrote, and in it, he covered vastly more and in stunning depth some years ago. It is something everyone interested in this topic should read. The publisher priced the book higher than we wanted, but ask your library to order it! https://www.amazon.com/Bias-Psychiatric-Diagnosis-Paula-Caplan/dp/0765700018/ref=sr_1_1?ie=UTF8&qid=1515116354&sr=8-1&keywords=bias+in+psychiatric+diagnosis

  • Dr. Hickey, I appreciate your clarification about this matter. But I think it is important to point out that, quite apart from anything related to “unduly severe,” I hope people will read the following criterion from Major Depressive Episode in DSM-IV, noting as you say, the word “or,” so that any ONE item in the list of “marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation” causes the person to meet section “E.” And given that it has been shown (e.g., by Meadow Linder in https://www.amazon.com/Bias-Psychiatric-Diagnosis-Paula-Caplan/dp/0765700018/ref=sr_1_1?ie=UTF8&qid=1508806000&sr=8-1&keywords=Bias+in+psychiatric+diagnosis) that even very caring therapists often assign a psychiatric label even if the person does not meet ALL of the criteria, and given that (as Cacciatore and Lacasse have shown) professionals often immediately prescribe psychiatric drugs for the bereaved and of course have to find and assign a psychiatric label to justify the prescribing, it is clear that, in effect, there was no effective bereavement exclusion in DSM-IV.
    E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

  • THIS IS URGENT, because there is a major error in Dr. Hickey’s article here, although he has always before been absolutely accurate and compelling about everything. This is urgent, because the huge numbers of people who were diagnosed with Major Depressive Episode from DSM-IV even during the very earliest stages — even in the first few days of bereavement — will know that it is not true that there was the “bereavement exclusion” that DSM-IV king Allen Frances CLAIMED was in DSM-IV was actually in there. In other words, there was no effective bereavement exclusion. There is something about not diagnosing Major Depression if the person has been bereaved in the past two months. HOWEVER, if you look in the DSM-IV on about the fourth page into the description of Major Depressive Episode, you will see that it says not to diagnose this if the person was bereaved UNLESS the person had ONE of these things — “unless they are associated with marked functional impairment or include morbid preoccupation with worthlessness, suicidal
    ideation, psychotic symptoms, or psychomotor retardation” (p.352 of DSM-IVTR). ALL OF THESE ARE absolutely typical of bereavement — NORMAL (I have problems with the words “normal” and “abnormal,” but you know what I mean) bereavement. In other words, Frances’ DSM-IV included the clear specification that normal bereavement even on the day of the loved one’s death SHOULD BE classified as Major Depression (it was Major Depressive Episode). And Joanne Cacciatore and Jeff Lacasse wrote a paper in which they neglected to mention all of the above but importantly documented how speedily bereaved people were put on psychotropic drugs, so clearly by implication, those were people who were not classified as having deeply human, even typical reactions to bereavement but were mentally ill and thus needing drugs. I’ve written about this in these two places and, I think, in something I wrote for MadInAmerica, too:
    –Caplan, Paula J. (2014). When you try to speak truth to power, what happens if the powerful turn off their hearing aids? In D. Holmes, J.D. Jacob, & A. Perron (Eds.), Power and the psychiatric apparatus: Repression, transformation, and assistance. Surrey: Ashgate, pp. 165-181.
    –Caplan, Paula J. (2013). Psychiatric diagnosis as a last bastion of unregulated, rampant harm to the populace. In M. Dellwing & M. Harbusch (Eds.), Krankheitskonstruktionen und Krankheitstreiberei: Die Renaissance der soziologischen Psychiatriekritik. Wiesbaden: Springer, pp. 351-388.

