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Tuesday on the Soapbox

You’d Be Surprised How Psychiatrists Determine Who’s “Normal!”

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A few months ago, on a whim, I checked out a book titled They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, by Dr. Paula Caplan. The title sounded interesting, especially to a person like me who had made some forays into the study of psychology during undergrad and graduate studies. But I had no real idea of the epiphanies that I was about to read.

This book, published in 1996, covered how the APA (American Psychological Association) makes its handbook of mental disorders, called the DSM (short for Diagnostic and Statistical Manual of Mental Disorders). Caplan had worked with the mostly-male committees who made the DSM in the first place–her recountings were an insider’s perspective, and she told of the arbitrary, biased decision-making and filibustering of “unfavorable” ideas that formed this so-called “scientific” manual.

At first it was hard to believe that men of psychology could allow the process to be so political and biased. After all, they’re supposed to be held to the scientific method just like every other scientist, right? They’re supposed to form a hypothesis, test it repeatedly, and prove beyond a shadow of a doubt whether the hypothesis is true or not. But all throughout Caplan’s book, she documented experiences of exactly the opposite: mental “disorders” which were seemingly invented to marginalize the valid emotional experiences of women and minority groups.

For instance, the APA was going to outline a supposedly “new disorder” called “Self-Defeating Personality Disorder,” in which the sufferer actually invites someone else to abuse them and acts in overly submissive ways toward the other person. Um, excuse me, but when someone is being abused, the abuser is the one who chooses to actively hurt that person. And not only that, but when one is being abused, one tends to try to minimize and avoid abuse as much as possible–usually by acting submissively, trying to vanish as much as possible.

The only reason this disorder was even suggested in the first place was because all the committee members (mostly old white guys) deemed this behavior “pathological.” They could not fathom someone acting in this way, because they had never acted in that way themselves–thus, this was a “disorder.” Not really scientific reasoning at work here, even to an untrained eye like mine. And SDPD wasn’t the only “disorder” to make it into the DSM without proper testing. They Say You’re Crazy also details other cases of wrongheaded disorders being legitimized, much to the detriment of patients who were diagnosed and medicated for these ultimately nonexistent problems.

Does This Problem With the DSM Still Exist? YOU BET!

After I finished the book, I was disturbed about the huge problem Dr. Caplan had presented. “But this book was published back in ’96,” I thought. “Surely the field of psychology has matured past all this junk.” Still, I wanted to see whether Dr. Caplan had written any more books.

So, I Googled her name…and was astounded at the sheer amount of information–RECENT blog articles, petitions, Websites, and the like–which were still talking about this problem. And the most troubling part? It seemed that the APA was no closer to listening to Dr. Caplan and her allies than they were back in ’96, either.

For instance, this 2012 article by Dr. Caplan chronicles another case of harm done by misdiagnosing and overmedicating, in which a young, overworked mother was diagnosed with bipolar disorder, forcibly committed to a psych ward, and given psychiatric drugs. The woman lost friends and husband because of this misdiagnosis, ended up on permanent disability, and the drugs they gave her gave her an eye condition that could end up leaving her blind. And This WordPress.com blog archives quite a number of other informational (and eye-opening) posts about Dr. Caplan’s recent work on this issue, including a video series called “The Stories of Harm the APA Refused to Hear.”

Stories of individuals’ struggle with being misdiagnosed abound all around the Web. It’s not just average everyday people, either–military veterans have suffered with misdiagnoses too, often being given drugs that only exacerbate the problem or keep them drugged to avoid real emotional healing. Even some members of the APA have gone on record admitting that the DSM series has serious problems which must be addressed.

Yet the APA has apparently closed its ears and eyes to all of this. In a painfully honest article in May of this year, Dr. Caplan admits that even her stalwart resolve to keep talking about this problem has wavered in the face of such stony rejection and determined dismissal. But she continues to write about this in objective yet passionate tones, striving toward the goal of changing bad diagnoses and really using psychology to help people rather than just slapping on a label.

My Conclusion: This Needs Attention, Yesterday

I’m not a psychological or psychiatric expert, by far. But I have been exposed to some mental health services, especially in middle and high school, and I have experienced how a label, whether right or wrong, can have such a powerful effect on a person’s life. (I was 12 when I discovered that the “counselor” I’d been seeing in school actually worked for my county’s mental health services. I remember the hysterical question I flung at her: “So y’all all think I’m crazy?!” It was like my stories of being mercilessly teased and physically abused at school had meant nothing; I had been labeled as a “troubled child,” as if I myself were “the problem,” instead of the mean kids I had the misfortune of going to school with.)

Even just seeking therapy these days carries a social stigma, after all; imagine how a wrong mental diagnosis could wreck your career, marriage, social life, etc. How do you fight back against doctors who are telling you that you’re permanently screwed up and you’re always going to need drugs? How do you insist that you’re screwed up because of the things that have happened to you, not because of some inborn defect, when they are telling you exactly the reverse?

I for one applaud Dr. Caplan’s work, which draws attention to the need for more research and sheer SCIENCE to be applied to such a delicate problem as the human mind. We aren’t just talking about using the right medication at the right time–we’re talking about actually alleviating emotional pain rather than staving it off and avoiding it. (We in America tend to want, as Dr. Caplan says, “a quick fix and a pill for everything,” but our minds must be treated with more care.)

One last troubling thought: if the APA is more concerned with handing out drugs rather than actively treating mental illness as the serious, life-altering group of conditions that it is, then we as a society ought to be concerned that maybe their interests don’t lie in helping hurting people anymore. After all, if psychiatry has become a “science” of “diagnose somebody in 5 minutes and shove pills at them,” is it worth our money and time anymore?

Resources/Further Reading

Calls to Action/Petitions

Find They Say You’re Crazy Online

Online Articles About or By Dr. Caplan

Profiles and Archives of Dr. Caplan’s Online Work

Selected Bibliography for Dr. Caplan, from FeministVoices.com

  • Caplan, P. J. (1985). The myth of women’s masochism. New York, NY: New American Library.
  • Caplan, P. J. (1991). How do they decide who is normal? The bizarre, but true, tale of the DSM process. Canadian Psychology, 32, 162-170.
  • Caplan, P. J. (1992). Gender issues in the diagnosis of mental disorder. Women & Therapy, 12, 71-82.
  • Caplan, P.J. (1995). They say you’re crazy: How the world’s most powerful psychiatrists decide who’s normal. Jackson, MI: De Capo.
  • Caplan, P. J. (2000). Don’t blame mother: Mending the mother-daughter relationship. New York: Routledge.
  • Caplan, P. J. (2004). The debate about PMDD and Sarafem: Suggestions for therapists. Women & Therapy, 27, 55-67.
  • Caplan, P. J. & Caplan, J. (1998). Thinking critically about research on sex and gender, 2nd edition. New York: Addison-Wesley Longman.
  • Caplan, P. J. & Cosgrove, L. (Eds.).(2004). Bias in psychiatric diagnosis. Lanham, MD: Jason Aronson.