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The Great "Crazy" Coverup: Harm Results from Rewriting the History of DSM

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The Great "Crazy" Cover-up and Its Human Costs

Paula J. Caplan


Psychiatric diagnosis is fiction sold to the public as fact.

   -- Gary Greenberg (2013, p.333)

[Psychiatry] has something rotten at its foundation: its have-it-both-ways, real-until-it-isn't diagnostic manual.

   --Gary Greenberg (2013, p.351)

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From DSM-5
(image by Wikipedia)

Is anything less regulated than the financial giants that have so damaged the United States economy? The enterprise of psychiatric diagnosis. 

Does that matter? Aren't those who seek help in the mental health system safe in the hands of people who have committed their lives to being helping professionals? The tragic answer is "no."

In the land of total lack of regulation, bizarre things transpire. History is rewritten. Cover-ups of facts that destroy people's lives are the rule. There are no black-box warnings. In the brouhaha leading up to the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), absence of regulation was not mentioned. Furthermore, the cockfight among the most powerful men in the realm of psychiatric diagnosis, with two previous DSM chiefs trashing the newest ones, pulled the focus from what matters most, that people's lives are being destroyed, and no one with power is taking steps to redress past harm or prevent future harm. Even some of the previously most trenchant critics of psychiatric diagnosis have seemed blinded to crucial aspects of the history by the recent drama. [1] With crucial portions of the history of psychiatric diagnosis dramatically rewritten, falsehoods have been widely accepted by the public and professionals as truth.

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People whose version of history is considered true wield enormous power. The great journalist I.F. Stone (1907-1989) rigorously checked a person's claims and statements against what they had said previously and against the facts. Those who maintained power by rewriting history had much to fear from Stone. His approach is too much missing [2] from the DSM-5 debate (APA, 2013), its absence especially alarming because the previous edition, DSM-IV, led for nearly two decades to psychopathologizing of millions more people than ever before in history, and the consequences for many have been tragic ( Caplan, 2012a, 2012b). 

This article is less about the specific people who do the rewriting -- although some are especially culpable -- than about the forces they embody and the power they have to invent history that becomes the basis for wrong assumptions, for misplaced outrage, for lack of outrage where it is justifiable, and for failure to take action aimed to prevent harm.

It is a major and dangerous myth to assume that psychiatric diagnosis is scientific and always or usually helpful and never harmful and that the traditional approaches of psychotherapy and drugs are the most effective and safe ways to reduce suffering. That combination of myths is used to justify depriving psychiatrically labeled people of their human rights on the grounds that it is good for them, for society, for both (Caplan, 2013b).

In 1988 I accepted the invitation of Allen Frances, DSM-IV Task Force head, to serve on two of his committees that were charged with producing that fourth edition. As a longtime DSM advocate, I had believed it was scientific. Serving on the committees, I was stunned to watch as high-quality science that failed to support the goals of those in power in the DSM-IV hierarchy was ignored, distorted, even lied about (Caplan, 1995), with junk science presented as though it were of good quality when it supported their goals. After two years of attempting unsuccessfully to persuade the committees and Frances to base decisions on the good science, be forthright about their work, and pay attention to the harm to people from psychiatric labels, I resigned from the committees. After that, I watched as the misrepresentation of the DSM-IV as scientific and the failure to redress and prevent harm continued, while increasingly across the world, not only the DSM and American Psychiatric Association leadership but also many other professionals, media people, and laypeople spoke as though these diagnoses were scientifically grounded, while its risks received scant attention. I initiated protests and public education about psychiatric diagnosis, so journalists often interviewed me, and when I compared what I had told them with what ended up in print or on the air, I was dumbfounded. I took care in the interviews to provide proof of my claims, but in dozens of interviews, only the rarest of journalists accurately reported the story. Nearly all ignored the fact that the diagnosis advocates' claims were largely unfounded, and mine were supported by evidence. Terminology in the stories followed the pattern of "Caplan claimed X, but the DSM people explained that she was wrong" (Caplan, 1995). Either the reporters had not asked the advocates for documentation or, knowing there was none, neglected to report that fact.

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Paula J. Caplan, Ph.D., is an advocate, activist, clinical and research psychologist, and awardwinning nonfiction author and playwright. She is Associate at the DuBois Institute, Harvard University, and a past Fellow in the Harvard Kennedy (more...)

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