  • This is a much bigger scandal than this journalist describes, and I have two concerns about this article, although I am of course glad that yet another article about the Risperdal scandal has been written. One concern is why the “marketing group” to which the writer refers is not identified, why this writer — like every other major media person who has written about the scandal — fails to mention the readily available information about the three psychiatrists who were paid vast sums of money to create a false “Practice Guideline” for using Risperdal that laid the very foundation for all that followed AND who also were paid vast sums after that to produce what their leader, Allen Frances of DSM-IV fame (infamy) called their “marketing plan.” Why do the major media people protect these people over all these years, when they readily name the names of others who were involved. The full story is told in this video https://www.youtube.com/watch?v=tgilBaRbulc and in these articles, one of which is in MadinAmerica: http://www.oa.uottawa.ca/journals/aporia/articles/2015_01/commentary.pdf and https://www.madinamerica.com/2015/10/diagnosisgate-a-major-media-blackout-mystery/
    My other concern is about how the writer of this article, like investigative Stephen Brill in his 15-part series (!) about the Risperdal scandal, focus so intensively on gynecomastia. Certainly the photos that accompany the current article are intended to be shocking, but I would not have expected MadInAmerica to decide to include any such photos, never mind several! I do feel badly for the young males who were already suffering in some way — or causing trouble for others — because why else would they have come to the notice of whoever put them on Rispderal? And on top of whatever else was going on, to be adolescent boys or men and develop breasts must have been terrible. But it is terrible because of the combination of misogyny — “Eww, who wants to have a body part that is associated with women?!!” — and the rigidity, manifested in so many ways, that people have about sex and gender. As some of the other people who commented on this article have wisely observed, where is the alarm about the other Risperdal-caused harm, including shrinkage of the brain, diabetes, hyperglycemia, and even death? Why is this entire article and a 15-part series focused on gynecomastia?

  • It is very important to expose the appalling practice of the prescribing of so-called antipsychotic drugs for people who are suffering from war trauma. But I am surprised that Madinamerica would allow the unchallenged use of terms for psychiatric disorders like “PTSD,” since there is no scientific validation for them, a point that has been documented over and over and over. I hope that Madinamerica and Ms. Pagan-Ortiz will not do this in the future.

  • Begging Madinamerica and everyone who writes for them and posts comments will refrain from using “ECT” or “electroconvulsive therapy.” Please, please call it electroshock instead. Many years ago, I heard the brilliant survivor of electroshock, Leonard Roy Frank, who suffered in devastating ways from electroshock, plead with people never to use the “T” or “therapy” in connection with electroshock. As Audre Lorde wrote, “We cannot use the master’s tools to dismantle the master’s house.” Using “T” or “therapy” is using the marketing term for electroshock and helping perpetuate the coverup of its dangers.

  • In this otherwise interesting and important article, what is not mentioned is that Allen Frances was the driving force behind probably the most stunning conflict of interest and story of corruption in the modern mental health system…and it involved his creating a marketing plan for a dangerous antipsychotic drug. That information is in “Diagnosisgate: Conflict of interest at the top of the psychiatric apparatus.” APORIA:The Nursing Journal 7(1), 30-41. The article is at http://www.oa.uottawa.ca/…/articles/2015_01/commentary.pdf To clarify some other bits of the history: Frances started trashing DSM-5, on whose Task Force he did not serve, while simultaneously making false claims that his own DSM-IV was “scrupulously scientific.” It most certainly was not, as I know from serving on two of his DSM-IV committees for two years before resigning after seeing how resistant he and his colleagues were to accurately reporting the findings of high-quality research, how they regularly based decisions on appallingly poor research, and how they ignored and even denied the harm done by psychiatric diagnoses. Furthermore, the grounds on which he trashed DSM-5 — that it is unscientific, that many of the Task Force’s deliberations were carried out secretly, that they were expanding the boundaries of abnormality — were the very grounds on which his DSM editions had been accurately criticized, but he never mentioned that. What has been fascinating, though bizarre, has been to see how he tries to position himself as the White Knight who warns people about the harm that diagnoses and drugs can do (and astonishingly, he has some people believing that he is a true critic, that he has somehow totally switched sides) while claiming that many people who need drugs are not getting them. And what class of drugs is he pushing in this way? Anti-psychotics. Think there might be a connection between that and what Johnson & Johnson paid him to help them market their anti-psychotic drug Risperdal?

  • How wonderful of Lauren Tenney to recognize that this story needed to be told and then to do all of the digging, FOIA request filings, and analysis of the information obtained! She so often is way ahead of the pack at spotting dangers and reporting them with penetrating analysis.

    And I love the comments posted above!

