DSM-5 COULD BE HAZARDOUS TO YOUR MENTAL HEALTH
Ava C., adopted from Asia and raised in small-town America, knew she looked different than 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.”
As the new Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is released this year, experts are sounding cautionary notes. Among the “psychiatrist’s bible” critics 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 lose 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.”
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.”
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 may have difficulty expressing anger “appropriately.” 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.”
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.”
That’s enough to make anyone call for hearings instead of professional help.
WHAT WILL MICHELLE’S SECOND TERM LOOK LIKE?
I have enormous respect for Michelle Obama. She has brought dignity to the White House and set a high bar in terms of intelligence and style for first ladies to follow. Jodi Kantor, author of The Obamas, argues that this First Lady is a force to be reckoned with in the White House. Still, I wonder if she will now be a bit more 21st century in her role.
Ms. Obama’s nutrition initiative is good and so is her commitment to military families, although some say there’s more front than back there. Also, I understand that a lot occurs behind the scenes and that as a mom of adolescent girls, it’s important to put family first.
Still, as an experienced professional and a first lady with deep convictions, Ms. Obama has an extraordinary opportunity to address selected critical issues in this contentious time, and to exert her influence around current issues such as pay equity, violence against women, and reproductive rights. Instead, in her first term, she chose to be cautious, positioning herself as a traditional first lady addressing safe issues. She tread lightly, more akin to Nancy Reagan than to Hillary Clinton.
As first lady, Ms. Clinton set an extraordinary precedent. One can criticize her handling of the health care debacle, but not the fact that she took it on. Nor can you fail to admire her public commitment to women, even though she took a lot of heat for speaking out forcefully on their behalf. For those of us who watched her in Beijing at the 1995 Fourth World Conference on Women there was no more thrilling moment in the history of first ladies than when she read the riot act to the Chinese for their oppression of women.
Cataloging a litany of human rights abuses the world was stunned as Clinton declared, “It is time for us to say here in Beijing, and for the world to hear, that it is no longer acceptable to discuss women’s rights as separate from human rights.”
It’s not as though Clinton is the only former first lady who had fire in her belly. Eleanor Roosevelt was the most influential wife of a president this country has ever seen. She used her role to advance New Deal proposals, education reform, and equal rights for all in a time of violent racism. As her biographer Blanche Wiesen Cook noted, “Her gift for organizing and her astonishing energy and determination to do good combined with her famous name made her an influential figure in both social reform and partisan politics.” Involved with the League of Women Voters, the Women’s Trade Union League, and the Women’s Division of the New York State Democratic Committee, she wrote, “Against the men bosses, there must be women bosses who can talk as equals, with the backing of a coherent organization of women voters behind them.”
There were other first ladies who made their mark. Helen Taft advocated for women’s right to vote. Edith Wilson undertook many “details of government” when her husband Woodrow suffered a stroke. More recently Betty Ford transformed the role of first lady when she publicly confronted breast cancer as well as her battle with substance abuse. In 1991 she won the Presidential Medal of Freedom for “selfless, strong, and refreshing leadership on a number of issues,” including women’s rights.
The wife of the U.S. president can exert enormous influence on issues of her time. She has the ear of the president and her own bully pulpit. So Michelle, show us the real fire in your belly. What is it you truly want to speak out about or see changed? What do you want your legacy to be as a 21st century first lady?
You might as well go for it. As Eleanor Roosevelt said, “Do what you feel in your heart to be right, for you’ll be criticized anyway. You’ll be damned if you do, and damned if you don’t.”
Surely when you’ve got the right stuff – and you do, Michelle – it’s better to be damned if you do. So while you have this unique opportunity, why not go out there and make a big difference? As your husband would say, “Yes, you can.”
Are you “fired up and ready to go?”