How the NY Times Portrays Psychiatric Diagnosis


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 The response was that they do not publish letters about that column but that in any case they would not do so “mainly to attack the credibility of the writer; we prefer that the focus stay on the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.”

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.”

Tags:
allen frances, american psychiatric association, apa, blackbox warning, civil liberties, congressional briefing, debra turkat, defining mental illness, dsm, harm from psychiatric diagnosis, jenny mcclendon, laura delano, leah harris, leon hoffman, michael f. grunebaum, new york times, patrick singy, psychiatric diagnosis, ronald pies, sera davidow, stigma, sunday dialogue, the need and the 9 demands, they say you’re crazy, victor a. altshul

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