    I have to say that twice, people I respect tremendously have told me that electroshock was helpful to a close family member when nothing else had helped. My reactions to those reports are (1) I am first and foremost glad that they felt better, (2) I hope that they were fully informed ahead of time about the real and devastating kinds of harm that so often result from electroshock (but I know that it is highly unlikely that they were), (3) if it was in fact the electroshock that helped them, rather than something else, that of course does not disprove the harm that electroshock has been shown to cause in so many people, and I have heard far more first-person stories from people I greatly respect about its devastating consequences.

    With regard to footnote 3 of the article, if people are interested in the work I’ve done and am doing with veterans, better websites than the one given there are listen2veterans.org and whenjohnnyandjanecomemarching.weebly.com

  • You are so right, and I appreciate your posting all of this.

    Bipolar Disorder is no more scientifically valid than anything else in the DSM. All of these labels are based on criteria that are so subjective that in essence, your therapist gets to decide if you have too much of one thing or not enough of another. Do some people suffer terribly from severe mood changes? Of course! Do they deserve help? Of course! But applying an unscientific label and then prescribing treatments that cannot be proven to help with something that has not been shown to exist is in effect experimental treatment without the patient’s knowledge or consent. Do some people say they were helped by treatments that were held out as based on their diagnosis? Yes. Do we need to believe what they say? Of course. But how many of them were ever told, “I don’t want to label as a mental illness what is happening to you, I see that you are suffering, and I will try to help. Now here is a huge array of things that have been found to be helpful by at least some people who have experienced something like what you are experiencing, and all of them are low-risk are no-risk”? We have 28 of these — and there are MANY more — at http://www.youtube.com/playlist?list=PL51E99E866B9D735E. The people on these 28 very brief videos are referring to veterans, but these are all helpful for anyone.

  • Having served on two DSM-IV committees — to which I was appointed by Allen Frances and from which I resigned in horror after witnessing the way they ignored, distorted, or lied about good research if it failed to fit with what they wanted to do and the way they ignored and some even publicly denied that psych diagnosis causes harm, though I had given them many examples — I feel a kind of existential nausea every time I see that Allen has again trashed DSM-5 and contrasted it with what he has called the “scrupulously scientific” process he followed for DSM-IV. My article about this whole matter in the journal APORIA: The Nursing Journal at http://www.oa.uottawa.ca/journals/aporia/articles/2015_01/commentary.pdf sheds much more light than this briefer article that the MIA people kindly published here. I think the devil is in the details, and I hope that people will read that APORIA article, because it is packed with information that is truly illuminating with regard to Allen Frances. If he were an ordinary citizen with no influence and no power to cause harm, it would not matter what he does, of course. When he first started trashing the DSM-5 people, I wrote to tell him I thought it was great that he was doing that…until I noticed the pattern, i.e., that he would criticize them for the very things many of us had asked him to stop doing with DSM-IV, including taking no notice of what the good scientific research showed, pretending his process was scientific, failing to document and warn of the harm of so many kinds that all begin with getting classified as mentally ill, failing to make any attempts to redress the harm, and operating so much in secrecy.

  • Thank you, Steve Spiegel, for your lovely comments. Because the facts are so clear and so well-documented in Dr. Rothman’s sterling report, and because that report has been in the public domain for some years, really anyone who spent some time reading the report and knowing some about the positions of the main characters could have written this article. I wonder if you or anyone else might want to suggest how it happens that these three men have escaped major media coverage…and what can be done about it. Note that I have not received a single inquiry from any major media person since this MIA article was published the other day, in spite of the huge MIA readership and the fact that I sent it to my own extensive media list, which is primarily composed of reporters and producers who initially reached out to me for interviews about the mental health system.

  • Thank you for the lovely comments about the article. What a nightmare your story is. I hope you have gotten help for the osteoporosis. My mother is 92 and a few years ago had osteoporosis and then found some (partly Rx and partly supplements and partly spending 20 minutes on the treadmill EVERY DAY) things that helped, to the point that she now has the less alarming condition of osteopenia but not osteoporosis. It is a tribute to her and to her doctors!

