Ava C., adopted from Asia and raised in small-town America, knew she looked different from her classmates, but no one ever talked about her origins.
Over time, she began to withdraw. Following a psychiatric diagnosis of depression, she thought of herself as “mentally ill.”
One day, while in a major city’s bustling Chinatown, she realized, “All around me were people who looked like me, doing ordinary things. They apparently didn’t feel ‘sick.’ That’s when my depression lifted.”
People like Ava — from different cultures, classes, races, or genders — often experience life’s stresses in unique ways. Too frequently, they are labeled ill or abnormal by the psychiatric establishment.
Dr. George Albee, emeritus professor at the University of Vermont, once noted that “the highest rate of ‘idiocy and lunacy’ in America was first among the millions of immigrant poverty-stricken Irish after the potato crop failure of 1845, then on successive waves of poor Swedes, then Slavs and Russian Jews, then Southern Italians, now Blacks and Hispanics...as each group achieved economic success their incidence of ‘idiocy and lunacy’ fell to the population average.”
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As the new Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is released this year, experts are sounding cautionary notes.
Among the critics of the DSM, considered the “psychiatrist’s bible,” is Dr. Paula J. Caplan, a feminist psychologist who served as advisor to two DSM-4 committees before resigning due to concerns about “how fast and loose they play with the scientific research related to diagnosis.”
Caplan has become the leading voice in alerting therapists and the public to the manual’s “unscientific nature and the dangers that believing in its objectivity poses.”
“It is widely believed … that if only a person gets the right psychiatric diagnosis, the therapist will know what kind of measures will be most helpful. Unfortunately, that is not usually the case,” Caplan says.
“Getting a psychiatric diagnosis can often create more problems than it solves, including difficulties with obtaining health insurance, loss of employment, loss of child custody, the overlooking of physical illnesses...and the loss of the right to make decisions about one’s medical and legal affairs,” she adds.
Caplan worries that the authors of the DSM make “expansive claims about their knowledge and authority, wielding enormous power to decide who will and will not be called mentally ill and what the varieties of alleged mental illness will be.”
She doesn’t deny that psychotherapy and medication can be helpful, but she sees worrisome connections between “drug companies’ concealment of the harm their products can cause and some professionals’ pushing of particular drugs while on the payroll of pharmaceutical companies.”
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The American Psychiatric Association (APA), which writes the DSM, says its purpose is to establish criteria for diagnosis and “not to create medical conditions out of the full range of human behavior and emotions.”
It also claims to be dedicated to “ensuring that the development of DMS-5 is the most open and inclusive in the history of the manual.”
Still, Caplan remains concerned about the “shroud of secrecy” that she sees enveloping the process.
As director of the Coalition for Informed Patients and Doctors, she has called for Congressional hearings about psychiatric diagnosis “in an attempt to explore the nature and extent of harm that many Americans have suffered solely because of being given a psychiatric label.”
Feminist therapists are concerned for women in particular. Diagnoses such as borderline personality disorder (BPD) and sexual dysfunction have disparaged women and compromised them in troubling ways.
For example, one expert says that BPD is almost exclusively applied to women because its symptoms relate to emotion and anger. Some women with the diagnosis have histories of abuse and might have difficulty expressing anger in ways others might consider “appropriate.”
Such vulnerable women need to have their coping styles better understood before assumptions are made about their behavior.
Similarly, “sexual dysfunction” among women is often based on assumptions about what constitutes normal sexual behavior.
“If only performance failures or lack of desire count, the entire context of sexual activity becomes invisible and of secondary importance,” says one member of the Association of Women in Psychology (AWP).
Another AWP member focuses on classism in psychiatric diagnosis.
“Poor women and women of color are particularly likely to be misdiagnosed or encounter bias in treatment,” she says. “Therapists may interpret chronic lateness or missed appointments as hostility or resistance to treatment rather than the outcomes of unreliable transportation, irregular shift work, and unpredictable child-care arrangements.”
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Caplan and her colleagues warn that “the absence of science creates a vacuum, and biases and distortions rush in.” Serious problems like depression are overlooked as people are diagnosed with unproven mental illnesses.
“Many people who are suffering — because of social problems like poverty, or because they are victims of hate speech or violence — are wrongly treated as though the problems come from within them,” she says.
That’s enough to make anyone call for hearings instead of professional help.