Language also signals how the reader should evaluate the scientific respectability of leading figures such as Frances. Discussing why Frances was chosen to head DSM-IV, one author reported that he was "believed to have the credentials" (rather than that he had the credentials: Davies, 2013, 46), while others attributed the selection partly to Frances' being "an expert on personality disorders" (Kirk et al., 2013, 175). The latter illustrates how easy it is for even trenchant critics of psychiatric diagnosis to write as though (1) there existed clearly identifiable, scientifically-established conditions properly called personality disorders, and (2) that it is possible somehow to be an expert on a subject whose very existence is in question.
Motivation, too, is easily attributed, praised or blamed by simple selection of a term of praise over a more neutral one. Kirk et al. (2013, 185) call Frances's sudden acknowledgement of the "three false epidemics" to which his edition had given rise -- "autistic disorder, ADHD, and bipolar disorder" -- "an astounding mea culpa." Certainly it was astounding that Frances's first acknowledgement of the harms done by these "false epidemics" came only at the end of the two-decade reign of his edition. However, the authors neglect to report that Frances blamed the "epidemics" entirely on persons and factors other than himself and his colleagues, who "had not foreseen" these consequences.
Greenberg (2013) is wonderfully candid at many points in describing his own views and motives over the course of his years of writing about diagnosis and his longstanding, complicated relationship with Frances. Yet after giving a fascinating account of Frances time after time saying one thing publicly and the opposite in private, he twice describes Frances as "honest." And despite Greenberg's having revealed Frances's "Diagnosis is bullshit" statement to the world, and having heard him make many similar, though more decorously-worded, statements about diagnosis over the years, at some points he portrays Frances as caring about scientific standards, quoting him as having, in essence, recovered from what Frances himself described as his earlier arrogance (47).
One author describes Frances's concerns about a particular diagnosis as based on scientific standards ("Frances thought it was poorly conceived and had little empirical support"), comparing his negative view with the negative view of a critic (PJC) whom Frances didn't like, for whom the diagnosis was "just plain sexist" (2013, 237). That seriously minimizes the scope of the latter's concerns, which were about the lack of empirical support, as well as the potential for causing harm. Because many people believe (mistakenly) that sexism has ceased to exist, to cite this as the only ground of a person's concern is to dismiss that person as frivolous and lacking credibility.
A few more examples of the effects of word choice in the rewriting of this history are instructive. Writing about similar sequences of events, one writer (Davies, 2013) describes a questioner/advocate (PJC) as speaking "energetically" (26), having "convincingly argued" (27) and "extensively assessed the evidence" (25), and goes on to describe the details of that person's scientific critique. Another writer (Greenberg, 2013) describes the same person as simply having "tormented" Frances, neglecting to mention her detailed scientific critique and proofs of harm, meanwhile accusing that person of having submitted her own proposal for a new diagnosis as a result of being "inflamed" rather informed (237). The repeated use of words ascribing overemotionality to female professionals is an old but persistent practice that neatly shifts attention from the substance of her work to its supposed psychosexual origins.
Coda
If you have enough power, you can rewrite history, and if you are lucky, no one will correct the record. The DSM-IV leaders who led the charge against DSM-5 have been hailed as white knights. "How brave of them to warn us of the upcoming dangers!" people have said, although all of the knights' criticisms of 5 had been made for decades about their own editions and been ignored or even denied at the time. . As I have written:
Those responsible for causing harm to others ought to be held accountable, and it is alarming when such people take it upon themselves to rewrite history to cover up their role in causing harm. I am as quick to repudiate much of what the DSM-5 heads have done as what editors of previous editions have done; but the virulent attacks by Spitzer and especially Frances on the DSM-5 heads has been wildly successful in taking the attention of the public and professionals away from the harm they themselves caused. Spitzer and even more, Frances, oversaw the ballooning of numbers of diagnoses in DSM-III, III-R, IV, and IV-TR and thus of people classified as mentally ill on a scale far beyond anything anyone else had ever done. (Caplan, 2013a, 386).
The mountain of writings and broadcasts about the DSM-5 debate has centered on roughly only a dozen of the hundreds of categories (Caplan, 2013a; Davies, 2013; Frances, 2013; Greenberg, 2013; Kirk et al., 2013). Left unmentioned in Frances's and others' critiques of those categories is the fundamental question of the very need for a manual of psychiatric diagnosis. The current debate largely proceeds as though the basic approach, creation, and marketing-as-scientific of an arbitrary and idiosyncratic classification of the varieties of human suffering had been proven reliable, valid, beneficial, and harmless.. In this connection, Greenberg accurataely wrote: "Without a single mental disorder that meets the scientific demands of the day, let alone enough of them to make the DSM more than an invented world, and with its claim to "real medicine' still mostly aspirational, it cannot make good on its assertion that psychological suffering is best understood as mental illness. So it must guard its position jealously. Lacking confidence in itself, psychiatry must work ever harder to command ours. [Allen Frances] and Darrel Regier [head of DSM-5] may be bitter opponents, but they both have the fear that comes with knowing the fragility of the edifice they share" (Greenberg, 2013, 335).
Robert Whitaker calls the manual "the most barren philosophy of life imaginable" (2013, December 5 personal communication), something Kriss (2013) brilliantly demonstrates by "reviewing" the manual as though it were a bad novel.
As even post-5 debates continue, the focus needs to shift to redressing past harm and preventing future harm. All over North America and, increasingly, throughout the world, living, breathing people who have sought help in the mental health system because they were suffering and (though some were helped) have suffered devastating and often lifelong losses and damage because of having been psychiatrically labeled. Frances and Spitzer are unclothed emperors who draw attention away from their own nakedness by crying out about the nakedness of the emperor who has replaced them (Caplan, 2013, 387). And their distorted claims have been reified by professionals, academics, media people, and laypeople who neglect to check out their verity, simply repeating them as gospel, and thus become complicit in the harm.
Note:
Those looking for ways to redress and prevent harm might look at click here and at the description of "The Need and 9 Demands" document that we attempted to deliver to the American Psychiatric Association and that they refused to accept (Caplan, 2012b).
References
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