  • I sent a Facebook message (the only way I knew to reach him) to Steve Brill after the first or second chapter of his excellent series, saying I assumed he was aware of the Rothman Report and the participation of the three psychiatrists that I described in my initial “Diagnosisgate” paper but in case he had not I was sending him the link to it — Caplan, Paula J. (2015). Diagnosisgate: Conflict of interest at the top of the psychiatric apparatus. APORIA:The Nursing Journal 7(1), 30-41. http://www.oa.uottawa.ca/journals/aporia/articles/2015_01/commentary.pdf
    I received no reply. I had hoped he would read the article and the Rothman Report and include it somewhere in the rest of his very lengthy series, but he did not.
    And when Nicholas Kristoff wrote a glowing column in the NYTimes about the Brill series, I sent him a similar message and received no reply, and he apparently has also not written about it.
    Isn’t this strange and disturbing?

  • Yes, Dr. Hickey, you are absolutely right. When people who have power and have caused enormous harm seem to have seen the light but are not coming straight out and acknowledging the harm and are not using their own time and money to redress the harm but instead spend their time and energy calling out others for causing harm, it is frightening that people will put their trust in them. That is why in the article cited in footnote #1 of this current piece, I reported his own words — comparing what he says at one time and place with what he says in another — so that people can see the facts and make up their own minds. Your work in getting the truth out about what is done to people who are suffering and come seeking help is stellar and so important. Thank you.

  • Lauren Tenney, your analysis is brilliant, as usual!
    A word of caution, however, about the framework Bob Whitaker and Lisa Cosgrove advocate in their book — which they in fact do not follow consistently even within that book — is that they baldly state, “There are no bad apples, only bad barrels.” And Bob has said that the only way to make real change is to use that framework. However, if that were true, it would mean that the enormous power that many individual people in mental health and other fields hold, as well as their free will and their responsibility to behave ethically, are pretty much considered irrelevant. Sort of like “The dog ate my homework” excuse, people who abuse their power would by the Whitaker and Cosgrove theory be able to avoid being held responsible for unethical behavior by saying, “I couldn’t help it! That awful system MADE me do it!” Surely whistleblowers within those systems are to be commended and rewarded for bravely speaking the truth, and that is precisely because often it is only when _individuals_ within a corrupt system speak the truth publicly that these systems change. In fact, there is a good argument to be made that that has often been the primary way to make them change.
    Bob Whitaker has made it clear that he considers Dr. Biederman reprehensible for having been such an ardent promoter of the appalling notion that Childhood Bipolar Disorder both exists and should be cause for feeding children and even toddlers dangerous psychiatric drugs. He is right to see Biederman that way, but both Biederman’s role in causing harm and the roles that a vast number of other individuals have played in causing harm in the psychiatric and psychological systems belie the “no bad apples” assertion, rendering it clearly hollow. Thus, in their book, Bob and Lisa repeatedly name individuals whose conduct was deceitful, harmful, and otherwise unethical, but they protect others who have caused great harm and even quote them unquestioningly as though their claims should be considered true and reliable. So I want to caution people not to worry that it is somehow inappropriate or unwarranted to hold individuals responsible for harm that they cause by knowingly participating in corrupt systems and profiting from their participation. Such individuals by exercising their free will in harmful ways have deprived many readers of Mad In America, among others, of their freedom, human rights, dignity, and self-respect. And the full truth must always be spoken — about corrupt systems and about the individuals who keep those systems humming.

  • How troubling that in this entire article that comes across as terribly scientific and technical, the author reifies “psychiatric disorders.” Indeed, referring to them as though they are real, reliable, and valid entities — in the context of the citation of theory and statistics about heritability — is stunningly misleading. Why worry so much about alleged heritability of entities that have been used to cause so much harm, including to so many of the people who read MadinAmerica?

  • I hope that Bob and/or Rob will write an article about the apparent and quite dramatic change in the policy of Madinamerica, since it now is giving space to the kinds of unfounded and dangerous claims that Bob has spent years — at great personal cost, I suspect, and certainly with great courage — exposing. And it would be good to know why this particular study is presented as news, when there are enormous numbers of such studies coming out all the time. If MIA wanted to publish full-fledged, thorough, informed critiques of many of these, that would be great. Having taught critical thinking and research methodology for decades, I have a neat “How To Do a Critique” page composed of the step-by-step way one goes about evaluating a study. Bob and/or Rob, would you like to publish that page and invite people to write in-depth critiques so that readers of MIA will be well-armed to refute Pharma’s irresponsible claims, you could do a great service. I would be glad to help with this in other ways and write some such critiques myself. Just let me know.

