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.
The following is a recent example of how history gets distorted. It is by no means the worst, but I report it because I was directly involved in it and thus can describe with confidence what transpired. In 2013, shortly before DSM-5's scheduled publication, Elizabeth Saenger asked to interview me for the publication RecoverE for the Coalition of Behavioral Health Agencies, Inc., "to showcase problems with the DSM-5"where doing so could make a difference" (Saenger, 2013). We did the interview, and she sent me her writeup as it went to press. Immediately, I wrote to her that most was fine but that it contained serious errors, and a companion article by the DSM-IV head included a "completely false and totally misleading statement." I left details about the errors on her voicemail. Without explanation, she replied that I should rewrite the story but cut it to half its original length, much shorter than the companion pieces by the head of DSM-IV, DSM-5, and the National Institute of Mental Health director. I wrote to her and her supervisor that "I have been trying to get these changes [in the article] and warnings made on the assumption, which I am sure is warranted, that you do not wish to participate in perpetuating falsehoods that destroy people's lives." They then eliminated my interview altogether, and published the pieces by the three top dueling banjos who had huge stakes in promoting the traditional mental health system as " Three Perspectives on the DSM-5 from Superstars in Psychiatry" ( http://www.coalitionny.org/the_center/recovere-works/RECOVERe-worksMay2013.html )
The Functions of the Rewritten History
This rewriting of history is serious business. It:
Draws attention from the facts. If you believe psychiatric diagnosis is scientific, then when a professional tells you that you "are" Bipolar, you are unlikely to ask, "Is there solid proof that "Bipolar Disorder' is a real and reliably identifiable entity?" "Is there evidence that giving me this label will help you alleviate my suffering?" and "Does getting the label carry risks of harm?" Not knowing that they need to ask such questions has meant that the lives untold numbers of people have been damaged due to a cascade of consequences from labeling. And journalists have gone far to perpetuate the cover-up of the poor science underlying diagnosis (e.g., Jabr, 2012, claimed in Scientific American -- without evidence -- that the DSM-5 would improve the basis for choosing treatments).
Draws energy and resources away from stopping, redressing, and preventing harm. DSM-IV earned the APA more than $100 million, and there is no sign that one penny was spent to gather (never mind solicit) information about the harm from diagnosis, redress past harm, or prevent future harm through such actions as implementing professional and public education about the truth regarding these categories (Caplan, 2013a).
Draws everyone's attention from the most important people, those who have suffered from being psychiatrically labeled. The public debate was largely about what the men who headed III, III-R, IV ands 5 were saying to each other.
Maintains the status quo . The nature of the debate about DSM-5 includes the DSM-IV editor's false assertions that his own edition was scrupulously scientific and caused only a tiny number of problems, and he attacks only a dozen or so of the many hundreds of DSM-5's categories. The need for the manual to exist at all was was rarely challenged, and the challenges got little or no media attention. Only a miniscule fraction of the devastating harm caused by previous editions was mentioned, and ways to redress and reduce the harm were almost totally ignored. One can just imagine how the people who had suffered that harm must have felt about being thus rendered invisible.
Causes history to repeat itself. Journalists ask the head of each new edition why their edition was needed, and each head answers, "The previous one wasn't scientific" (Caplan, 1995). They fail to respond with, "How can you say that, when that is what your predecessor also claimed?" Over the decades, each leader has claimed that their edition is truly scientific, when in fact each new one actually was based on errors and problems uncannily like those from before. To understand the rewriting of history about DSM-IV is to see more clearly how the same problems and dangers happen in DSM-5. Most of these are inevitable as long as the current obsession with psychiatrically diagnosing people continues.
The Nature of the Rewriting
This article contains not comprehensive coverage of what has been rewritten but rather key points of the generally false portrayal of earlier editions as scientific, helpful, and not harmful (or far less harmful than is the case). The portrayal was driven primarily by the DSM-IV head but minimally challenged even by the DSM-5 heads, other professionals, media people, and the public.
False Portrayal as Scientific . Work on DSM-IV began in 1988, it was published in 1994, and from 1988 onward, Allen Frances knew that work his enterprise could not honestly be described as scientifically based (Caplan, 1995; Davies, 2013; Greenberg, 2013; Kirk, Gomory, & Cohen, 2013). Yet in 2009, when he began his diatribes against the in-progress DSM-5, he claimed that, in contrast to DSM-5's "remarkably weak methodology," work on DSM-IV had been scrupulously scientific (Frances, 2009, 2013). To describe his own work, he used terms like "obsessively meticulous," "strict criteria," "extensive literature reviews," "painstaking data analysis," "precise terms," "rigorous field trials," "objectivity," "methodological rigor," and "we couldn't afford mistakes" (Frances, 2013, xiii, xiv, 23, 67, 70, 72, 74; Frances, 2012a), and even after DSM-5 was published, he unjustifiably claimed reliability for his edition (Frances, 2013). Curiously, he also told Davies that "DSM-IV was faithful to DSM-III-R" (Frances, 2013, 72), but he had told me when inviting me to join his IV committees that unlike those of the head of III-R, his decisions would be scientifically-based (Caplan, 1995). Strangely, he also told Davies that "the most important value" when creating IV was to "stabilise the existing arbitrary decisions [DSM-III-R's hundreds of categories rather] than to create a whole assortment of new ones" (Davies, 2013, 51). Were stabilizing the system or creating many new categories the only two possible options?
Frances attacked the DSM-5 editors for failing to produce a scientifically sound document (2012c). He said they focused too much on reliability and not on validity (Frances, 2013) but neglected to mention that, given the poor reliability of the manual, there is no validity, that the reliability of categories in editions before his was poor (Kirk and Kutchins, 1992; Greenberg, 2013), and that for IV, he did not even do reliability studies, despite the fact that IV contained 77 more categories than III-R (Caplan, 1995). He faulted DSM-5 work groups for ignoring many research papers (Kirk et al., 2013), but for IV, he and his colleagues ignored, distorted, and even lied about research when it did not fit with their goals (Caplan, 1995).
False Portrayal about Who Expanded Abnormaliy. More rewriting of history involves portrayal of DSM-5 as an unprecedented move toward classifying all behavior as abnormal (Frances, 2013). However, despite its copious faults, that edition actually slows down the rate of increase. The number of categories skyrocketed from 297 in III-R to 374 in IV (Caplan, 1995), for a rate of 11 more categories per each of the seven years between those two editions. DSM-5 contains 481 categories, which works out to the lower rate of 5.6 categories added per each year between IV and 5. As Davies writes, due to Frances's work on IV, "the dramatic medicalization of normal human reactions"was allowed to proceed unchecked" (2013, 52).
Despite having headed the edition that led to the pathologizing -- and thus quite likely the harming -- of probably millions more people than anyone in history, Frances titled his 2013 book Saving Normal and casts himself as having led the fight to save normal from the time he began work on IV (Frances, 2013, xiii). He told Greenberg that in IV they added "a few" categories (as noted, his edition actually had 77 more than III-R) and made only one mistake with one category, and that their work led to three epidemics -- diagnoses of Asperger's, Attention Deficit Hyperactivity Disorder, and Bipolar Disorder -- that they could not possibly have foreseen (Frances, 74; Greenberg, 2013, 48, 98, 156). Only three? This would surprise untold numbers of people who have been harmed by the hundreds of diagnoses in IV. An article in the influential Scientific American (Jabr, 2012) included the false statement that IV was "largely similar to its predecessor," helping reify the claim that few additions were made.
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