When you are sick or injured, you want to know what’s wrong and what can be done. You want a diagnosis. A correct diagnosis reveals what is wrong, what is the preferred treatment and what is the likely outcome. For example, a
When you are sick or injured, you want to know what’s wrong and what can be done. You want a diagnosis. A correct diagnosis reveals what is wrong, what is the preferred treatment and what is the likely outcome. For example, a diagnosis of pneumonia indicates a serious lung infection that can usually be cured with antibiotics.
While medical diagnoses are based on science, psychiatric “diagnoses” are not at all scientific. They do not reveal what is wrong, what is the preferred treatment, and what is the likely outcome. Nor are they reliable. Different psychiatrists who examine the same patient typically offer different “diagnoses.” Moreover, psychiatric “diagnoses” move in and out of favor, depending on a variety of social factors.
Psychiatric “diagnosis” is actually a labeling process, where the patient’s symptoms are matched with a grouping of symptoms listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Psychiatric Disorders (DSM). As we shall see, this psychiatric “bible” was developed and is maintained by financial and political interests.1
Who decides what is normal or healthy and what is deviant or sick?
Before the 20th century, life stresses were generally seen as spiritual problems or physical illnesses, and people turned to religious advisors and physicians for help. Medical doctors treated “hysteria” and “nerves” as physical problems. Psychiatry was restricted to the treatment of severely disturbed people in asylums.2 The first classification of psychiatric disorders in the United States appeared in 1918 and contained 22 categories. All but one referred to various forms of insanity.
In 1901, Sigmund Freud revolutionized psychiatry by breaking down the barrier between mental illness and normal behavior. In The Psychopathology of Everyday Life,3 Freud argued that commonplace behaviors — slips of the tongue, what people find humorous, what they forget and the mistakes they make — indicate repressed sexual feelings that lurk beneath the surface of normal behavior.
By linking everyday behavior with mental illness, Freud and his followers released psychiatry from the asylum. Between 1917 and 1970, as psychiatrists cultivated clients with a broad range of problems, the number of psychiatrists practicing outside institutions swelled from eight percent to 66 percent.4
The social movements of the 1960′s opposed psychiatry’s focus on inner conflict and emphasized the social sources of sickness instead. Dr. Alvin Poussaint recalls the 1969 convention of the American Psychiatric Association (APA).
“After multiple racist killings during the civil rights movement, a group of black psychiatrists sought to have murderous bigotry based on race classified as a mental disorder. The APA’s officials rejected that recommendation, arguing that since so many Americans are racist, racism in this country is normative.”5
Growing the industry
In 1980, the APA overhauled the DSM. The Task Force established to create the new manual declared that any disorder could be included,
“If there is general agreement among clinicians, who would be expected to encounter the condition, that there are significant number of patients who have it and that its identification is important in the clinical work it is included in the classification.”6
In other words, the new DSM was not based on science, but on the need to maintain existing patients and include new ones who might seek help for any number of problems. A profitable and self-perpetuating industry was born. The more people could be encouraged to seek treatment, the more conditions could be entered into the DSM, and the more people could be encouraged to seek treatment for these new conditions.
By 1994, the DSM listed 400 distinct mental disorders covering a wide variety of behaviors in adults and children. Significantly, racism, homophobia (fear of homosexuality) and misogyny (hatred of women) have never been listed as mental disorders. In 1999, the chairperson of the APA’s Council on Psychiatry and the Law confirmed that racism “is not something that is designated as an illness that can be treated by mental health professionals.”7 Homosexuality was listed as a mental disorder until activists campaigned to have it removed.8
The women’s liberation movement condemned labeling symptoms of oppression as mental illnesses. In They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, Paula Caplan explains,
“In a culture that scorns and demeans lesbians and gay men, it is hard to be completely comfortable with one’s homosexuality, and so the DSM-III authors were treating as a mental disorder what was often simply a perfectly comprehensible reaction to being mocked and oppressed.”9
Caplan describes efforts to prevent “Masochistic Personality Disorder” from being included in the DSM. This disorder assumes that women stay with abusive spouses because like to suffer, not because they lack the resources to leave. Despite protest, “Masochistic Personality Disorder” was added to the 1987 edition of the DSM, although it was later dropped.
The inclusion of “Pre-Menstrual Dysphoric Disorder” (PMDD) in the DSM also raised a protest. According to Caplan,
“Th