  • When a colleague sent me this article, and it looked like it was published in Madinamerica, I swear to you that my immediate thought was that this had been published in The Onion as a joke — because everyone knows that Madinamerica would never publish something that goes so totally against what Robert Whitaker has long and bravely stood for. How many readers of Madinamerica — especially those with no background in scientific methodology (and I do have that background but find that the criticisms in this form make my eyes glaze over) — will understand the important implications of the minimal bit of Vipond’s “critique” of this study, which comes across as though these are just some limitations of the study? Rob Vipond, I am at a loss to know why you failed to state clearly that the whole article is based on a never-proven, indeed a disproven and harmful claim about serotonin. Finally, does the headline Madinamerica chose allow room for the minimal critique to be seen as substantial? It looks like a headline that Pharma would have written. Can we now expect that Madinamerica’s policy will be to publicize more pieces of “research” that are based on the kinds of disproven assumptions that have destroyed the lives of so many readers of Madinamerica?

  • Nancy, thank you for this thoughtful, powerful, nuanced essay. Wonderful work.
    As for suing the APA for racketeering, I have been trying for decades to find even one lawyer who would file suit against the APA for all the harm they caused through the DSM, which they knew (or ought to have known) was unscientific, did not lead to reduction of human suffering, and carried enormous risks of harm. No one (except one Scientologist, so I cannot work with him) has been willing to take on the huge financial burden that such a lawsuit would involve, especially given the vast fortunes the APA has at its disposal and the fact that Pharma would surely kick in huge amounts of money as well to hire the top attorneys to oppose such a lawsuit. Furthermore, the barriers to winning any lawsuit against the APA are very high and numerous…no time to go into them all here. But when I wrote They Say You’re Crazy in 1995, I very carefully documented a vast amount of unscrupulous activity on the part of the DSM people, and I did it partly to save a lot of time and trouble for attorneys who might take them on. But I would be glad to work with any lawyer who is considering any kind of lawsuit against the APA, because I am happy to share with them tons of information that is very damning.

  • This is in reply to a couple of things said by two different people here above.

    One is that it is correct that one reason lawsuits are hard to win in this field is that the pernicious approaches — all of which start with assigning a DSM label, which means it is not scientific and carries risks of harm — are indeed considered the “standard of care,” and the Daubert decision by the Court helps maintain that problem.

    The other is to mention that the very brave attorney Jim Gottstein of PsychRights has done groundbreaking work about doctors who knowingly prescribe drugs that have been proven to be harmful and rarely helpful.

  • Just in case the question about what is normal is not intended as a rhetorical question, an entire chapter in my book, They Say You’re Crazy, is dedicated to that question, and I go through many different ways of deciding what is normal and address the serious problems with each.

    May I request that people commenting in here refrain from name-calling against anyone and just focus on facts and debate. As people who write essays here and post comments here know better than most people, there is much nastiness and hurtfulness in the world, and I know that some people come to MadInAmerica looking for information, validation, or thought-provoking material…but not nastiness.

    And if you have not read everything that any given author has written, how about instead of calling names and assuming the worst, just asking the author if they have addressed Question X or Y?

  • Dr. Lawhern,

    People are constantly asking me why I don’t organize a class action suit about psychiatric diagnosis. It seems such an obvious question, and I can see why you raise it, and I appreciate your interest. First, for two decades (first in my 1995 book, They Say You’re Crazy), I have been searching for lawyers (who are NOT affiliated in any way with Scientology or its CCHR or any of its front groups) who will take on even a single case about this. I have not found one. With regard to class action suits, it can take years of attorneys’ work to try to figure out the best way to define the “class” — and often it goes to an appeals court, even the U.S. Supreme Court, which then declares the lawsuit cannot go forward because it is not a legitimate class. Since this happened with so obvious a class as the women employees of WalMart, when there was massive evidence that they had been discriminated against systematically and appallingly, just imagine what would happen with trying to define, e.g., the class consisting of “people who have all been harmed by psychiatric diagnosis.” The kinds of harm and the routes through which they were done are so varied. Furthermore, I have spent endless hours talking with and writing to lawyers who at first expressed an interest and who then dropped out, often because they know that a lawsuit against the APA for harm done by its DSMs would be opposed with the vast sums of money the APA has and no doubt joined by the vast sums Big Pharma and other entities such as perhaps insurance companies would provide in order to keep the diagnosis juggernaut rolling along, and I don’t know any law firm or even individual lawyer who can afford or is willing to risk everything they have to fight a case like this. I have ideas for much less demanding cases that could be wedge cases and very effective, though.

  • Such brave, important work you have done on this, David Oaks!!! Remember when we were at a conference ages ago, and the late, dear Leonard Roy Frank urged the audience when he gave a talk — since he had been subjected to electroshock, and the effects on him and many others had been so devastating — never to call it “ECT” because the “T” stands for “therapy”? So I always call it “electroshock” instead.

  • If you look in my book, They Say You’re Crazy, and in the chapter on sexual orientation by William Metcalfe and me inmo the book Bias in Psychiatric Diagnosis, you will see that it is a huge myth created by DSM-III head Robert Spitzer that he REMOVED homosexuality from DSM-III. Here are the facts: They CHANGED it to “ego dystonic homosexuality” but announced very publicly that they had decided that homosexuality was no longer a mental illness (because they voted that it was not — a vote — that is how “scientific” it all was). What is “ego dystonic homosexuality”? It is being homosexual but not being totally comfortable with that, not feeling like it is fully consistent with who you are. In the very homophobic society at the time DSM-III was published, it was extremely rare for anyone who was homosexual NOT to have “ego dystonic homosexuality.” So Spitzer and his cronies had it both ways — they continued to pathologize being lesbian or gay, AND they got all the acclaim from lesbians and gays who mistakenly believed the lie that homosexuality itself had been removed from DSM-III. Right now, it is not in the current DSM, but there are still ways to diagnose homosexuality as a mental illness, such as by classifying a homosexual with a DSM category like Sexual Perversion. Be aware, too, that, as Jeremy Caplan and I document in the chapter on sexual orientation in our book, Thinking Critically about Research on Sex and Gender, after claiming to have removed homosexuality from the manual, Spitzer announced that he did “research” in which he “proved” that people could be converted from homosexuality to heterosexuality! But even later than that, after many of us pointed out how horrifically poor was his research — it was like a made-up research design in which as many methodological errors as possible had been included! — he acknowledged that his study had been appallingly bad.

  • One more crucial point that has not been mentioned in this article or the comments yet: The whole enterprise of psychiatric diagnosis is — at least in the U.S. — _totally_ unregulated. That means that it is even less regulated than the financial giants who have so damaged the economy. I hope that everyone who reads this will consider signing the Call for Congressional Hearings about Psychiatric Diagnosis, which was posted more than a year ago at http://www.change.org/petitions/everyone-who-cares-about-the-harm-done-by-psychiatric-diagnosis-endorse-the-call-for-congressional-hearings-about-psychiatric-diagnosis This is a follow-up for such a petition that I created many years ago, but it has been difficult to get members of Congress to pay attention to this need. I hope that people will contact their Senators and Representatives to urge them to support this call. It is just another of the many ways it will be necessary to come up with in order to dismantle a damaging system or at the very least provide sorely-needed safeguards, because now, there are none.

  • Thank you for raising this. I have seen a letter to the effect that Medicare and Medicaid are switching from the DSM to the ICD. I would love to know why, and if anyone knows the back story, I hope they will post it here or write to me directly. I am wondering whether the military and VA mental health systems are also considering making the switch. And I have not yet heard what private insurance companies will do. I would also be interested in learning about that if anyone has any information. But let us not let our guard down and assume that these changes will result in less damage. In fact, for those of us in the U.S., at least we were able to find out how to file ethics complaints with the APA about harm from the DSM in order at least to _make the effort_ to hold them accountable. But so far, we have not even been able to get clear information about _whether_ there is a way to file a complaint with the World Health Organization if one has been harmed by psych diagnosis that came from the ICD. And is the filing of complaints the only thing that needs to be done? Of course not. But it seems important to file such complaints in order to see whether the purveyors of these diagnostic classification manuals can ever be held accountable when their work leads to harm.

  • Just a few updates:

    –It is so encouraging to read Amy Smith’s post about alternatives to diagnosing, and I hope she will post more details here when she has a chance.

    –I guess that it was as a result of my having written the book about what I learned when I served on two of Allen Frances’s DSM-IV committees — the disregard for both what the science really shows and for the suffering caused by diagnosis — that has, over many years, led many whose lives were destroyed by diagnosis, whether from the DSM or the ICD, to contact me. And thinking back over much of what various people posted and emailed yesterday, I find myself hoping that more people who sincerely seem to consider the ICD a less dangerous alternative would hear more of the stories of harm. Once heard, those tragic stories live in one’s heart forever.

    –In light of the discussions yesterday, I decided to make an effort in a different way to find out whether the ICD enterprise has a procedure for filing complaints when people have been harmed by its use (as we filed complaints ethics complaints last year with the APA because of harm from the use of the DSM … something about which I wrote in two articles at madinamerica.com as well as on my Psychology Today blog). I also made an effort to find out what the World Health Organization does with the income from sales of the ICD. Their medical officer wrote back promptly but only referred me to other websites that did not in fact include any of that information. So I have written to him again and will post here whatever he replies if I hear back from him again. It is proving to be tough to find out about the internal workings of the ICD and thus for therapists who want to use the ICD to be fully informed about what they are doing and whether their patients, should they suffer harm because of getting ICD labels, would even have the most minimal recourse of filing a complaint about it. (I realize, of course, that the WHO might be as utterly cold and unresponsive if such complaints were filed as the APA has been about complaints about harm from the DSM, but it seems important to learn as much as we can.) If anyone who reads this knows anyone who has been an inside in the ICD enterprise and can put them in touch with me, I would appreciate that. I think it is healthy for people concerned about adding to the suffering of people who seek help in the mental health system to be able to toss ideas and suggestions back and forth and to have different perspectives. But I feel strongly that it is important for us to do this from a base of as much knowledge as possible. So I hope to learn from others what they know, and I will be grateful for that.

    –I hope that our awareness of the massive power of the systems that are supposed to help people in need but end up too often harming them will not lead us to aim only to try to disarm or dismantle one small part while we look away from the harm caused by the rest. Yes, it is daunting to aim to do it all, but if we do not make the effort, who will?

  • I should have added that the DSM editions both current and future are unscientific and harmful, but at least the DSM’s publisher, the American Psychiatric Association publicly announces that it has an Ethics Committee and that complaints can be filed. The fact that they summarily dismissed all nine complaints about harm from DSM labels that we filed last summer is truly terrible, but listen to this about the ICD: When we wrote to ask the ICD people what procedures they have for filing an ethics complaint, they wrote back but would not even give us an answer. The only reason I can think of for considering the ICD less horrible than the DSM is that the APA is a lobby group and, as far as we can determine, has never used a dime of its vast profits from the DSM to prevent or redress the harm its manual causes, whereas the ICD is published by the World Health Organization, so MAYBE — though we have not been able to find this out either — MAYBE the WHO uses the profits from the ICD for some better cause than supporting a lobby group. If anyone can find out, please let me know. Thank you.

  • I am sure Jack Carney’s intentions are good, but sadly, to urge a boycott of the DSM while urging people instead to use the ICD if they are going to use psychiatric labels reflects an overlooking of the fact that the authors of the DSM and the ICD have said repeatedly and publicly that they work hard to make sure that the contents of the DSM are as close to the contents of the mental disorders portion of the ICD as possible. It is actually dangerous to give people the impression — as Jack’s petition and this article do — that the appalling risks of serious harm caused by the use of DSM diagnoses (which have also characterized the unscientific editions of the DSM produced by both Robert Spitzer and Allen Frances) will be avoided by use of the ICD.
    As for the price of DSM-5, why is charging $199 in 2013 suddenly shocking, when there was no such outcry for Allen Frances’ current edition, DSM-IV-TR, which a call to Barnes and Noble just revealed a price of $142 plus tax? After all, DSM-IV went on the market nearly two decades ago, and the “TR” version has only a tiny number of changes and went on the market in 2000.
    Those who know my work know that I have been a critic of the DSM since serving on two of Allen Frances’ committees to plan DSM-IV from 1988 till I resigned in 1990 because I was so horrified to see how they used junk science, ignored good science, and falsely and publicly claimed that their work was scrupulously scientific (as Frances continues to do, allegedly in contrast to the DSM-5 people, who are also appallingly unscientific) and not harmful. So I, too, wish people would boycott the DSM but also that they would not assume anything about the ICD psychiatric section is either scientifically grounded, helpful in reducing human suffering, or less risky for patients than the DSM.
    I created the first anti-DSM petition in the late 1980s, which drew signatures from individuals and huge organizations (including NOW, the Canadian Psychological Association, and others) representing more than six million people, and I created a year ago last December the first “Boycott the DSM” petition at change.org http://www.change.org/petitions/boycott-the-dsm because I was so alarmed by how many people would continue to suffer from the DSM-IV-TR (as indeed they do right this minute) while Spitzer and Frances and others have focused all of their attention on trashing the DSM-5 editors for doing the same kinds of ignoring of science and harm and making of false claims of which Spitzer and Frances themselves were guilty). Hence, I did not limit my petition to boycotting the next edition of the DSM only. I wish that Jack had accepted my offer to work together on his new project, and it is unfortunate when the few people who want to take action in this movement cannot see their way clear to working together, but I hope his petition will be wildly successful. Not having volunteers or funding to pay people to help get the word out about my “Boycott the DSM” petition, I hope that he will get many more boycott pledges than I have done. But I hope that he will revise his petition to remove the misleading urging to use the ICD instead, because that is just urging people to flip their patients out of the frying pan and into the fire. Remember: unscientific and harmful labels were plentiful when Spitzer created DSM-III and then DSM-III-R, and then Frances freely acknowledges that he got rid of almost none of that when he created DSM-IV and DSM-IV-TR, and it is a good bet that most of that garbage will also appear in the DSM-5…and thus in the next ICD.

  • Thank you, Duane Sherry, for your kind words.

    And thank you, anonymous and powerful, moving writer for the letter you sent to Linda Hughes at the APA. I hope what you did will inspire others to do the same. Her email address is [email protected] She seems to be not a psychiatrist but the administrative head of the APA’s so-called Ethics Department. I hope people will also send their letters to the APA’s General Counsel, Colleen Coyle, at [email protected]

  • I have tried to work with Allen Frances, since the time in the 1980s when he put me on two DSM committees. If you read my books about psych diagnosis, or if you read the essays I have written about it on my Psychology Today blog, you will not be surprised that he wants nothing to do with me. In setting himself up as a hero who is trashing the DSM-5, he continues to make the unfounded claim that his own editions of the DSM were produced by a scrupulously scientific, multi-stage process. The multi-stage part is true. The rest is not. He, more than probably any other single individual in history, has been responsible for more people being pathologized, but in his recent public statements he manages to blame everyone but himself. Gee, he claims, he just had no idea what would be done with the diagnoses in his manual. Furthermore, he has publicly warned about what he calls the anti-psychiatry people (few or none of whom are actually totally opposed to all psychiatrists, just to the problems in psychiatry AND in psychology and all other mental health professions) and defends psychiatry rather than ever taking a single step to redress any of the harm his manuals have done. Many of the people he warns against are the very ones who have been hurt by not only the production of his manual but his failure and the failures of many in the APA (this is part of what the complaints are about) to educate professionals and the public widely about the facts that the DSM is unscientific, does not improve outcome, and carries huge risks of harm. I have been pointing this out since resigning in 1990 from those two committees to which Allen appointed me. Now do you understand why he is not interested in working with me? The complaints filed would have named him as a respondent, had he still been a member of the APA, but he no longer is, and APA says it is a secret when and why that changed. I heard something I thought was a joke but is apparently true: He has a book coming out just when the DSM-5 is due, and his book is to be called … Saving Normal.

  • Dear Marsie,
    Many thanks for this beautiful message.
    I am not sure what you are asking. Decades before 1980 there were two earlier DSM editions. DSM-III was published in 1980.
    In the nine complaints we filed (each of which runs to about 60 pages), we did indeed document that the respondents knew or ought to have known that a vast amount of harm had been caused by DSM diagnoses over the decades. And that is included in the template we have prepared that allows others to spend a minimal amount of time to submit their own complaint — but anyone is also free to add anything else to their own complaint (and to leave out any parts of the template that they do not wish to include).
    Paula

  • I am glad that this work has touched a chord for people who have written comments here, and I hope that more people will file complaints and/or help locate an attorney who will file one or more actual lawsuits.

    As for the beautiful things some people wrote about me, I am deeply touched and grateful, but the people who were harmed by diagnosis and have had the courage to file complaints are the remarkable ones.